Terminally Ill Adults (End of Life) Bill

Public Bill Committee, 30 January 2025.

Examination of Witnesses

Carolyn Harris (Labour, Neath and Swansea East)

We are now sitting in public and the proceedings are being broadcast. I remind Members to switch off any electronic devices. We will now hear oral evidence from Alex Greenwich, MP for Sydney in the Parliament of New South Wales, and from two witnesses joining via Zoom: Dr Chloe Furst, a dual-trained geriatrician and palliative care physician in South Australia and a board member of Voluntary Assisted Dying Australia and New Zealand, and Professor Meredith Blake from the University of Western Australia. Could the witnesses briefly introduce themselves for the record, starting with Alex Greenwich?

Carolyn Harris (Labour, Neath and Swansea East)

Before calling the first Member, I remind all colleagues that questions should be limited to matters within scope of the Bill. We have to stick to the timings set out in the programme motion. The first session will finish at 12.30 pm, so can we stick to the points and keep them as short as possible, please? Members who wish to ask a question have indicated that, and I will call them in no particular order. I will start with Simon Opher.

Simon Opher (Labour, Stroud)

I would like to direct this question to Dr Furst. There has been some concern in this country about the efficacy of end-of-life medications. Could you share some of your experience in Australia about how effective they are and any problems you have encounteredQ265 ?

Simon Opher (Labour, Stroud)

Q Just to confirm—you have not had any failures of treatment, as far as you are aware?

Naseem Shah (Labour, Bradford West)

To follow up on that, there is no requirement that the doctor is present when the person self-administers the substance that leads to assisted dying. Am I correct? If that is the case, why does the law not make it necessary for the doctor to remain present until death, because at that point, the doctor would pick up any complications, would they not?Q

Naseem Shah (Labour, Bradford West)

Q We have had lots of witnesses testifying about gaps in palliative care and end-of-life care provision here in the UK. What is the current state of palliative care and end-of-life care provision in Western Australia, please?

Sarah Green (Liberal Democrat, Chesham and Amersham)

On that point about palliative care, I will direct my question to Dr Furst. What has been the response from palliative care professionals to the introduction of assisted dying in Australia? We have heard evidence from people working in the sector in the UK, but I am keen to hear about your experience in Australia. I understand that Palliative Care Australia’s national workforce survey explicitly looked at this, so I am keen to hear what its findings were.Q

Jack Abbott (Labour/Co-operative, Ipswich)

My question is to you, Mr Greenwich. I understand that in New South Wales—and please do correct me if I am wrong—similarly to the Bill we are proposing, you adopted legalised assisted dying for those who are terminally ill and will die within six months, but you also added an additional criterion, which was within 12 months for a neurodegenerative disease such as motor neurone disease. That element is not proposed in our Bill, but we have heard from other witnesses over previous days about that issue. What reflections might you have regarding that, and why did you add that element into the Bill beyond the six months that we are proposing hereQ ?

Kim Leadbeater (Labour, Spen Valley)

Thank you to the witnesses for joining us this morning. I would like to address my comments to Alex Greenwich, if I may, but also come back to Dr Furst and Professor Blake.Q

It is really valuable for us as a Committee to hear your reflections on the experience of the process of passing this legislation. How did you manage to keep that process patient-centred but also take into account the concerns around the broader societal issues, particularly when it comes to equality and human rights—those really important issues? What was that process like, and what are your reflections on it? Also, Dr Furst and Professor Blake, one thing that I feel really strongly about is having really good training around assisted dying, and end-of-life care and choice. Would you like to make any comments on what that looks like?

Carolyn Harris (Labour, Neath and Swansea East)

Colleagues, before we continue, let me say that we have 13 questions and less than 30 minutes, so the question and the answer need to be no more than two minutes.

Daniel Francis (Labour, Bexleyheath and Crayford)

I want to ask about capacity. Chloe, I think you said patients are sometimes given the drug some time before they die, so I want to understand where capacity assessments are taken and at what stage during the process.Q

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

I will direct this question initially to Mr Greenwich. The issue of coercion has been a significant concern to many in the debate. In line with the New South Wales legislation, the Bill as proposed does not provide a definition of coercion, either explicitly or by reference to other legislation. Have you found that to pose a difficulty in your jurisdictionQ ?

Danny Kruger (Conservative, East Wiltshire)

Can I have one minute with Dr Furst and one minute with Mr Greenwich? Dr Furst, I have had a look at the reports of the South Australia Voluntary Assisted Dying Review Board, and I can find no data on referrals for additional assessments of eligibility or decision-making capacity, or reasons why people were considered ineligible. There is no provision for reporting on complications, the time between the administration of the drugs and loss of consciousness, or the time between the administration of the drugs and death, and as we have heard there is no requirement for a doctor to be present. I do not understand how you can say that there is no evidence of coercion, issues around capacity or complications at the death, because you clearly do not collect the evidence on those things.Q

Danny Kruger (Conservative, East Wiltshire)

Q Okay. Thank you very much for that.

Mr Greenwich, you said a couple of things. You said that voluntary assisted dying supports palliative care in terms of funding. I read that although New South Wales committed to spending an extra 743 million Australian dollars on palliative care, in fact the budget was cut by 249 million Australian dollars in 2023; at the same time, New South Wales allocated 97 million Australian dollars in new funding to assisted dying. I do not understand how you think that palliative care benefited from this introduction.

You talked about suicide prevention. The fact is that unassisted suicide rises in states that have assisted suicide laws, because suicide is contagious. It is too early to tell what is happening in New South Wales, but in recent years in Victoria unassisted suicide rose by 50%, while in New South Wales, before it had this law, it stayed the same. Again, I do not understand how you think that this helps with suicide.

We have just heard about the so-called safeguards and we heard yesterday from Australian colleagues. Do you agree that the safeguards that were introduced were in fact impediments to access and that it would be the right thing to do to remove them?

Carolyn Harris (Labour, Neath and Swansea East)

I remind colleagues to stay within scope of the Bill, please.

Kit Malthouse (Conservative, North West Hampshire)

I want to go back to the issue of gag clause/doctor initiation. Alex, could you quickly talk to us about the thought processes? Can you say why some states introduced it and why you did not? How in legislation have you circumscribed the way doctors should approach this with patients? Perhaps our two medical guests could talk about how, in territories where there is not a gag clause, doctors are obliged not to lean towards a particular recommendation, as they might do with other courses of treatmentQ .

Kit Malthouse (Conservative, North West Hampshire)

Q But how did you approach that in the legislation? Is it silent as to what doctors should do, or does it have a prescription?

Kit Malthouse (Conservative, North West Hampshire)

Doctors?

Carolyn Harris (Labour, Neath and Swansea East)

Order. I am sorry, Meredith, but we have to move on to the next question.

Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)

My question is probably more for Alex. When you were coming to the criteria and the safeguards in the Bill in your state, how did that then interplay with other regions and states nearby? Obviously, in the UK the Bill that we are looking at would be applicable to England and Wales. Scotland has its own assisted dying Bill, which is happening at the minute, and we will hear about that later on. Is there information you can share? Can you talk about how different states and regions interplay with each other when they have assisted dying laws?Q

Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)

On that—

Carolyn Harris (Labour, Neath and Swansea East)

Order. I am sorry, but you are only allowed one question.

