Danny Kruger MP: speeches

Speeches

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting) · Hansard source

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  Will the Minister confirm that the Secretary of State could simply reintroduce that ambiguous term at their own discretion? If they are being given the freedom to decide who can be a proxy, they might decide that it should be a term of equal ambiguity. My right hon. Friend the Member for North West Hampshire is absolutely right that I have great respect for the concept of “standing”; nevertheless, I do not believe that the Government have yet been able to define exactly what that means. Does the Minister agree that there is still the opportunity for ambiguity? We are just leaving it completely blank at this stage and hoping that some future Secretary of State will have more clarity than we do.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting) · Hansard source

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  The hon. Lady is quite right that there is nothing to object to in these amendments or the clause. It is worth stating at this point, though, that in the context of the debate we are having in this Committee, we are moving at some pace. The likelihood is that there will be opportunity for only a five-hour debate on Report—maybe more, but possibly not. This Committee is the time we have to consider in detail the content of the Bill. My concern is that moving too quickly and trying to do too much too soon means that we will miss the opportunity to debate very important aspects of the Bill. The hon. Lady says that these are “nice, simple” amendments, as if the only thing being discussed here is the paperwork around the declaration. What should we say to patients who decide to cancel their declaration? My concern—I am unaware of any other point when we could appropriately discuss this question—is what happens in the event of a cancellation. What duty of care do doctors have to patients who have decided not to proceed with an assisted death? The Bill does not currently address that question: it imposes no obligation on doctors to follow up in any way after a declaration has been cancelled.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting) · Hansard source

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  Before I give way to my right hon. Friend, I want to posit the hypothesis of a private provider that has been established explicitly for the purpose of facilitating the assisted death procedure for patients. If that provider steps back when the patient decides to cancel their declaration, the provider is required to notify the GP as soon as practicable, whatever that means—the timeframe there is clearly at the convenience of the provider, not the patient. My concern is what happens when the patient’s GP is not quickly informed that they have decided not to proceed with the assisted death and they are sitting in limbo. Obviously, there are significant concerns about their wellbeing, given their decision and the state they are in. It is not yet fully clear to me what the obligations on the doctors would be at that stage.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting) · Hansard source

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  I am grateful—I really do thank the hon. Lady, because the effect of this process on the medical professionals who will be involved is a very important consideration, and one that we have perhaps not given enough attention to. That is why we will come to the conscience clause in due course, although we have discussed it a little already. The hon. Lady is absolutely right that there is a difference for the medics in the extent to which they are involved in the administration of the death. I am afraid I do not see a major moral difference between providing the wherewithal—setting things up for, or indeed helping, the patients to ingest or otherwise self-administer the fatal drug—and people performing the act themselves. The distinction is very obscure; there is a significant grey area there. On the hon. Lady’s point about appropriate consideration of the feelings of the medical profession, if she believes in doctor autonomy, she should believe that doctors ought to have the autonomy to decide for themselves whether to perform euthanasia, if euthanasia were legal. That is what happens in other countries. In Canada, doctors can decline to take part, or they can participate. Given the question of autonomy, it is worth noting that in countries where euthanasia is legal, it is the overwhelming choice of the patients, as I think it would be for me. If I were facing that terrible moment and choice—we will come in due course to the question of the drugs involved and the process of taking them, but swallowing all these pills is not a pleasant process—it would be far easier, more humane and less painful for a doctor to administer the drugs intravenously. I visited Canada and met a doctor who had been responsible for over 300 deaths, which she herself has performed, because that is the overwhelming choice of the patients. As I am sure the hon. Lady would agree, that doctor is acting with full professional discretion and autonomy. To go back to my point, I am afraid this is one of the impossible dilemmas that the Bill and the whole concept of assisted dying set up: whether we allow the doctor to do it to us. My concern is that if the stress on self-administration is genuinely felt—not, as I cynically believe, because this is the only way to get assisted dying through the House of Commons—because the Bill’s authors recognise the need to be absolutely sure that the act is voluntary, and if the reason why we insist on self-administration is because we want to be sure that the act is voluntary, what does that say about all the so-called safeguards that exist up to this point? We have been told that those safeguards are sufficient to ensure that we have absolute confidence about the person’s clear and settled wish. If we are sure that people at this stage in the process have a settled, informed and free wish to end their lives, why should they not be able to ask a doctor to do it to them? The only answer to that question can be that we do not genuinely believe that we are completely sure. We want, subsequent to death, to be sure—in terms of our own moral propriety and sense of amour-propre—that those people did it themselves. It was not our choice; it was not us doing it to them—they did it.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting) · Hansard source

