Danny Kruger MP: speeches

Speeches

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  In the light of the suggestion from the hon. Member for Spen Valley that there will be further amendments later, when we can discuss the shape of the provision and presumably any remuneration, I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Amendment proposed: 186, in clause 5, page 3, line 23, at end insert— “(3A) The Secretary of State must by regulations make provision about the training, qualifications and experience that a registered medical practitioner must have in order to act as the coordinating doctor. (3B) The regulations must include training about— (a) assessing capacity; (b) assessing whether a person has been coerced or pressured by any other person. (3C) Subject to that, the regulations may in particular provide that the required training, qualifications or experience is to be determined by a person specified in the regulations.”— ( Kim Leadbeater .) See the statement for Amendment 185. Amendment made to amendment 186 : (a), after “(b) assessing whether a person has been coerced or pressured by any other person.” insert “(c) specific and up-to-date training on reasonable adjustments and safeguards for autistic people and people with a learning disability.”— (Daniel Francis.) Amendment 186, as amended, agreed to.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I was not intending to speak on this amendment, but since you have called me, Mrs Harris, I will quickly respond to the comments of the hon. Member for Rother Valley. I sincerely think that he should withdraw the suggestion that the amendment was made in bad faith and his remarks about the motivation of the hon. Member for York Central. She clearly tabled it only to make the Bill safer, which is the purpose of all the amendments, even if there might be very good reasons to disagree with them, so I regret that attack on her integrity. On the point that we should simply rely on the integrity of clinicians—although the hon. Member for Rother Valley has not done so in respect of the hon. Member for York Central, who is herself a clinician—of course we do that. Nevertheless, the laws we make and the guidance we introduce send strong signals about priorities. The purpose of the amendment is to ensure that doctors do not feel that the obligations created by the Bill impose a duty on them to prioritise the assisted death procedure over other priorities. In fact, it would give clinicians genuine autonomy and freedom to make their own decisions—obviously, in consultation with colleagues and patients—about the appropriate prioritisation of the treatments and services they are offering. The hon. Member for Rother Valley made the point that there is, in a sense, an attempt to suggest that the Bill should not become law because of the pressures it could impose on the NHS. I think that such pressures are a valid concern. When we create new laws, we should consider what new burdens they will place on existing services. We should consider whether the new service will be introduced and implemented safely, and its knock-on implications for the wider system.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  The hon. Lady is absolutely right. We should not forget that doctors are indemnified against any civil claims under the Bill. Nevertheless, they will want to protect themselves against the accusation that they inappropriately prioritised one case over another. That is the purpose of the amendment, and I urge the Committee to support it. I will finish with this point. I am ashamed to say it, because my party was responsible for the NHS for the 14 years until last year, but the fact is, as Labour Members said frequently when they were in opposition, that there are enormous resource constraints on the frontline in the NHS. I do not think that is inappropriate to consider, when we create a new service, how it might have an impact on existing treatments in the NHS. Leaving aside all the ethical questions, including on coercion and capacity and our concerns in that respect, what will this mean for hard-pressed GPs and clinicians of all sorts on the frontline? What protections can we offer them when they make difficult decisions about whether to support an assisted death application?