Rachel Hopkins (Labour, Luton South and South Bedfordshire)

My question, directed at Chloe, is about the practical application of access to doctors for patients, as suggested in the proposed legislation, and how doctors have those conversations with patients—particularly, when it comes to geriatricians, older patients. We heard from somebody yesterday who said that there were concerns around how older people were treated, and the potential risk of elder abuse. I would be interested in the practical application of those conversations, in your experience.Q

Marie Tidball (Labour, Penistone and Stocksbridge)

This question is for Dr Furst and Professor Blake. Many of us on the Committee are committed to the need to protect disabled people and to ensuring that the Bill has as many safeguards in as possible. We heard evidence yesterday that anorexia may qualify under assisted dying laws in other jurisdictions. Have there been any cases of people with anorexia accessing assisted dying in Australia, and in your view do the respective laws across Australia allow for that? Secondly, are there any lessons that we can learn on building in safeguards in relation to those with learning disabilities?Q

Carolyn Harris (Labour, Neath and Swansea East)

Order. I can only take one answer. I am sorry, Meredith, but we have not got time. It is one answer to one question.

Sojan Joseph (Labour, Ashford)

Dr Furst, can I ask a follow-up about anorexia? I know that anorexia is not classified as a terminal illness, but long-term starvation can lead to severe physical health conditions, and patients may end up in palliative care. Do you have any experience of those cases in AustraliaQ ?

Lewis Atkinson (Labour, Sunderland Central)

Mr Greenwich, we are minded that as well as passing really good legislation we want to get public confidence Q behind this. We have heard a level of concern from disabled people’s representative bodies about the inadvertent implications of this law for disabled people. Were those concerns shared when you took your legislation through, and how it has gone since the implementation of the legislation?

Jake Richards (Labour, Rother Valley)

This question is probably best for Alex. Yesterday we heard evidence about the health inequalities in our society and fears that they would be exacerbated by the introduction of assisted dying. What was the experience in Australia?Q

Carolyn Harris (Labour, Neath and Swansea East)

I think this will probably be the last question.

Sean Woodcock (Labour, Banbury)

ThisQ question is for Meredith Blake. Does it concern you that a large proportion of people who opted for assisted dying cited being a burden as their reason?

Sean Woodcock (Labour, Banbury)

Let me just clarify. The state’s own report in 2023-24 had 35%.

Sean Woodcock (Labour, Banbury)

I am taking that as a no.

Carolyn Harris (Labour, Neath and Swansea East)

Order. I remind colleagues that it is unacceptable for a Member to interrupt a witness once they have started answering. That brings us to the end of the time allocated for the Committee to ask questions. I thank all witnesses on behalf of the Committee for their evidence.

Carolyn Harris (Labour, Neath and Swansea East)

We will now hear oral evidence from three witnesses: Dr Amanda Ward, who holds a master’s and a PhD and is the legal adviser to the Scottish Parliament on proposed legislation changes; Professor Gareth Owen, who is a professor of psychological medicine, ethics and law and an honorary consultant psychiatrist at South London and Maudsley NHS foundation trust; and Professor Laura Hoyano, emeritus professor of law at Wadham College, University of Oxford. Before I call the first Member to ask a question, I remind all Members that questions should be limited to matters within the scope of the Bill. May I ask the panel to introduce themselves?

Carolyn Harris (Labour, Neath and Swansea East)

We must stick to the timing of the sittings resolution, as decided by the Committee. We have a long list of people who want to ask questions, so it will be one question with one answer; if Members could indicate who they would like to answer, that would be helpful.

Before we proceed, Dr Tidball has a declaration of interest to make.

Marie Tidball (Labour, Penistone and Stocksbridge)

I just want to make sure that it is on the record that I have been taught by Professor Hoyano; indeed, well before I was elected, she was a colleague at work.

Carolyn Harris (Labour, Neath and Swansea East)

Thank you.

Jack Abbott (Labour/Co-operative, Ipswich)

Professor Owen, you have talked extensively about the complexity of the Bill. I think it fair to say that our previous witnesses this week believe that the simplest safeguards are the safest. I stress that the simplest does not necessarily mean the weakest; it means a straightforward plan. Do you agree with the points that the chief medical officer and others have made about simplicity? Where do you stand on that, and on the broader point about complexity?Q286

Daniel Francis (Labour, Bexleyheath and Crayford)

To elaborate on that point, Professor Owen, the Mental Capacity Act 2005 sets out the principles that a person must be assumed to have capacity, that a person cannot be treated as lacking capacity unless all practicable steps have been taken to support them and that a person cannot be treated as lacking capacity merely because their decision is unwise. Is it those issues that are causing you concern about capacity, or is it something else?Q

Daniel Francis (Labour, Bexleyheath and Crayford)

The Chair may cut you off, but I am happy for you to continue if she allows it.

Carolyn Harris (Labour, Neath and Swansea East)

It is one question, one answer. I call Danny Kruger.

Danny Kruger (Conservative, East Wiltshire)

Professor Hoyano, what do you think about the indemnity against civil liability in the Bill? Do you think it is appropriate to indemnify all doctors, even if they have made a Q woefully bad diagnosis, botched a prescription or, in some cases, actually caused some harm? Do you think it is appropriate that they be excluded from civil liability?

Lewis Atkinson (Labour, Sunderland Central)

Professor Hoyano, the Bill would establish offences relating to coercion, pressure and so on. In the processes set out, there are a number of checkpoints, for want of a better term, at which a person seeking assisted dying may talk to doctors or others. What are your observations on how the criminal construct of offences is linked to the different opportunities for an individual seeking assisted dying to have conversations? In your view, is it likely to lead to the identification of those offences? How does that contrast with some of the considerations at the moment, where people are withdrawing treatment in a life or death situation, for example?Q

Sojan Joseph (Labour, Ashford)

Professor Owen, written evidence from the Royal College of Psychiatrists states that 65% of psychiatristsQ

“are not confident that consent can act as an adequate safeguard”.

On mental capacity, it says:

“These decisions are opinions with a margin of error and are time specific. A person’s capacity can change”.

What is your view?

Sarah Green (Liberal Democrat, Chesham and Amersham)

Dr Ward, I am keen to hear about your work on the Bill in the Scottish Parliament and about how best practice in other jurisdictions has informed the legislation that is currently going through Holyrood. How has it influenced and informed that draft?Q

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

Clause 9(3)(b) would permit an assessing clinician to refer to a psychiatrist if they have concerns about the assessment of capacity. Some have suggested that in fact all patients who are seeking a voluntary assisted death should be assessed by a psychiatrist. Professor Owen, in terms of workforce capability and capacity, is it reasonably practicable to have a consultant psychiatrist assessing each and every one of these patients?Q

Kit Malthouse (Conservative, North West Hampshire)

Professor Hoyano, I am interested to explore your views on the third layer. I understand your view about the Court of Protection, but we have heard in previous evidence, not least from eminent members of your profession, that the Spanish model of a panel of experts might be an option worth examining. In those circumstances, what is your view of the investigatory processes, either for that or for the Court of Protection, or the type of evidence that might need to be adduced? What could be specified in the legislation as a requirement on those people involved in the process? Q

Simon Opher (Labour, Stroud)

My question is directed to Amanda and Laura. There is a lot of natural concern about coercion with the Bill. We recognise that it is a difficult thing to assess. Would either of you change the wording of the Bill to make coercion less likely?Q

Simon Opher (Labour, Stroud)

Now you’re asking. Let me check.