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  I recognise that, but that is not germane to the debate that we are having, which is about the actual cancellation. There is a question about why there would have been a cancellation. My right hon. Friend is right that there is no obligation to proceed once a patient passes a particular hurdle. Many will not, but when someone decides actively to renounce their decision, a big question should be asked: what is going on, and what further help is needed? My right hon. Friend suggests that we do not step in and ensure that care is provided—that, in other circumstances, there is no additional obligation in relation to patients. I am afraid to say that he has, as ever, a coldly rationalistic vision of healthcare and of the sorts of patients we are dealing with. As I have said to him, these patients will be acting much as I imagine he would imagine—I think from a position of health and self-confidence—himself acting in that circumstance. In fact, we are dealing with people who have decided to renounce their decision to proceed, and so are by definition in some turmoil. I crave the indulgence of the Committee, because I am talking at length about a set of amendments that I do not intend to oppose, and I recognise the value and necessity of the clause. However, I draw to the Committee’s attention that we are dealing not simply with a bit of paperwork, but with a human being who, having made one enormous decision—to die—is now making an enormous decision to live, and we are treating it as if it is only a bureaucratic question. I finish with a question to the hon. Member for Spen Valley or to the Minister, to help me understand something that confuses me in the clause.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting) · Hansard source

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  I very much respect the hon. Lady’s intention, and I support the amendments. On clause 16, however, I must take the opportunity to express a certain concern. The clause applies if, under subsection (1)(b), the co-ordinating doctor “refuses to make…a statement” to be entered into the person’s medical records. That is good but, as I understand it, a statement could be made that complies with the Bill but does not put on record, in relation to subsection (2), which requirements the co-ordinating doctor did not believe were satisfied. We have missed an opportunity to have more clarity about which exact requirements have not been met. There is also the eternal question about the co-ordinating doctor’s reasons for reaching that conclusion. I just note the missed opportunity to be a little safer with the drafting. My more general point is about the importance of effective record keeping and declaration. I thank the hon. Member for Spen Valley, who throughout the whole Bill process has stressed the importance of good data collection and record keeping, which will be vital so that in later years, if the Bill passes, we can judge whether it is working as intended. I am concerned about going on the evidence of other countries, which is frequently adduced in support of the Bill, particularly in respect of the absence of evidence of coercion, questions around capacity, proper administration of drugs or the support that patients receive. It is often said that concerns are exaggerated or inappropriate, “because look at what happens in other countries”, but let me briefly run through some evidence from abroad. The fact is that no other country does adequate record keeping. One ambition of the hon. Member for Spen Valley that I really do share is to have a better system of keeping data than in other countries. In Oregon, the most recent annual report demonstrates a whole series of failures in record keeping. Ingestion status was unknown for 25% of the patients prescribed the drugs, so we do not know whether they took the drugs or what the process was. In 72% of cases, it was unknown whether there were complications; we have been talking about how exaggerated my concerns and those of other Members are about complications, but in 72% of cases in Oregon we do not know. In 30% of cases, it was unknown whether a healthcare provider was present. In 44% of cases, the duration between ingestion and death was unknown. I very much recognise that the intention of the Bill is not to have those sorts of mistake. Indeed, the intention is to ensure that some of them should be impossible, because a doctor should be present and so on. Nevertheless, there is evidence that in other countries that have inspired the Bill, the data is inadequate. I will give a few more examples. British Columbia has poor documentation, incomplete assessments, recurrent and excessive delays in reporting. In the debate on the last group of amendments, we spoke about the necessity that a doctor be informed if a declaration is cancelled; I am very concerned that that will not happen quickly and that people could fall through the gaps. That is what happens abroad. We have seen evidence from the former Attorney-General of Victoria, Australia, of all sorts of irregularities, with doctors falsely certifying that patients had signed statements and so on.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting) · Hansard source

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  I think the hon. Lady is about to say that her own amendment addresses that point.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting) · Hansard source

