Danny Kruger MP: speeches 2025

Speeches

• 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?

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

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  Not really. It is within the rights of managers—particularly hotel managers or people who host a bed and breakfast—not to admit prostitution on their premises, even if it is legal. Although it is illegal to discriminate against particular groups, it is legal for the occupiers of premises, in certain circumstances, to determine that some activities will not take place on their premises. That reflects the rights of property, which are appropriate. Given that we are creating an entirely new legal event—something that has never been legal in our country before, namely the deliberate administration of death—it is appropriate to consider the impact on certain places where people live or will end their days, and to give those places a specific protection.

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

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  I entirely agree. The regulations need to specify not only what drugs may be approved, but, as the hon. Gentleman suggests, how they should be stored and transported. I would expect that to be part of the package of regulations under the Bill. As I have stated, I do not accept that we are talking about healthcare here; nevertheless, we are using products that are comparable to health products. The MHRA would need to significantly adapt its work in order to identify the most effective drug to cause what we currently perceive as harm—namely, the death of a patient. I recognise that that would be a significant change of remit and work for the MHRA, but we need to do it. One of the reasons that we need regulation of approved substances is to help ensure that falsified versions of the drug—drugs that do not have a licence for use in assisted dying—cannot enter the market. Such drugs may not be effective and could cause distress to those ending their lives and their families. I would be grateful if the Minister could clarify whether, in his view, clause 20 is sufficient to establish the necessary regulatory regime, or whether further legislation will be needed. We had evidence from Greg Lawton, and other pharmacists, who wrote to the Committee to suggest that the approved substances would not legally come within the definition of a “medicinal product”, so medicines law, the protections associated with medicines and the MHRA licensing process might not apply. If that is the case, what do we do about it? We need a new licensing regime to ensure that the MHRA is able to properly regulate the substances, or, potentially, another regulatory agency would need to be established to do the job. The Committee needs to make sure that there is a process that applies to approved substances used for assisted dying. It is not necessarily the case that a product licensed for treating a medical condition could not be used to bring about death—it is not the case that we cannot use any drug that is currently used for genuine health treatment—but it would not be being used as a medicine, so medicines law may not apply to its use for that purpose. There is an ambiguity, and I would be grateful for clarity on it. The amendments that I am supporting would ensure that the MHRA had approved the drug for the specific purpose of ending someone’s life, and that there was scientific consensus that the drug would be effective for that purpose. The MHRA, in the marketing authorisation for the approved substance, would define the dosage of the drug required to bring about death. It would also ensure that specific considerations and warnings were placed in the product licence. For example, some patients have allergies to certain drugs. If they decide to end their own life, that should be brought about as a result of the effect of the drug, not an unintended allergic reaction to it. Some patients would not be able to take drugs orally and might need to have the drug administered through a tube into the stomach, so different formulations would need to be available. Some drugs may need to be administered by injection. Patients may be unable to do the injection themselves, as we have discussed. Even if the patient is physically capable, injection techniques require proper training, and that needs to be considered when licensing drugs for assisted dying if the patient is responsible for self-administration. There will be further considerations when deciding what drugs can be used. Patients will have a right to know what to expect. If they take the drug orally, how long will they have to wait before they die? Will they lose consciousness first? If so, how long will that take? Could there be some side effects or reactions after taking the drug, such as seizures or choking, that the family or carers will have to deal with? Can the drug be taken at home—that relates to the point that the hon. Member for Ashford made—or must it be used in a clinical setting? We have suggested that it could be used at home, so questions about transportation arise. Is a combination of drugs required? If so, in what order should they be taken? What happens if the patient passes out before taking the entire concoction of drugs? Has the drug formulation been optimised for the purpose of assisted dying, so that it reaches maximum blood levels as quickly as possible? All these sorts of questions are appropriate for medical regulators. The MHRA could ensure that the patient information leaflet, and the warnings associated with it, given with the drug when it is prescribed prompt doctors to think about what drugs are most suitable for the patient and to provide information to the patient about what to expect. Parliament must have oversight. It must bear responsibility for the kinds of deaths that it approves. Both Houses of Parliament should approve the statutory instrument. To inform that decision, the Secretary of State should provide all relevant information on the likely time to death, and on complications and side effects. When the state is creating a regime that will end lives, there must be maximum transparency and accountability, yet the Bill provides that this will be done by a negative statutory instrument. In other words, Parliament will get a say on the regulations only if the Leader of the Opposition prays against them—that is the process for a negative SI. That is the only circumstance under which the Government would make time for a debate and a vote on a negative SI. Given that this is an issue of conscience, I find it inconceivable that the Leader of the Opposition would want to take a position on it and so pray against it to trigger a proper debate. I think it is highly likely that Parliament would never get a say on this crucial issue because of the use of the negative procedure. That situation has been recognised repeatedly as being unacceptable. When Lord Falconer introduced his Assisted Dying Bill to the House of Lords in 2014, it too provided for a negative SI power on this matter. The highly respected House of Lords Delegated Powers and Regulatory Reform Committee—we do not have an equivalent Committee in the Commons, but it sits over Parliament—said that it did not consider either the power or the procedure in the Falconer Bill to be appropriate, yet that is the procedure that we are being presented with here. In 2021, when Baroness Meacher introduced her Assisted Dying Bill to the House of Lords, the Delegated Powers and Regulatory Reform Committee again issued a report, in which it said: “In the interests of clarity and transparency on such important issues of public policy, the matters that are in due course to be dealt with under clause 4(7) by negative regulations should in our view be spelled out in detail on the face of the Bill from the outset. Accordingly, the Bill should contain a definitive list of medicines, and details of the manner and conditions under which such medicines are to be dispensed, stored, transported, used and destroyed. The power to amend such matters should be a matter for regulations subject to the affirmative procedure.” We then come to Lord Falconer’s 2024 Assisted Dying for Terminally Ill Adults Bill, which he withdrew following the introduction of this Bill by the hon. Member for Spen Valley. That Bill in part took on that feedback from the Lords Committee. Although it did not provide a list of medicines, it did at least provide that the power to specify the drugs would be through the affirmative procedure. The Hansard Society, which is non-partisan and neutral on assisted dying, has issued a critical report on this power. It says: “MPs may wish to enquire why Kim Leadbeater has chosen not to adopt the scrutiny procedure set out in the 2024 bill, but has preferred that proposed in the 2014 and 2021 incarnations of the bill, despite the advice to the contrary of the Delegated Powers Committee.” I would be grateful to learn from the hon. Lady why she has chosen this procedure. It might be objected that the list that I am requesting might need to be modified quickly and that the affirmative procedure—having a parliamentary vote—would be an obstacle to doing that. The Hansard Society anticipated that objection. It said that “this could be addressed by making provision for the use of the ‘made affirmative’ procedure in urgent cases where the Secretary of State wishes to remove a substance from the approved list and is of the opinion that it is necessary to do so immediately in order to prevent adverse medical events or failed assisted deaths. This would mean Ministers could act expeditiously but Parliament would have to debate and approve – albeit retrospectively – the change in the list. Whilst not perfect it would provide more opportunity for oversight than that offered by the negative scrutiny procedure.” It seems to me that there is no justification for this vital matter to be regulated under the negative procedure. Too much power and responsibility is being given to Ministers subsequent to the passage of the Bill— if that is what happens. My amendment 467 would ensure that Parliament has a meaningful say, through the affirmative procedure, and that a report is published as part of that process setting out the expected efficacy of the drugs that will be used. I hope that the Committee will support it.