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  The hon. Gentleman is impugning the motivation of his colleague, the hon. Member for York Central, who is herself an experienced practitioner in the NHS. To suggest that she has tabled this amendment improperly is a serious accusation, which I cannot believe that he really wants to make against his colleague. He said that the amendment’s intention is to suggest that assisted dying would cause problems in the NHS, but the explicit terms of the amendment are to ensure that that does not happen. Of course, no practitioner would want to take choices that would prejudice other patients’ care.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I am not sure that is right. The amendment insists that this referral and assessment should happen at the earliest stage possible, in the same way as for organ donation. One of the confusions of the Bill is that multiple different conversations could happen. The purpose is to ensure that this conversation with a psychologist or social worker, as per organ donation, happens at the very earliest opportunity.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I do not, but other colleagues will, I am sure.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  You’re the boss.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I am sorry for having begun speaking to the wrong amendments earlier. I was trying to speak to amendment 58—I could not read my own notes—not amendments 55 or 56. I do not want to reheat the previous arguments about the imperative—as I believe it is—to refer to a psychiatrist. I support the suggestion of the hon. Member for Ashford and the hon. Member for Runnymede and Weybridge (Dr Spencer) that the independent doctor should have relevant qualifications in psychiatry and experience in assessing mental capacity through their professional qualifications. The importance of having a holistic multidisciplinary team has been well argued and subsequent amendments to the Bill have attempted to delivered that. I want to emphasise that if we adopted the amendment tabled by the hon. Member for Ashford, we would be acknowledging the reality that assisted dying is not like other medical decisions. By explicitly including psychiatrically trained clinicians, we would be giving special regard to the mental state of patients making an existential decision, not just a treatment decision. That is particularly appropriate for patients who are not expecting to significantly suffer bodily due to their terminal illness. We have heard many stories of people who have died in painful or undignified ways, but that does not reflect the experience of the majority of those with a terminal illness—90% of cases, according to some studies—who are able to receive adequate or complete pain relief. For people who do not have an obvious motivation to have an assisted death, such as avoiding extreme pain, an investigation by a psychiatrist of their mental state would surely help to safeguard against those with depression or other ameliorable mental conditions that impair capacity accessing an assisted death. I want to emphasise the evidence that we received from Professor Gareth Owen, who in 2021 conducted a large-scale survey of medical professionals in England and Wales. That found that non-psychiatric doctors—general practitioners and other doctors not trained in psychiatry—were less confident than other professionals in assessing capacity. It also found that 6.9%—less than 7% —of non-psychiatric doctors rated themselves as assessing capacity very well, which I think is significant. To place all the responsibility for assessing capacity and coercion, which are difficult to assess and contain complexities that psychiatrists are best placed to appreciate, in the hands of doctors who do not have specialist expertise is to be content with coercion being missed and capacity being poorly assessed. If we want to ensure that these tests are done well, the only way to do that is to involve psychiatrists, as the hon. Member for Ashford said.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  No. I am so sorry. The confusion of the last group has thrown me. I am very grateful to my right hon. Friend.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I appreciate the hon. Member’s point, and it is very logical that it should only be in the case of doubt, but does he not recognise that in the case of organ donation, it is mandatory? If people have this proper assessment when they are giving an organ, why should they not be asked to have one if they propose to give their life?

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I was going to speak briefly to amendment 420(a), as per your ruling earlier, Mrs Harris.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  On a point of order, Mrs Harris. I defer to you, but my understanding is that amendments 346 and 348 and new clause 11, which are in group 6, have not fallen yet.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I beg to move amendment 257, in clause 7, page 4, line 15, at end insert— “and that there is no real risk that the criteria in paragraphs (a) to (g) have not been met.” This amendment provides that the request for assisted dying will not go ahead if there is a real risk that the eligibility criteria are not met.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  We cannot have it both ways. We cannot give doctors and clinicians autonomy, which the Committee has repeatedly seen as a ground to reject all sorts of obligations that I and others have proposed to ensure that doctors do the job in a specific way, and then suggest the opposite in this instance. I recognise what the hon. Gentleman says, and he may be right that that is inappropriate.