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  Is that the case? I apologise.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  The Minister suggests that it is appropriate for the patient to give some advance indication of what should be done in the event of complications, but that it would not be right for Parliament, too, to give advance direction of the sorts of responses that would be appropriate in the circumstances. I am afraid that I do not understand the Minister’s distinction. Either it is possible to set in advance the sorts of responses that would be appropriate in the event of complications—the word “complications” is already in the Bill, so is clearly acceptable—or it is not. In the event of complications arising when the patient has not given clear instructions in advance, surely it is appropriate for the doctor to be able to rely on guidance, whether that is in the Bill or set out by the Secretary of State subsequently. There needs to be clarity about what to do because, to repeat the point, this is not normal medicine—a fatal drug has been introduced into the body. That is not a normal medical situation in which a doctor just uses their clinical judgment; the only appropriate clinical judgment in such circumstances is to attempt to save the patient’s life, because that is what doctors are supposed to do. But we are telling them that they have been allowed to help a patient to die artificially. In that circumstance, what are they supposed to do when that is clearly not working?

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  The Minister said that the Government find it impossible to understand the word “complications” —that it is too complex and full of ambiguity. Yet in clause 9 of the Bill, we have that very word. The suggestion is that the doctor should “discuss with the person their wishes in the event of complications”. Is that unclear? If not, what is the difficulty with specifying “complications” in clause 30?

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  The hon. Lady puts her finger on the tension—my hon. Friend the Member for Reigate and I expressed it as well—about whether it is appropriate to give the health regulator responsibility for regulating a product that is about not health, but death. Does the hon. Lady agree that no other agency would be appropriate, given the skills she has set out? The purpose of these lethal drugs is to kill the patient; nevertheless, it is appropriate that we consider them in terms of not only that objective but their potential side effects. The purpose is not one of healthcare, but the product is very close to a healthcare intervention. Therefore, despite all our anxieties, it feels appropriate for the healthcare regulator to oversee this.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  Even in terminal care, when it is understood that a patient is close to death, doctors would surely not overlook a patient for whom an assisted death is clearly failing. The hon. Gentleman suggests that it would be inappropriate to—and that he would never—call an ambulance, or send a patient to A&E; I wonder whether he also means that he would never seek to revive a patient or bring them back to life, as it were, if they were experiencing complications. To his often-repeated suggestion that there is no difference between this and normal medical treatment, there is an enormous difference. Doctors administer lethal drugs to a patient, and are then also supposed to be somehow caring for the patient in the traditional way that doctors should. These things are inherently incompatible, and there is a choice between the two : is the doctor helping the patient to die, or is he helping them to live? That questions remains, and does he not acknowledge that there will be circumstances where it would be appropriate to revive the patient, and seek to support them as if they were living?