Simon Opher (Labour, Stroud)

It was clause 26, sorry.

Kim Leadbeater (Labour, Spen Valley)

For clarity, Dr Ward, you are right that clause 34 requests that the chief medical officer submits an annual report. You clearly have many years of experience in this subject. For you, what does best practice look like when it comes to assisted dying, end of life choice and end of life care? That is what we are all aiming for in our deliberations. How do we keep it patient-centred?Q

I notice that you have also spoken a lot about misinformation; how do we tackle that? How do we make sure we are dealing with facts rather than speculation? In particular, how do we provide reassurance to marginalised communities and people with disabilities, who are understandably nervous about this change in the law? When it comes to safeguards and protections, what does best practice look like?

Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)

Dr Ward, I think the point about a holistic and evidence-based approach is critical. In the work that you did in the Scottish example you gave, how was the terminal illness definition arrived at? How are you capturing those people who are vulnerable and want to have an assisted death, but might end up limited in their scope and ability to access it?Q

Naseem Shah (Labour, Bradford West)

Professor Owen, yesterday Professor Allan House gave evidence and talked about capacity and coercion, and I want to pick up on some of the concerns. In all four of the jurisdictions that collect data on the issue—Oregon, Canada, Western Australia and Washington—between 35% and 59% of people cite being a burden as a reason Q for assisted dying. What do you think is the level of confidence of psychiatrists to assess capacity and consent reliably? What would your concerns be, if any?

Bambos Charalambous (Labour, Southgate and Wood Green)

Dr Ward and Professor Hoyano, we heard yesterday evidence about the interplay between assisted dying, the Equality Act 2010 and the European convention on human rights. Should amendments be made to the Bill to deal with those issues? What are your thoughts about the interaction between those pieces of legislation and the Bill?Q

Carolyn Harris (Labour, Neath and Swansea East)

Time allows us to ask more questions. Three people have indicated that they wish to come in. I will start with Danny Kruger.

Danny Kruger (Conservative, East Wiltshire)

Q It is great to hear about the case for common law over the Human Rights Act. Yesterday we heard about parliamentary sovereignty. This is a tremendous process we are having here.

Professor Hoyano said that the person in the street would not see the difference between a patient requesting to die by the withdrawal of treatment versus the active administration of fatal drugs, whereas I think you said, Professor Owen, that you did see a profound difference between that decision on the part of the patient and also, presumably, the act on the part of the medical professional, in the case of either the withdrawal of treatment or the administration of fatal medication. You said that you would be happy to draw that out; could you do so?

Kim Leadbeater (Labour, Spen Valley)

Q This has been an incredibly helpful panel, so thank you for all your expertise.

Let me come back to the content of the Bill, and to some of your points, Professor Owen. In terms of capacity and coercion, I think we are absolutely having these really important conversations. What concerns me a little bit, though, is whether we are saying we are not confident that two doctors, potentially a psychiatrist and an oncologist, and a judge can make assessments of capacity and coercion between them. What does that mean for things that are happening at the moment? We have talked about the withdrawal of end of life treatment and those things; those assessments must be being done now, all the time, but at the moment there is no legal framework around that. Surely, putting a legal framework around that and having all those multidisciplinary people involved has got to be a positive thing. Professor Hoyano, I would appreciate your thoughts on that.

Lewis Atkinson (Labour, Sunderland Central)

Q Professor Owen, can I probe a little more something that you raised before—the interaction of potential impairment, potential family dynamics and so on in a way that is not malign, but that you think is a consideration? We have heard some evidence in the course of this week about whether there would be any benefit from a more multidisciplinary approach that could make a more rounded, psychosocial assessment of someone’s situation. That would be less about the clear test of whether there is capacity under the Mental Capacity Act and more about the wider considerations of those interactions. I just wonder whether the inclusion of, say, social workers or mental health professionals as part of a multidisciplinary approach would give you any reassurance on those points that you made.

Carolyn Harris (Labour, Neath and Swansea East)

We have two more minutes for questions and answers.

Simon Opher (Labour, Stroud)

Q Another hon. Member has asked my question, but I have another. We heard yesterday about domestic violence and elder abuse. Does the legislation need to be tightened around that type of area—the coercion of older people into taking their lives early, potentially for financial benefit?

Carolyn Harris (Labour, Neath and Swansea East)

I call Naz Shah to ask the final question.

Naseem Shah (Labour, Bradford West)

Q Professor Owen, to follow up on the interaction that Mr Atkinson talked about, where are the gaps in research right now?

Carolyn Harris (Labour, Neath and Swansea East)

That brings us to the end of the allocated time for the Committee to ask questions. I thank the witnesses on behalf of the Committee for their evidence.

Carolyn Harris (Labour, Neath and Swansea East)

Q We will now hear oral evidence from Professor Nancy Preston, professor of supportive and palliative care at Lancaster University; Dr Naomi Richards, director of the end-of-life studies group at the University of Glasgow; and Claire Williams, head of the pharmacovigilance and regulatory services for NorthWest EHealth, who is joining us via Zoom. We have until 3 pm. Could the witnesses introduce themselves for the record?

Carolyn Harris (Labour, Neath and Swansea East)

I ask colleagues to ask one question, indicating who you wish to answer. If there is time at the end, I will open the floor for further questions.

Sean Woodcock (Labour, Banbury)

My question is for Claire Williams, about the drugs that are used in the various jurisdictions and how that interplays with your view on whether this law comes into place. What are your views on the drugs that would be put forward for assisted dying?Q

Jack Abbott (Labour/Co-operative, Ipswich)

Q Professor Preston, you have extensive research into palliative and end-of-life care. It would be really helpful for the Committee if you could describe some of the underlying motivations about why people come to the decisions they do when choosing end-of-life care, and how you feel assisted dying would sit as an available option for those making those decisions, if it was available.

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

Q Professor Preston, in your written submission, you effectively propose reversing the presumption of capacity that is set out in the Mental Capacity Act. Could you go into a little more detail about that and the reasons behind that proposal?

Lewis Atkinson (Labour, Sunderland Central)

Q Dr Richards, in the light of your research, could you say a little bit more about the weight that individuals dying place on the importance of autonomy and how that is weighed up against other considerations around safeguarding and so on?

Danny Kruger (Conservative, East Wiltshire)

Q This is a question for Claire Williams. It was interesting that you said you were not aware of what drugs might be used in assisted dying. We obviously do not yet know what will be proposed here if we pass this law. There are lots of different combinations of drugs used in other jurisdictions, and we do not know much about them. I think that is fair to say.