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I rise to speak to amendment 55, in clause 71, page 4, line 33, leave out paragraph (a). The amendment would ensure that the independent doctor has qualifications and experience in psychiatry or in assessing mental capacity. We have heard a lot in the debate about the importance of a holistic, multi-disciplinary approach to patient care at the end of life. We have also discussed the need for that to happen throughout the process and, in particular, during the crucial stages of the patient’s assessment. In the oral evidence sessions, we heard from Dr Rachel Clarke about the need for teams to be involved with patients throughout the process. By requiring the input of a psychiatrically trained clinician in the assessment by the doctors, we would be making explicit the expectation that assisted dying should adhere to the best practice, which we already see in end of life care in our country. We would also be bringing our practice into line with jurisdictions such as Oregon, which require referral to a psychiatrist, as has been discussed.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Amendment proposed : 14, in clause 7, page 4, line 15, at end insert— “(2A) The coordinating doctor must take the report required under subsection (2B) into account in making an assessment under paragraph (2)(b), (f) and (g). (2B) One or more qualified persons must have conducted a separate interview with the person and made a report to the coordinating doctor on the matters specified in subsection (2C). (2C) The matters that must be covered in the report required under subsection (2B) are— (a) any evidence of duress or coercion affecting the person’s decision to end their life, (b) any difficulties of communication with the person interviewed and an explanation of how those difficulties were overcome, and (c) the capacity of the person interviewed to understand the information given to them under paragraph (9)(2), (b), (c) and (d). (2D) A person shall be taken to be qualified to conduct an interview under subsection (2B) if that person— (a) is a registered medical practitioner who— (i) is registered in the specialism of psychiatry in the Specialist Register kept by the General Medical Council, or (ii) has such training, qualifications and experience as the Secretary of State may by regulations specify, (b) has not provided treatment or care for the person being assessed in relation to that person’s terminal illness, (c) is not a relative of the person being assessed, (d) is not a partner or colleague in the same practice or clinical team as the coordinating doctor, (e) did not witness the first declaration made by the person being assessed, and (f) does not know or believe that they— (i) are a beneficiary under a will of the person, or (ii) may otherwise benefit financially or in any other material way from the death of the person. (2E) Before making regulations under subsection (2D)(a), the Secretary of State must consult such persons as they consider appropriate. (2F) Regulations under subsection (2D)(a) are subject to the negative procedure.”— (Daniel Francis.) This amendment, and its consequential and linked amendments (15, 16, 17, 18 and 19), would provide for an independent assessment, via an interview conducted by a specialist, of a person’s capacity to make the decision to end their own life, their clear, settled and informed wish to do so, and that they have made the first declaration voluntarily and without coercion. Question put, That the amendment be made .

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I appreciate the point that the hon. Gentleman is making, and that he will not be able to support the amendment, but does he acknowledge that its purpose is to clarify the triage process that needs to be done by doctors? It is a perfectly appropriate request to make of doctors.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I am grateful for your ruling, Mrs Harris, but I hope you will not mind if I do respond to the question.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I am afraid to say that we do impose obligations on doctors to do the things that we expect them to do. If that is offensive to doctors, so is all the guidance from the General Medical Council. It might well be argued that the amendment is otiose, because of course we would expect doctors to manage their resource requirements appropriately and to consider other patients. Nevertheless, the point that is being made in defence of the amendment, about which I feel strongly, is that we are creating a new service with unknowable resource implications, with strong parliamentary backing behind it, and with a whole set of guidance that will be created ex nihilo by the Secretary of State and that Parliament will have little control over. Because we have not seen the amendments on the design of the service, we do not even know what the service will involve and how much work it will take. It is therefore appropriate to specify explicitly that doctors have an obligation to consider the potential impact on other patients.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  My right hon. Friend is absolutely right, I apologise. I am speaking to later amendments, so I apologise to the Chair and to the Committee.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  Well, that concern for the individual clinician is in the context of their wider obligation to treat their patients well and to manage a resource—their own time—in a way that is equitable to all the patients they have to see. As often in these debates, we are really considering the extent to which we should be putting into the Bill an obligation on doctors to do the job that we hope that they are doing anyway. We do have such rules in the system to clarify what we expect of clinicians, however, and I think they would be appropriate in this case, given the resource requirements—which are unknowable, but with common sense one can see that they will be quite significant—that this new service would entail for many clinicians in the NHS.