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I beg to move amendment 480, in clause 23, page 15, line 3, leave out subsection (1) and insert— “(1) No individual is under any duty (whether arising from any contract, statute or otherwise) to be involved, directly or indirectly, in the provision of assistance in accordance with this Act. (1A) In particular, no individual is under any duty (whether arising from any contract, statute or otherwise) to— (a) provide information about assisted dying; (b) participate in an initial discussion; (c) participate in the request and assessment process; (d) supply, prescribe or administer an approved substance; (e) be present at the time of administration of an approved substance; or (f) dispense a prescription of an approved substance. (1B) Nothing in subsections (1) or (1A) of this section shall affect any duty to— (a) signpost someone to where they can obtain information about assisted dying (under section 4(5) or otherwise); (b) perform acts of a clerical, secretarial, or ancillary nature; or (c) perform any acts necessary to save the life of or to prevent grave injury to a person.” This amendment would expand the provision of Clause 23(1) to all individuals and clarify the activities in which they are not obliged to participate.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I am very pleased to hear it. I thank the hon. Lady for that. That helps me because I was perplexed about the difference. It is good to hear from her that there is no particular group of professionals who she thinks should not be included in the conscience clause. It is good to hear that she agrees with that. I would be interested to hear what her objections to the amendments are because, as I say, they simply bring this Bill into line with previous attempts to introduce assisted dying and with the Abortion Act and the Human Fertilisation and Embryology Act. My amendments provide a non-exhaustive list of activities that would be protected. The list was roughly adapted from the legislation in Victoria, Australia, so I hope Members can see that I am following precedents from elsewhere. If amendment 480 is passed and the list is in need of refinement or drafting changes, I would of course be happy to work with the Government on a tidying-up amendment at a later stage. The amendment would ensure that all professionals—indeed, all individuals —are properly protected and would not become involved in assisted dying if they did not want to. None the less, it contains three exceptions, which I will briefly explain. The first exception is to ensure consistency with clause 4(5), as amended. Members will recall that that clause imposed a duty on a doctor who did not want to have a preliminary discussion to refer the person to another doctor. We have amended the clause to now say that the doctor “must ensure that the person is directed to where they can obtain information and have the preliminary discussion.” The exception makes it clear that clause 23 cannot allow one to avoid that signposting duty. A person cannot say, “I am protected by this amendment from fulfilling the obligations under clause 4 to signpost somebody to where they can get the information they require.” The second exception concerns tasks of a clerical, secretarial or ancillary nature. The presence of that exception means that the Royal College of Nursing’s demand for clause 23 also to cover administrative tasks is not fully met. I regret that I was not able to go that far, but I will explain why. In a 1989 case, Janaway vs. Salford Health Authority, a medical secretary claimed that the conscience clause under the Abortion Act meant that she was not required to type out a letter on behalf of the doctor she was working for, referring a patient for abortion. Both the Court of Appeal and the House of Lords, albeit for different reasons, concluded that such types of secretarial tasks were not protected by the conscience clause in the Abortion Act. That decision was applied about 10 years ago in the Supreme Court case of Greater Glasgow Health Board vs. Doogan and another, in which it was held that the conscience clause did not protect an individual from having to carry out ancillary tasks such as managing the rota of a labour ward where abortions were performed. Interestingly, I note that in the Doogan case, the Royal College of Nursing took the view that the conscience clause should be narrowly interpreted, whereas for this Bill it seems to be asking for a wider exception that covers all administrative tasks. Given that assisted dying is far more controversial than abortion among health professionals, I can see a case for a wider conscience clause in this Bill, but to maximise the chances that my amendments are accepted I have compromised and tried to match the precedent of the Abortion Act and the case law in Janaway. That is why the second exception is as it is. Again, if the drafting is not perfect and we can make improvements through a tidying-up amendment, I would be happy to work with the Government or the hon. Member for Spen Valley. The third and final exception is for acts necessary to save someone’s life or health. The need for that exception arises because no one is under any duty to be present when self-administration happens but, if things go wrong, emergency services or other help might be required. It is important that that help is provided; there should not be a conscience exception to it. I hope that exception is uncontroversial. Obviously, if somebody requires emergency help, we expect all medical professionals—all people— to jump to it. For the sake of clarity, there can be no exception under the amendment in those circumstances. I sincerely hope that this amendment to the conscience clause, which reflects the requests we have had from the professionals who will have to deliver this service, will be accepted by the Committee. If it is not, I wish to indicate my support for amendment 483. New clause 22, unlike my amendment to the conscience clause, is only about the final act. It makes it clear that the occupier or operator of a premise has the right to refuse its use for the final act of self-administration. That applies regardless of who the occupier or operator is; it is not limited to hospices, but it certainly includes them. So anybody occupying or operating premises should be able to determine that they may not be used for assisted dying services. However, the new clause does not grant landlords or freeholders any right to insist that their property not be used. For example, the Church estates commissioners could not use it to prevent assisted dying from happening on land for which they own the freehold or land that they rent out. The same would be true of any other landlord, so if somebody lived in a rented property and wanted to die at home, this provision would not give their landlord any right to prevent that. It is instead focused on protecting the rights of those who occupy or operate premises. I hope I have explained the value of the new clause and the amendments.