What we do know is that there is a combination. In two thirds of deaths in Belgium, I think, and in the United States, where I have visited, the first drug that is used is an anaesthetic, and then there is a paralysing agent. A paralytic drug is introduced, which often gives the impression that the patient is having a peaceful death, but we do not actually know what is going on beneath the surface. I am afraid to say that, from studies into people who have been on death row who have been legally executed, there is often evidence of brain trauma. Can you speak to this at all? We know that in a minority of cases real complications occur—it often takes a very long time for the patient to die, and there is vomiting and all sorts of distress. How can we improve what we know about the actual process of dying, and how can we reduce these terrible complications?

Kit Malthouse (Conservative, North West Hampshire)

Q My question is to Dr Richards. Obviously health service medics are dealing with end-of-life situations at the moment—they are withdrawing treatment or declining to give treatment if they think it is futile. In those circumstances there are a set of safeguards. How do those safeguards compare with the safeguards in the Bill? From your research, do you think there is any adjustment required to the safeguards we have at the moment?

Marie Tidball (Labour, Penistone and Stocksbridge)

Q My question is to Dr Richards, although if Claire Williams has anything to add, it would be really helpful. We have heard evidence from overseas about the value of doctors being able to have holistic discussions about end-of-life choices under an assisted dying law. What research is there on patient experiences in those jurisdictions, in particular the evidence around quantifying the experience of dignity and respect in end-of-life choice making where assisted dying is available?

Marie Tidball (Labour, Penistone and Stocksbridge)

Or real-life examples?

Marie Tidball (Labour, Penistone and Stocksbridge)

Q There are two elements to my question. The first element is talking through the available evidence on how those holistic processes work in countries that have assisted dying. Secondly, we have heard a lot about choice from witnesses across the last two days, but a lot of the consideration about choice is about enabling patients to arrive at greater dignity and respect in their death, so it would be useful if you could reflect on any evidence around that.

Marie Tidball (Labour, Penistone and Stocksbridge)

Yes.

Naseem Shah (Labour, Bradford West)

Q Professor Preston, in your written evidence to the Committee, you said that Parliament should:

“Consider whether there should be a stated exception to the usual presumption of capacity under the Mental Capacity Act 2005 in the Bill.”

What kind of standard do you think Parliament should consider adopting instead of the use of the Mental Capacity Act, and why do you think that?

Rachel Hopkins (Labour, Luton South and South Bedfordshire)

Claire, you mentioned multidisciplinary teams and decision making. We have heard in a couple of other evidence sessions from palliative care social workers, nurse practitioners and the Royal College of Nursing about the multidisciplinary approach in care. What are your thoughts on the ultimate approval as set out in the Bill being a doctor, another doctor and then a legal okay at the end? Would a more multidisciplinary approach to approval have stronger outcomes or better safeguardsQ ?

Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)

Q Professor Preston, we have heard from a wide range of different people from different jurisdictions. What we have heard and the evidence suggest that where we see assisted dying as an option, we tend to see improvements in palliative care. Do you have any comment on that and how we could better integrate into giving people that choice? You talked earlier about different routes and different systems in countries where it might sit outside the healthcare setting. Would that limit the choice and hinder people’s ability? How do you see that having a play in this?

Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)

If you have systems where assisted death is offered outside the healthcare setting, as in some of the countries around the world that you have mentioned, how does that limit people’s access to it? Do you think that has an impact?

Simon Opher (Labour, Stroud)

Q I would just like to ask Claire about medication—not specifically the drugs and everything, but clause 18, “Provision of assistance”. We have heard that in Australia the medication is left with the patient, whereas under this legislation the co-ordinating doctor brings the medication to the house or the place where the patient wants to end their life. Do you feel, having seen the Bill, that that is safe, or do we need to amend it in any way?

Simon Opher (Labour, Stroud)

May I ask a further question, Mrs Harris?

Carolyn Harris (Labour, Neath and Swansea East)

Could you make it a supplementary? I want to get Kim Leadbeater in, and then we can come back to it.

Simon Opher (Labour, Stroud)

Certainly.

Kim Leadbeater (Labour, Spen Valley)

Q We have heard a lot from witnesses this week about safeguarding. That is something I am keen to pursue. The Bill has a significant number of safeguards already, but is there anything else that you think we could add? I think all on the Bill Committee are interested in hearing such ideas. In particular, we are thinking about how we can protect people, such as people from disadvantaged backgrounds, older people—Dr Richards, I think you have experience of working with older people—people from a range of different backgrounds, and people with disabilities, so that we keep the Bill very much focused on the people it is designed to help, who are terminally ill people with less than six months to live, while addressing more of the broader concerns about some of the inequalities in society.

Kim Leadbeater (Labour, Spen Valley)

That is really helpful.

Kim Leadbeater (Labour, Spen Valley)

Q Can you give an example? What do you mean by that?

Liz Saville-Roberts (Plaid Cymru, Dwyfor Meirionnydd)

There was one thing I wanted to ask about, but it led me to another question, which is to Dr Naomi Richards. It seems that much of what we are discussing assumes that being patient-centric is intrinsic and runs day to day through medical culture. Is that actually the case in your experience? If not, is there something within the culture that needs to change to become more patient-centric in order to enable autonomyQ ?

Juliet Campbell (Labour, Broxtowe)

My question is to Professor Preston. I will go back to something you said in your last answer, when we talked about how people are treated, and the differences and inequalities across society but also within our healthcare systems and how things are done. This was highlighted specifically during the pandemic. How do you think these inequalities will undermine the principles of the Bill?Q

Daniel Francis (Labour, Bexleyheath and Crayford)

Q My question is to Claire Williams and follows on from Dr Opher’s question. Clause 18(9) says that once the person has self-administered the approved substance, the doctor must stay with them until they have died, or until it has been determined by the co-ordinating doctor that the procedure has failed. We know from overseas that, in a very small number of cases, the procedure may take three or four days, so clearly the doctor cannot stay with them the whole time. Subsection (10) says that the doctor need not be in the same room as the person to whom the assistance is provided. I want to understand how that could be strengthened in terms of safeguarding. The clause says that the doctor must stay with them but, first, it is clearly not practical for the doctor to stay with them for a number of days, and, secondly, it goes on to say that the doctor need not be in the same room.

Daniel Francis (Labour, Bexleyheath and Crayford)

Thank you, Professor Preston. Sorry—if you agree, Mrs Harris.

Carolyn Harris (Labour, Neath and Swansea East)

I wondered who was chairing for a moment.

Carolyn Harris (Labour, Neath and Swansea East)

I call Simon Opher.

Simon Opher (Labour, Stroud)

I think that my question has been covered by my hon. Friend the Member for Bexleyheath and Crayford. I just wanted to be sure that we were secure if the doctor was not in the room, but that has been answered.