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  It is a very important point. Yes, we are talking about those people, but we are also talking about a different category of people who have a terminal diagnosis of six months or more, and may only be reasonably expected to die within six months. I am not just talking about people at the very end of their life, who are at death’s door; we are talking about people who qualify for the Bill, which is a much larger category of people, so it is appropriate to require them to do this.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I understand, but it would be interesting to know whether the Government have produced a delegated powers memorandum, and when it will be published. I have four quick points to make about my concerns about the amendments and new clause 8. First, new clause 8 provides that when making the SIs, the Secretary of State must consult the Equality and Human Rights Commission. That is a very positive step, but the other provisions on who should be consulted are, on closer inspection, illusory. The Secretary of State must consult those with expertise on capacity and coercion—that is all great—unless he or she considers that “it would not be appropriate”. What the new clause gives with one hand, it takes with the other. It would be good to identify in the Bill who the groups are that the Secretary of State must consult for each power. Secondly, the vast majority of the SIs made under the Bill, as amended by the amendments, are to be made by the negative procedure. The last time that an SI subject to the negative procedure was annulled by the House of Commons was 1979. The procedure gives only the outward appearance of involving Parliament again. The SIs take effect when signed by the Minister, subject only to a motion of either House to annul them. However, by strong convention the Lords will do no such thing, and the convention in the Commons is that the Government will make time to debate such a motion only if it is put forward by the Opposition Front Bench, and it is at the Government’s discretion. This being a matter of conscience, it is unlikely that any Opposition Front Bench would be in a position to table such a motion, and no one else has any standing. In practice, that means that there will be no opportunity for parliamentary scrutiny on, which lethal substances may be approved, for example, or on what events should be notified to the chief medical officer. These are not mere details. Thirdly, on some of the matters addressed in the amendments it is doubtful whether the use of delegated powers is even appropriate, because even if there is a debate and a vote in Parliament, debate on an SI is limited to 90 minutes only and an SI is not amendable. In fact, the House of Lords Delegated Powers and Regulatory Reform Committee considered it improper that the Assisted Dying Bill introduced by Baroness Meacher gave the power to the Secretary of State to decide which substances should be allowed to cause death, because it was an inappropriate question for an SI. Finally, and perhaps most substantially, clause 32 will establish a vast Henry VIII power. It allows Ministers even to amend primary legislation, and those changes would be subject to a simple yes or no vote in the Commons, without the possibility of amendment. It has been suggested in the Hansard Society podcast with the drafter of the Bill that the power is there because provision on the NHS could be made only if section 1 of the National Health Service Act were modified, removing the duty of the Secretary of State to improve the “physical and mental health” of the public. I look forward to seeing whether the amendments that have been promised include that. However, they will not necessarily amend the National Health Service Act, because that could be done under the statutory instruments created in these amendments. If such a foundational piece of legislation as the National Health Service Act needs to be modified to allow this law to pass, surely it would be better to do it on the face of the Bill. I want to know why a Henry VIII power is needed. I hope that the Government might bring forward the relevant amendments to the Bill so that a Henry VIII power is not needed. I see that the hon. Member for Spen Valley is nodding, which is encouraging. I stress that the Committee must bear it in mind that this power would exist on the statute book forever, unless the statute is repealed, so any Government could use this power. The last time that a Parliament found its voice to reject an SI by the negative procedure was back in the 1970s. When we come to a decision on amendment 233 and new clause 8, I will seek to make further amendments.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  There is no rule that can be applied universally in the abstract. All rules take their value from how they are introduced. On the hon. Gentleman’s hypothesis, I do not in principle suggest that every new treatment and every new obligation that is created in the NHS should require laws determining how clinicians prioritise them. In the case of a new service—I am trying not to use the word “treatment”, because I do not accept it as such, but it sounds like it will be treated as an NHS treatment—that is very significant and whose resource implications are unknown, it strikes me as appropriate that, as far as possible, we should be clear that doctors should manage the resource demands placed on them by the Bill in the context of their other obligations to patients.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I completely agree. The hon. Member for Spen Valley makes the important point that these patients are, indeed, being treated already; one would hope that the palliative care process would continue alongside their application. It is absolutely right that they are being treated, but as my hon. Friend the Member for Reigate says, there would be additional work being done for them. Does she agree that there is also an opposite threat—that the resource being expended on the patient might be less as a result of the assisted death that they get? I am afraid to say that that would introduce a terrible new incentive into the system, as happens elsewhere.