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I rise to speak in support of my amendments 480 and new clause 22, and amendments 483, 484 and 441, tabled by the hon. Member for York Central. The conscience clause that is provided for in clause 23 is too narrow in two respects: first, in who it covers, and secondly, in what it protects. I will start with the issue of what it protects. As drafted, the conscience clause protects against any duty to “participate in the provision of assistance in accordance with this Act.” My concern is that, as written, and especially in the light of the amendments tabled by the hon. Member for Spen Valley to clauses 24 and 25, it is very likely to be interpreted as limited to the final act of assistance. The Committee does not need to take my word for it, because the British Medical Association said in its written evidence to us: “we are concerned that using the word ‘assistance’ in the titles of Clauses 18 + 19 could be interpreted (by a court, for example) as narrowing the right to refuse in Clause 23(1). We would be very concerned if doctors only had the right to refuse to carry out the activities detailed in Clauses 18 + 19 which are the process of providing the approved substance for the individual to self-administer and remaining with the patient until they have died.” It goes on to say: “We urge the committee to review the use of the word ‘assistance’ throughout the Bill; Clauses 18 + 19 might be better titled as ‘Providing assisted dying’ and ‘Authorising another doctor to provide assisted dying’, or similar, to avoid confusion over multiple uses of (and meanings associated with) ‘assistance’ in the Bill. It is essential that the right to refuse is not (unintentionally) narrowed in any way.” The BMA makes a powerful point and is clear that the conscience clause must cover not just the final act but the entire process, with the exception of the signposting duty in clause 4(5). As Members will recall, the BMA opposed clause 4(5) as originally formulated, as it imposed a duty to refer if the original doctor did not want to participate in the assisted death procedure. The Royal Pharmaceutical Society makes a similar point in its further written evidence to us: “We would urge the Bill Committee to make it clear that clauses on conscientious objection (23) and criminal liability (24) extend to all activities associated with assisted dying, and are not limited to a narrower interpretation of the ‘provision of assistance’. Pharmacists, other health professionals , and indeed wider staff, should not unknowingly be involved in supporting an assisted dying procedure, directly or indirectly, without their consent.” I note that the promoter has tabled amendments to clauses 24 and 25 to make it clear that the exemption from both criminal and civil liability covers the provision of assistance under the Bill. Clause 23 also refers to assistance. Additionally, there is reference to a person “performing” any other function under the Bill. Clauses 24 and 25 cover liability, and refer to the provision of assistance and performing any other function under the Bill, but clause 23—the conscience clause—refers only to the former: the provision of assistance. That will likely be interpreted by the courts as Parliament having intended a narrow construction of clause 23. As the expert medical bodies are telling us, that is not acceptable. Health professionals and indeed anyone else must be able to opt out of any functions under the Bill. The Royal College of Psychiatrists found that 58% of its members would not be willing to participate as a medical professional in an assisted dying service, including determinations of capacity or assessments of mental disorder, if it became law in the UK. That is well away from the provision of assistance as we understand it from the Bill. The Royal College of Nursing told us in written evidence that the protection of the conscience clause “should extend to indirect involvement, such as administrative tasks or referrals, to ensure all professionals are supported in line with their personal and professional values.” There is widespread support among our medical institutions for a wide conscience clause that covers everything under the Bill and is not limited to the final act: the administration of the drugs. The second issue is who benefits from the conscience clause. Clause 23 limits it to registered medical practitioners and other health professionals. A “health professional” is defined in clause 40 as: “a) a registered medical practitioner; (b) a registered nurse; (c) a registered pharmacist or a registered pharmacy technician”. One set of professionals is omitted from that list: social workers. Under amendments 422 and 423 to clause 9, which we passed, social care professionals have a role in the process. The British Association of Social Workers, in its written evidence, said: “social workers have duties in relation to both mental capacity and adult safeguarding, so it is concerning that legal protection in Section 23 of the Bill is given to healthcare professionals but not to social workers. All professionals that could potentially be involved with assisted dying, such as social workers, should be able to conscientiously object to participating in work that could reasonably be argued would be contributing to an assisted death.” I am sure that other professionals who may be called upon to give an opinion on matters pertaining to the processes in the Bill would feel the same way. Members may be interested to know that the conscience clause in the Abortion Act 1967 simply says: “no person shall be under any duty” to be involved, rather than no registered medical practitioner, so there is a difference. The same goes for the conscience clauses under the Human Fertilisation and Embryology Act 2008. Baroness Meacher’s 2021 Assisted Dying Bill also referred to a person rather than a registered medical practitioner, as did Lord Falconer’s 2024 Assisted Dying for Terminally Ill Adults Bill, so I am not sure that the limitation to registered medical practitioners and health professionals can be justified. It is not the precedent from similar legislation. My amendment addresses all those mischiefs and provides that the benefit of the conscience clause be for all individuals and not limited to health professionals. That accommodates the request of the Royal Pharmaceutical Society on the importance of protecting wider staff and the British Association of Social Workers. It also fits with the precedents that I have described in the Abortion Act and the Human Fertilisation and Embryology Act.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I was not suggesting that pentobarbital has a paralytic effect. Often in assisted dying, a paralytic is administered first as part of the cocktail of drugs. Subsequently, we discover that while the patient may have appeared entirely calm, sleeping peacefully, significant trauma may have been occurring beneath the surface. I defer to the hon. Member’s knowledge, but my understanding from the scientific evidence I have read, and that medics have given to me, is that the extent to which people executed by lethal injection, by pentobarbital, have their lungs fill with fluid is peculiar—it is remarkable. They effectively drown beneath their peaceful exterior. I intend to press amendment 464 to a vote, and I intend to support other amendments in this group. Although I support the aspiration of amendment 532 to make provision for what to do in the event of a procedure’s failure, I think it gives too much leeway to the Secretary of State, so I will oppose that amendment. I think the amendments that the hon. Member for York Central and I have tabled are preferable. To make the obvious case for those amendments, and as I said in a previous debate, there are three choices in the event of failure. The first is to ignore the plain signs of distress, of things going wrong and of the patient suffering, which is clearly a failure of the doctor’s duty of care. The second is to expedite the death, which we have decided would be illegal under the Bill. Therefore, the only option is to revive the patient and escalate treatment, rather than actively or passively facilitate their death. I hope Members will agree that, on the rare occasions when assisted suicide goes wrong, it is right that the patient is immediately revived and taken to hospital, or for the doctor to take whatever action is necessary. I am interested to understand why those amendments should not be supported.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  The hon. Gentleman is making an excellent speech, setting out the gap at the heart of the Bill. Does he agree—I think that he does, as he has just explained it—that there are quite straightforward choices: to expedite a death, which is illegal; to do nothing, which is inhumane; or to treat, revive or resuscitate? Why does he think that should not be clearer in the Bill? Why does he want to leave it for the Secretary of State to determine that in the future? Why do we as Parliament not get to decide what the right options should be?