Naseem Shah (Labour, Bradford West)

Q My question is to Dr Richards. I will get to where I need to get to, so bear with me. You talk about this being a very explicit conversation, but I would argue that that is not entirely true. We are talking about a set of doctors who will have opted in to have that conversation; not all doctors will do that. We have also had evidence from people suggesting that doctors and lots of other people would leave hospice care if assisted death was provided on the NHS. Yesterday, we had care providers telling us that if people engaged in providing voluntary assisted death, they would leave those hospices. So it is not quite as explicit as what you are suggesting, is it?

Naseem Shah (Labour, Bradford West)

But it is not, because—

Carolyn Harris (Labour, Neath and Swansea East)

Order. One question, one answer. I call Danny Kruger.

Danny Kruger (Conservative, East Wiltshire)

Q Professor Preston, I wonder what you think about this idea of a panel instead of the High Court judge. A lot of Members who voted for the Bill on Second Reading did so partly on the basis that there would be that judicial stage. Although we can all recognise the value of having more expertise involved, the role of the judge is essentially adversarial in principle, and the public would expect it to be. They would be hearing arguments and taking evidence. Do you think that the Bill would be safe without that? Secondly, do you not agree that, as we heard earlier from a law professor, the right of appeal should be in both directions? There should be the right of appeal against an approval as well as against a denial?

Lewis Atkinson (Labour, Sunderland Central)

Q I have a question for Dr Richards. I note from your biography that you have done work studying the phenomenon of old age rational suicide. I noted your comments before about research suggesting that people who seek assisted death have got particular, strong preferences for control and agency at the end of life. We know there are around 650 people with terminal illnesses who take their own lives every year at the moment. I wonder, particularly given your work on old age suicide, what would be your assessment on how assisted dying becoming an option here in the UK might affect those statistics.

Carolyn Harris (Labour, Neath and Swansea East)

Before we move to the next panel, is there anyone else who has pressing questions, or would you prefer to have a five-minute comfort break?

Naseem Shah (Labour, Bradford West)

Q Dr Richards, you were talking about elderly people in particular. We have heard evidence, particularly yesterday, about young women under 40 where terminal illness was deemed legislatively applicable to anorexia. It appears that that is quite a phenomenon. When we talk about the explicit conversation that you are suggesting, I would argue that it is not necessarily clear cut. Do you agree that there would be a risk there when it comes to people with anorexia?

Carolyn Harris (Labour, Neath and Swansea East)

Thank you.

Kim Leadbeater (Labour, Spen Valley)

Q I have a very quick question. Professor Preston, you talked about nurses. Again, feeding into this multidisciplinary approach, one thing I am really clear about is that we must have the best training in the world around those end-of-life conversations and end-of-life choice. Do you have any thoughts about what that training could look like or what the important components of that would be? I am interested to know.

Carolyn Harris (Labour, Neath and Swansea East)

I thank the witnesses on behalf of the Committee. We will suspend until 3 pm, which gives us six minutes.

Carolyn Harris (Labour, Neath and Swansea East)

Q We will now hear oral evidence from families with relevant experience. On the panel, we have Liz Reed, Pat Malone, and Julie Thienpont, who is appearing via Zoom. I am afraid we have lost her for the time being, but we are trying to get her back. Could those on the panel introduce themselves?

Carolyn Harris (Labour, Neath and Swansea East)

Julie’s Zoom link is still down, so I will start with Kit Malthouse.

Kit Malthouse (Conservative, North West Hampshire)

Q Thanks very much, Mrs Harris, and welcome, everyone. Liz, you and I have met before. I am very conscious that during the last couple of days of evidence, we have heard from all sorts of people but not actually from anybody with a terminal illness or somebody who has been through the experience that you have been through—so, welcome. Over the last two or three days, we have heard quite a lot about the complexity of the issue that we are dealing with, but we also heard right at the start that we have to balance that with simplicity, access and speed. From your experience of the two methods in Australia and Switzerland, do you think that there is something to be learned from those systems about that balance?

Carolyn Harris (Labour, Neath and Swansea East)

Q Thank you. I can see that our third guest, Julie Thienpont, has appeared on screen. Welcome, Julie. Would you like to say a few words before we continue?

Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)

Q Thank you all for coming here and sharing your personal experiences. I think it really adds to this, and it is why we are all here. My question is about access, which is one of the conversations surrounding the Bill, and how, if we do not legislate now, we might not see another debate or Bill brought forward for potentially a decade or longer. What are your views on that? I think some people see it as a point from which we either will progress or will not. Do you feel that this needs to be a continuing conversation, particularly with regard to palliative care and the experiences that your loved ones might have had in that system?

Lewis Atkinson (Labour, Sunderland Central)

Q Pat, if the Bill, as it is currently drafted, had been in place in your family’s situation, what difference would that have made to your family’s experience?

Rachel Hopkins (Labour, Luton South and South Bedfordshire)

Q Thank you all for sharing your family stories today. It is really moving. Julie, I want to ask about your experience in Spain and how you found that particular process in comparison with what we have in the Bill. How did it work? What was positive or difficult for you?

Danny Kruger (Conservative, East Wiltshire)

Q This is a question for Mr Malone. May I say how greatly I sympathise with what you have been through? I am very sorry to be fighting against you in this matter. I really can imagine how that feels. Thank you for what you said. I just want to ask about your sister’s experience. On the eligibility question, is it your belief that she would have qualified for an assisted death under the Bill, with the six-month terminal illness criterion? To follow up on that, do you think we should expand the scope to include people with motor neurone disease who might not fall within the six months?

Naseem Shah (Labour, Bradford West)

Q Thank you very much for coming today and sharing your stories. I have two questions. Julie, you said that you had family liaison and counselling. How long did that go on for? This Bill does not have that requirement, so do you think it is something that we should put in it?

Naseem Shah (Labour, Bradford West)

Q Thank you very much for sharing such personal experiences. Liz, you talked about your brother, and going over, and how peaceful it was for you. We have heard lots of witnesses talking about people who have felt like a burden. I am glad that was not the case with your brother’s death. Would you support adding more safeguards to the Bill to make sure that we protect those who are at risk from coercion and who might not have capacity?

Naseem Shah (Labour, Bradford West)

Thank you very much.

Simon Opher (Labour, Stroud)

Q Liz, you spoke about excellent palliative care. What were the reasons, do you think, that your brother wanted to end his life? It did not sound as though he was particularly depressed.

Simon Opher (Labour, Stroud)

And he was having excellent palliative care, so what was in his mind, do you think? Why did he decide on that option?

Kim Leadbeater (Labour, Spen Valley)

Q Thank you to the three of you for coming here this afternoon and telling your stories. I know how hard it is to tell your story over and over again. I think it is important to reflect on the fact that we have had a lot of talk this week about amendments, clauses and various other technical details, but this is the reality of the subject. Thank you so much for sharing your stories.

Liz and Julie, I am interested to know whether you think any aspects of the processes that you went through in Australia and in Spain could have been done better or improved. Is there anything from your experiences that we could learn from to enhance what we are trying to do here?

I also have a question for all three of you—and Pat, goodness me, to come here and tell your story after everything you have been through is unbelievably brave, so thank you. What impact did these different types of death have on your grief and on bereavement? We are talking about different types of death, so I think it will be helpful to think what that looks like for people.