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

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  I agree.

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

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  I think the hon. Gentleman is right about this one. Does he agree that the hospices that have written to us have a very valid point of concern that they might be required to facilitate assisted dying on their premises, even if many members of staff or other residents do not wish that to happen? Does he agree that it is important that we protect hospices from having to have anything to do with assisted dying?

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

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  I will give way to my right hon. Friend, but I want to invite Committee members to recognise or consider evidence that I have heard, from the settings where assisted deaths take place in other countries, of the genuinely disturbing impact that an assisted death has on everybody involved, even those people who support the principle and support the act itself. It is not nothing when someone participates in the assistance of someone else’s suicide, and I can well imagine that care home operators would be very wary of inviting assisted suicides to take place in their premises, not least because of the disturbing signal it sends to residents about the end that might occur for them.

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

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  It is a pleasure to follow the hon. Lady; I very much agree with her points. I also pay tribute to the hon. Member for Harrogate and Knaresborough, who spoke with his now customary intellectual clarity and moral constituency. He believes in autonomy, and he is doing what he can to resolve the essential contradiction in the Bill, which is designed to enable people to end their lives at their own discretion. He recognises that some of the safeguards in the Bill, which of course I do support, nevertheless represent barriers to what we are now suggesting is a human right, and that that human right will be restricted to a limited number of people, according to the Bill. It is my view that the pressure, momentum or inherent direction of travel that the Bill sets us on will necessarily result in these sorts of amendments to the legislation in due course, whether in the form of subsequent amendments passed through legislation, the guidance that is issued, or indeed the practice of doctors. As I tried to explain in my comments on the previous group, my concern is that the Bill allows for quite a wide degree of discretion, naturally and necessarily enough, in the form of doctors interpreting their ability to assist in ways that respect the autonomy of patients, but are, in fact, a step beyond what the Bill—quite rightly, in my view—seeks to allow.

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

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  Does my hon. Friend agree that just as we are specifying that an individual who is in receipt of public funds—a public employee, a medical professional—is allowed to decline to participate in this service, institutions in receipt of public funds should be able to do likewise? Many institutions receive public funds for specific purposes and they are perfectly entitled to decline to take part in other activities. Just because they are in receipt of public funds does not mean they should do anything that any member of the public requests of them.

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

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  I thank the hon. Lady for explaining the purpose of the amendments. Amendment 500 specifies the information that a final statement must contain. Will she clarify why there is no requirement to record any details of what happened once the drugs were administered, other than the time between the use of the approved substance and death? In this debate, we have acknowledged the importance of record keeping. If the intention is to maintain public confidence in the system, should there not be some provision to record whether complications happen and what complications there were? This skirting of the issue of complications is concerning. We have ruled out explicitly informing patients of the risk of complications.

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

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  I am grateful to my hon. Friend. I was simply asking what causes him to object to physician-administered assistance to die. If he supports the principle of assisted suicide and believes in doctor autonomy, why does he not think that doctors should be able to administer the fatal dose?