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn .

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I rise to speak primarily to the amendments in my name and those in the name of the hon. Member for York Central with respect to the regulations for the approval of the approved substances—the drugs that will be used in the procedure of assisted death. My amendment 465 states: “A drug may only be approved under this Act if it has been approved by the Medicines and Healthcare products Regulatory Agency”. Amendment 437 in the name of the hon. Member for York Central would achieve a similar objective. My amendment 466 would require that the drugs “may only be approved under this Act if the Secretary of State is reasonably of the opinion that there is a scientific consensus that this drug or combination of drugs, is effective at ending someone’s life without causing pain.” I also support amendment 482 in the name of the hon. Member for York Central, which would move the approval of the regulations to the affirmative procedure. Those who support this Bill argue that death through the administration of lethal drugs offers dignity and the avoidance of suffering. If that is to be the case, the drugs used must be effectively regulated and life must be ended effectively and without pain. The amendments I have mentioned specify the role of the Medicines and Healthcare products Regulatory Agency; in my view, to leave this entirely in the hands of the Secretary of State, as clause 20 does, is quite an extraordinary step. It feels remarkable that the Bill as drafted leaves this enormous question to the Secretary of State. [Peter Dowd in the Chair ] Good afternoon, Mr Dowd; it is a pleasure to serve under your chairmanship. Throughout the Bill, important questions are left to regulations made subsequently by the Secretary of State. I think that is inappropriate here. When patients are prescribed medicines, in most cases the medicine will be licensed by the MHRA for use for the treatment of the particular condition. Patients can be assured that the medicine has been evaluated by the MHRA to ensure that it meets safety and efficacy standards. The MHRA reviews clinical trial data, inspects manufacturing facilities, monitors post-market safety and conducts independent quality testing so that there is regulation of medicine. I have two concerns with my own amendments here; they might have occurred to other hon. Members, too, if they are paying attention. First, I do not accept that the procedure we are debating here is in fact healthcare. The question then arises, “Why are you proposing that the healthcare regulator would oversee the administration of the drugs?” My response to that is, “Well, somebody’s got to do it.” In fact, we are talking about substances that might be used in a medical setting, that would be appropriate in other medical settings, and that will have an effect on the body comparable to that for which they are licensed for medicine. Obviously, the intention is the direct opposite: they are licensed for genuine medicine and healthcare in order to preserve life and treat symptoms, but the intention here is to eliminate life without reference to symptoms. Nevertheless, the only appropriate authority in our country is the MHRA—unless we were to conceive of another new body that would have that specific responsibility. However, that body would have the same obligations that the MHRA does to ensure that the substance is safe, paradoxically, in the sense of not causing unwanted side effects or distress to the patient. The second objection—there is no reason why hon. Members present would know about it, but I have spoken in the main Chamber before about my concerns about the MHRA—is that, while I have just cited all the work that the MHRA is supposed to do in the regulation of medicines and healthcare products, I am afraid it does not do that job well. I do not want to give the Committee the impression that I think we have a perfect regulator; I think we have a very imperfect regulator in all sorts of ways. In fact, the hon. Member for Stroud and I have participated in debates on the regulation of antidepressants and addiction-forming prescribed drugs, an important debate in which he and I are on the same side. There is genuine concern about the way the health regulator operates—we will not get into covid vaccines and other things at this moment; we have enough on our plate. Nevertheless, despite the problems with the MHRA and the fact that I do not want to give the impression that I am concluding that assisted suicide is in fact healthcare, somebody has to do this. We cannot allow a situation in which the patient takes an overdose of a drug with no controls to ensure that the drug meets quality standards and does the job that it is meant to do. A tablet that is licensed for prescription or sale would need to have a minimum level of purity of the active substance, and to be free from other substances and contaminants that might cause unpleasant side effects or reactions. Without regulation, there is a risk that the drug may fail to work as intended or may induce unwanted side effects, such as those that we are all concerned about. The question is: what safety standards should apply to an approved substance used for the purpose of assisted dying? A drug used to bring about death is not curing or preventing disease, or alleviating symptoms to improve death.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I am not objecting to that suggestion. No one would want me working in any sort of clinical setting. I just wanted to emphasise my hon. Friend’s point, and that speaks to the point from my right hon. Friend the Member for North West Hampshire about the symmetry. Her amendment would enable a service like Dignitas, or the equivalent to be set up in the UK, to ensure that it only employed workers who supported the work that they were doing, and there would not be some sort of fifth column of objectors coming in to cause trouble. That could happen. We worry about all sorts of things happening in the context of this Bill in future. It would at least ensure that people who worked in an assisted suicide clinic would actually support the procedure.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I am sorry; I was going to give way to my right hon. Friend.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I wonder whether, in the hon. Gentleman’s view, it might be appropriate for the Secretary of State, when framing the guidance he requests, to leave it to a doctor’s discretion. Would that be an appropriate outcome that he would be happy with? My concern is that we will end up with a Bill that has a blank space when it comes to what should be done in the event of complications, as it does currently, and that the Secretary of State might find it equally confusing and unclear and might be reluctant to specify too precisely what should be done in the range of different circumstances that the hon. Gentleman has mentioned. Will we not end up with a further passing of the buck to clinicians to make that decision? Given that, is it not even more appropriate at this stage for us to give a direction to the Secretary of State stipulating that, whatever the guidance will be, it is entirely inappropriate for a doctor to expedite the death of the patient in any way?