Kim Leadbeater (Labour, Spen Valley)

Thank you so much.

Sarah Olney (Liberal Democrat, Richmond Park)

ThankQ you all for coming today and for sharing these really personal recollections. I have one question, but to both Liz and Julie, if that is okay. According to the notes that I have here—apologies if I have got this wrong—in both your brother’s situation and your husband’s situation, it was administered by the doctor. The Bill proposes that the person who has made the choice about ending their life should self-administer a solution. I am really sorry if this causes you any distress, but, on reflection, do you think that a self-administration regime would have made a difference?

Carolyn Harris (Labour, Neath and Swansea East)

Pat, I think you wanted to say something.

Sarah Olney (Liberal Democrat, Richmond Park)

Q The Chair has given me permission to ask a very quick follow-up, Pat, since you mentioned that. I am really sorry to ask this, but do you think that if it had been administered by a doctor, she would have chosen to live for a little longer?

Sarah Olney (Liberal Democrat, Richmond Park)

Thank you for answering that.

Simon Opher (Labour, Stroud)

Q I have been fascinated by this discussion, so thank you all. It strikes me that we have spent a number of days looking at the other end of this, if you like—coercion and capacity and that sort of thing—but I am concerned that we had a judge with Parkinson’s who would not be allowed through this, like your sister with MND. I just think we should consider as a Committee whether we need to make any amendments on these things, and also on self-administration. I wondered whether you thought we should widen the Act. I presume you have read some of it, at least.

Carolyn Harris (Labour, Neath and Swansea East)

Order. I am going to let you continue, but that question is out of scope. Is there anything else you want to say, Mr Malone?

Lewis Atkinson (Labour, Sunderland Central)

Q I have a question for Mr Malone. The Bill as drafted talks about the commencement period and how quickly it would commence in the UK if Parliament passed it. There have been some suggestions that we should delay the commencement in order for improvements to palliative care or other such things to be made. Could you speak to your experience on that and give your opinion?

Carolyn Harris (Labour, Neath and Swansea East)

Are there any more questions?

Carolyn Harris (Labour, Neath and Swansea East)

Of course. Please do.

Kit Malthouse (Conservative, North West Hampshire)

Q We have heard a lot in evidence over the last two or three days about how the doctor should approach the initial conversation and whether doctors should be allowed to initiate a conversation about assisted dying. I realise that each of you has experienced this at second hand, but could you talk a bit about how those conversations were handled? Do you have a view about the ability of doctors, if this Bill should pass, to raise assisted dying as an option for people facing this kind of decision? Liz, could you talk about the experience in Australia?

Kit Malthouse (Conservative, North West Hampshire)

Q Julie, you said that you got to a point where Guy said to you that he had made his mind up. Had he made his mind up after conversations with doctors about what his options were?

Kim Leadbeater (Labour, Spen Valley)

Q I wonder if you have been on your own journeys around your personal views on assisted dying and choice at the end of life. I have spoken to lots and lots of people about this, and anybody who has had experiences similar to yours are very clear that the law needs to change. People who have not been as close to this issue as you have often hold a different view.

Prior to your personal experience, you might have had a different view or friends and family who had different views. For me, speaking to people who have had the experiences you have had, it becomes very clear that we have problems with the law as it stands, or the lack of the law as it stands. Would anybody like to share their own journey about that?

Carolyn Harris (Labour, Neath and Swansea East)

May I offer all three of you the collective condolences of everybody on the Committee? I thank you for your bravery in attending today and for speaking to us. Thank you very much.

Carolyn Harris (Labour, Neath and Swansea East)

We will now hear oral evidence from Professor Emyr Lewis, emeritus professor at the department of law and criminology at Aberystwyth University; Dr Michael Mulholland, honorary secretary at the Royal College of General Practitioners; Dr Annabel Price, from the Royal College of Psychiatrists; and Dan Scorer, head of policy, public affairs, information and advice at Mencap. Could you please introduce yourselves, so that we know who you are before you start giving evidence?

Carolyn Harris (Labour, Neath and Swansea East)

Thank you. Liz Saville Roberts, Danny Kruger has kindly forfeited a question in order for you to have two, so I will call you first.

Liz Saville-Roberts (Plaid Cymru, Dwyfor Meirionnydd)

Q Thank you very much to Mr Kruger, and to you, Chair.

Professor Lewis, I am glad to say that the Committee appreciates that scrutiny is necessary for Wales-related aspects of this private Member’s Bill. What are the risks of insufficient scrutiny?

Liz Saville-Roberts (Plaid Cymru, Dwyfor Meirionnydd)

Q Could you expand somewhat on which aspects those are?

Sarah Green (Liberal Democrat, Chesham and Amersham)

Q To follow up on what you just said about legislative consent, in October of last year, the Senedd voted against Julie Morgan’s assisted dying motion. In your opinion, what implications does that have for the Bill and its progress?

Sarah Sackman (Labour, Finchley and Golders Green)

Q To be clear, I am here as a Government Minister on this Committee, and the Government are entirely neutral on the Bill, so we do not take a position on the substance of the issues you have raised. Clearly, the draft Bill is intended to apply in both England and Wales, as you say, and your note is extremely helpful in highlighting some of those issues that will need to be worked out. As a Government, we will work closely with the Welsh Government to assess the legalities and practicalities of any potential changes to the law.

You have highlighted in particular the distinctions between health law, which is a devolved matter, and the law on suicide, which currently is not devolved. On the first page of your written evidence, you draw out clauses 32, 31, 33 and 34 in particular as issues that we should focus on in ironing out those legalities. Is there anything else you want to add to that that you think that we as a Government should focus on in our work consulting with the Senedd?

Sarah Olney (Liberal Democrat, Richmond Park)

Q Dr Price, I am really glad that we are able to have the Royal College of Psychiatrists in front of us today; thank you for making the time. I want to ask you about paragraph 11 of your written evidence, which states that it is the royal college’s view that the Mental Capacity Act

“is not sufficient for the purposes of this Bill.”

Could you expand a little on that and, if you feel able, make some recommendations as to what you think could be sufficient?

Marie Tidball (Labour, Penistone and Stocksbridge)

Q This is a question for Dan Scorer. I have worked with a learning disability charity, My Life My Choice. I have done a lot of work with that charity on self-advocacy in the context of healthcare, so I am really keen to hear from you. We know there are excellent initiatives that focus on supporting people with learning disabilities to engage with advanced care planning, so that their preferences at the end of life can be respected. I just wondered whether you could share some lessons learned, particularly in relation to giving people with learning disabilities a voice and an opportunity to talk about what matters to them at the end of life, and say, as part of that, what we could incorporate into the regulations that are being developed as part of the Bill.

Sojan Joseph (Labour, Ashford)

Q I want to come to you, Michael. The Royal College of Psychiatrists has given a written statement, which says:

“Mental disorders, such as depression, are more common in people nearing the end of their life. Delirium is more common… Hopelessness is a common symptom of depression…And people’s capacity and consent can be affected when they are going through this condition.”

In the last few days, we have heard much evidence that expressed concern about capacity assessment and that said, as Dan mentioned, there should be an advocacy service available. Rather than having the current model of two doctors and the court, if we have a panel with experts on it who can consider psychosocial assessment and capacity, would that make the Bill stronger, with more safeguarding being introduced to it?

Sojan Joseph (Labour, Ashford)

The evidence is from the Royal College of Psychiatrists, but anybody can answer the question.

Carolyn Harris (Labour, Neath and Swansea East)

In the interests of time, to allow everybody to ask their question, will Members indicate which of the panel members they would like to answer so that only one gives an answer? That allows everybody to get in.

Tom Gordon (Liberal Democrat, Harrogate and Knaresborough)

Q We have had a lot of conversations and taken a lot of evidence over the last few days about a gag clause to prohibit medical professionals raising assisted dying as part of the options at end of life. We have heard from different states and jurisdictions on whether or not that is something that they had. Broadly speaking, the consensus was that it did not seem to work. Dr Mulholland or Dr Price, I wondered if you had any comment on that.

Jack Abbott (Labour/Co-operative, Ipswich)

Q My question is also for you, Dr Price. The Royal College of Psychiatrists has been really clear in its statement that we as parliamentarians have to consider the outstanding questions about a person’s capacity to decide to end their own life, and whether it can be reliably assessed, and you particularly cite the implications for those with mental disorders, intellectual disabilities and neurodevelopmental conditions. Do you believe that anyone requesting assisted dying should be assessed automatically by a psychiatrist, or that certain criteria should have to be met for a psychiatric assessment to be undertaken?

Simon Opher (Labour, Stroud)

Q Conveniently, my question follows on from that. On our first day of evidence, we had Chris Whitty, the chief medical officer, saying that when you are assessing capacity, the vast majority either clearly have capacity or clearly do not, and there is a small section in the middle. Michael, would you say that a role of a GP would be to inform those definite yeses and definite noes, and then they would perhaps not have the skills for the intermediate ones? I am just suggesting that.

Daniel Francis (Labour, Bexleyheath and Crayford)

Q My question is to Dan Scorer. In the Mental Capacity Act 2005, the definition of “capacity” means that many people with a learning disability are presumed to have capacity. We have heard comments from others on the panel, and I am trying to understand whether you feel that the existing provisions in that Act would cover those with a learning disability or whether you would need that greater advocacy, as you discussed, or something different from the Act. Do you have any comments on the fact that family members—lifelong carers, in many cases—would have no requirement, under the Bill or the Act, to be involved in the decision or to comment on their family member’s capacity?

Kim Leadbeater (Labour, Spen Valley)

Q I take that on board fully, so thank you for those helpful comments. In terms of capacity assessment, point 12 in the feedback and the written evidence from the Royal College of Psychiatrists mentions having multiple opportunities to assess capacity. To provide reassurance on that, those are in the Bill—I think there are four or five opportunities to assess capacity.

My question relates to point 15 in your written evidence, around the Human Tissue Authority. This is a model I looked at in terms of the decision making on coercion and capacity around people involved in organ donation. Can you tell me a little about that, and whether you think that there are parallels? It is a very serious decision, so we are in that territory. This is about what that looks like and what the role of psychiatrists is. We have talked a little about this already, but if we were to take this multidisciplinary approach, which I think is really powerful, what should the role of psychiatrists be?

Kim Leadbeater (Labour, Spen Valley)

Q I think you have answered it, but it was whether there was any specific detail about the Human Tissue Authority, how it operates and what that looks like.

Neil Shastri-Hurst (Conservative, Solihull West and Shirley)

Q My question is directed to Dr Mulholland. Thank you to the Royal College of General Practitioners for the helpful written evidence. I want to pick up on something in it, which is summarised in paragraph 6 but gone into in more detail in paragraph 7, and that is around the refusal of practitioners to engage in the assisted dying process. I note the wording that has been used by the Royal College, which is that GPs and any other healthcare professionals can refuse “on any ground”. That is distinct from the Abortion Act 1967, which in section 4(1) sets out that it can be a conscientious objection. Can you explain why you have decided to take what appears to be a broader expansion of that definition, and why you have chosen that particular wording?

Naseem Shah (Labour, Bradford West)

Q My question is to Dr Price. We heard yesterday from Professor House and this afternoon from Professor Owen, who were talking about capacity and coercion. They also talked about how different people’s life experiences impact their ability and their state of mind, and the lack of research or evidence in that area—the courts are grappling with those issues at the moment. Is there any evidence about the effect on patients’ mental health when they have a diagnosis of a terminal or serious physical illness?

Lewis Atkinson (Labour, Sunderland Central)

Q My question is for Dr Price as well, please. We heard in the week from the chief medical officer earlier, who said that he was “relieved” that this Act based capacity on the Mental Capacity Act, noting that it already provides that

“the more serious the decision, the greater the level of capacity”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 30, Q3.]

and that it is used in tens, if not hundreds, of life and death cases in the NHS every week. The example he gave was someone refusing blood products that they would need to continue their life. In the light of that, I suppose I am a bit confused about your evidence saying that the MCA is not suitable for life or death decisions of this type. Do you think the MCA is not fit for purpose for those current life or death decisions that are being made, or is there something about the life or death decisions that would be made in an assisted dying context that makes that different?

Kit Malthouse (Conservative, North West Hampshire)

Q I also want to explore this issue of capacity a little further with Dr Price, because I share my colleague’s slight confusion.

You talked about a percentage who wish to hasten death. The people we are talking about are facing death in any event within a foreseeable period, and they may be contemplating a death that is not pleasant. Some of the characteristics you talked about are presumably to be expected and may not necessarily interfere with their ability to make rational decisions in what they believe is their own best interest. In those circumstances, I do not understand why the Mental Capacity Act would not apply. I understand that you may be coming at it from a practitioner point of view, but if I make a decision to decline treatment to hasten my own death, I am not sure I would necessarily see that as qualitatively different, from the point of view of my own capacity, from saying, “I know I am going to die in three months’ time and I would like you to assist me to die slightly earlier.” Why are the two qualitatively different, from an MCA point of view? At the moment, one would be dealt with through the MCA, but you are saying the second would not necessarily be.

Rachel Hopkins (Labour, Luton South and South Bedfordshire)

Q Dr Mulholland, I want to push a little on where you were saying the royal college sits on the ability of members to say that they would not want to participate in assisted dying, if it came through, and on your written evidence saying that you would like to see a separate body. Given that many GPs are already very much involved in the care of their patients and will often be doing a lot of palliative care themselves, particularly around medications, and given that the Bill is about terminally ill adults with a diagnosis of six months left to live, do you mean that all GPs would stop at that six months and it would go over to an independent body, or are you saying that those GPs who want to continue that care could do so but that those who do not want to be involved in a potential route to assisted dying would step out? I would like a little clarity on that, given the person-centred care that so many GPs do so well.

Carolyn Harris (Labour, Neath and Swansea East)

As we have time, I call Danny Kruger.