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  I am grateful for that; I particularly respect my hon. Friend’s concern to protect the doctors from any confusion in the law they might be operating under. Just to take him back to the question of technology resolving what I regard as an insuperable problem—the difference between assistance and administration—is it my understanding that my hon. Friend would oppose a patient’s being able to ask a doctor to administer a lethal drug to him or her, but that he would support a patient’s being able to ask a computer to administer a lethal drug to him or her? Would he accept the computer performing the act at the patient’s request?

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  We are not necessarily talking about someone who is dying right here and now in consequence of the drugs they have taken—we could be talking about someone who is many months away from their death. The scenario we are envisaging is that fatal drugs —poisonous drugs—have been administered to the patient’s body and we are asking doctors to be normal doctors in that scenario. In a genuinely normal scenario of doctors being doctors, they would attempt to revive the patient and to save their life in that circumstance. If the parallel is with the last moments of someone’s natural death, the doctor’s job is simply to make them comfortable, but that it is not the scenario. The scenario is some months away from their natural death, when they have months to live. They may not even be exhibiting extreme illness—they may just have a terminal disease. If they have been given fatal drugs, what on earth is the doctor to do in the scenario where the drugs are not working? Surely that is a question for all of us, rather than just leaving it up to the doctors.

• 18 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-fifth sitting) · Hansard source

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  The hon. Gentleman suggests that this is something that should be left to the medics. Nevertheless, here we are legislating for medics to be able to administer lethal drugs to people; we are responsible for what happens subsequent to the administration. Let me put this another way: does the hon. Gentleman foresee any scenario in which the guidance from the Secretary of State could be anything other than that the patient should be revived and helped to live in the circumstances where there are clearly complications under way? What else could be the appropriate direction given by the Secretary of State?