Danny Kruger (Conservative, East Wiltshire)

Q Following straight on from that, do you imagine it to be an NHS-funded service if it is outside core general practice? If so, what might the implications be for resourcing, assuming that it was funded out of general NHS resources? In the practical terms of the Bill, what do you think of the provision that the co-ordinating doctor must remain present with the person until they die, bearing in mind that that might take some hours? I am interested in your view on the implications for resourcing the service.

Simon Opher (Labour, Stroud)

Q I would like to go back to the point about depression, because it is common. In the general population, 20% are on antidepressants—on SSRIs. GPs diagnose the vast majority of depressions. Dr Mulholland, what are your thoughts on whether checking for demonstrable depression should be a standard part of the assessment before you refer people into the service? The idea of getting a psychiatrist who wanted assisted dying to see every case, given how difficult it is to see a psychiatrist in the NHS at present, would really limit the service.

Kim Leadbeater (Labour, Spen Valley)

Q I will stay in the same territory, if I can. The Bill includes, very clearly, an opt-in model for doctors. I took that from the BMA, which was very clear on that, and I think it is very important. My slight concern, on which I would like you to expand, is about the removal of assisted dying from the holistic approach to end-of-life care and conversations that GPs have all the time—as do other healthcare professionals, including nurses, as we have heard this week. Where this works well in other jurisdictions is where it is integrated and where we talk about palliative care, we talk about decision making and we talk about choices. I would appreciate your thoughts on that concern.

On capacity, just to reflect on the previous panel, my view is that psychiatric assessment would not be necessary in every case. We have heard from three families this afternoon; we can probably all agree that there was a clear wish from those individuals that this was the choice they wanted to make. I agree with the colleague who said that there will be a percentage of people; that is why I think referral to a psychiatrist is important in those cases. Have you any more thoughts on that, Dr Mulholland?

Carolyn Harris (Labour, Neath and Swansea East)

There are three people left who want to ask questions, so can I beg for brevity?

Naseem Shah (Labour, Bradford West)

Q Under clause 4(2), doctors would be allowed to raise the issue of assisted dying with a patient, unprompted. Dr Rachel Clarke gave evidence to this Committee that, in some circumstances,

“The very act of raising assisted dying in that way will make that vulnerable patient think, ‘God, is this doctor telling me that my life is not worth living any more?’”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 75, Q93.]

We heard from Dr Jamilla Hussain yesterday. She talked about mistrust of the NHS, particularly post-covid, where people had DNRs attached to them—disabled people and people of ethnic minority backgrounds in particular. Dan, are you concerned about the potential impact on people with learning disabilities?

Marie Tidball (Labour, Penistone and Stocksbridge)

Q Dan, I am really keen that we ensure that if the Bill passes, the voices of disabled people are continually involved in understanding its impact, particularly on the issue that you have just raised. Earlier, we heard evidence about implementation taskforces that are used in other jurisdictions. I am considering tabling an amendment on an advisory council. How might we ensure that the voices of people with learning disabilities can be included in such a body?

Lewis Atkinson (Labour, Sunderland Central)

Q It is late, and I am far from being an expert on Welsh devolution, but I want to ask Professor Lewis a question, not least because we have not come to him for a little while.

Although it is not my area, I absolutely note the concerns and the discussion about respecting the democratic will of the Senedd in these matters. Would you suggest any potential avenues in the Bill to incorporate an element of positive affirmation by the Senedd, or its consent? What do you suggest we look at?

Naseem Shah (Labour, Bradford West)

Q Dr Price, you talked in your earlier evidence about depression. One Committee member suggested that 20% of people were on antidepressants; actually, the factual position is that 10% to 11% of the adults in this country are on antidepressant medication, according to the latest statistics. To be clear, are you saying that people who are depressed are more likely to ask for or go down the road of assisted dying?

Carolyn Harris (Labour, Neath and Swansea East)

May I thank the panel for giving evidence today? We really appreciate your attendance.

Daniel Francis (Labour, Bexleyheath and Crayford)

On a point of order, Mrs Harris. Yesterday, we heard evidence about the impact of the Bill on different groups with protected characteristics, including age, disability, race and sexual orientation. We heard from the EHRC, an arm’s length body of the Government, that it strongly recommends that a full impact assessment, a human rights assessment and a delegated powers memorandum be undertaken before the Committee begins line-by-line scrutiny.

We have also heard from witnesses about the impact that the Bill will have on disabled people, from Disability Rights UK and others, on black and minority ethnic people, from Dr Jamilla Hussain, from LGBT people, from Baroness Falkner, and on those from a low-income background, from Sam Royston of Marie Curie. We heard from Dr Sarah Cox and Dr Jamilla Hussain that evidence from their work shows that this Bill has a higher probability of pushing minority groups further away from seeking healthcare, while inequality pre-exists. As observed through the pandemic and from available data, minority groups do not always trust that their interests will be best represented in institutions that would enable the facilitation of someone’s death, should this Bill become law.

I therefore believe that on the basis of that advice, so as not to inadvertently widen health inequalities through Bill, it is essential to have health impact assessments. I appreciate that an equality impact assessment will be produced for Report stage, it will not be available for detailed line-by-line scrutiny. When we agreed the timetable for line-by-line scrutiny last Tuesday, we were not aware that this assessment would be produced, given it was first reported to the House during the money resolution last Wednesday. There is a risk that there will be a bigger impact on people with protected characteristics, and this will not be understood fully until the Government have produced the equality impact assessment. As things stand, that means that we will move into line-by-line scrutiny of the Bill on 11 February without a full understanding from the assessment of the impact of the Bill.

I am therefore minded to request a short Adjournment of the Committee so that, as advised, we can receive the assessments before we progress to line-by-line scrutiny. Please will you advise me, Mrs Harris, how I could secure such a motion to adjourn the Committee until we are in receipt of the evidence, as advised by the witnesses yesterday?

Sarah Sackman (Labour, Finchley and Golders Green)

Further to that point of order, Mrs Harris. I want to clarify the Government’s position. As the Committee knows, the Government are neutral on the Bill, but once the Committee has concluded its work and prior to Report, we are committed to publishing the ECHR memorandum, a delegated powers memorandum, the economic impact assessment that was committed to during the money resolution debate, and an assessment of the equalities impact of the Bill. In terms of the timing, it is necessary that the impacts that are assessed be of the Bill as it is brought forward. If the Bill is liable to change via amendments proposed by members of this Committee, it is important that we know what it is that we are assessing the impact of. That is why the proposed timing is to publish the impact assessment at that stage. The point is that before Members of the House come to a vote on Report and Third Reading, they will all have before them the impact assessment in respect of equalities and all those other aspects of the Bill.

Danny Kruger (Conservative, East Wiltshire)

On a point of order, Mrs Harris.

Carolyn Harris (Labour, Neath and Swansea East)

I am going to proceed now. I thank the hon. Member for Bexleyheath and Crayford for notice of his point of order. I am sure that the Member in charge and the Government have heard his points. If he wishes to look at procedural options, he should consult the Clerks in the Public Bill Office.

That brings us to the end of today’s sitting. The Committee will meet at 9.25 am on Tuesday 11 February to begin line-by-line consideration.