Kim Leadbeater MP: speeches

Speeches

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Twelfth sitting) · Hansard source

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  I do worry about the lack of faith in our professionals. We have medical practitioners on the Committee and we have heard stories of the very good practice that happens, so it concerns me that we are so cynical about our system. Ultimately, we have to put faith in our professionals to do their job and to take that patient-centred approach, as I firmly believe they do. Dr Sarah Cox from the Association for Palliative Medicine said in her evidence to the Committee: “In clinical practice, we make all these decisions in multi-professional teams…shared decisions are much better quality, much more robust and much safer.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 74, Q90.] I absolutely agree with her, and that would continue to be the case.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Twelfth sitting) · Hansard source

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  I am interested to know where the hon. Member has got the idea that someone is going to scrap the six-month prognosis from.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Twelfth sitting) · Hansard source

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  My hon. Friend talked about the stories that we heard on Second Reading. Does she acknowledge, as Dr Sarah Cox from the Association for Palliative Medicine said, that there are cases where palliative care cannot meet a patient’s needs? We have a lady in the Public Gallery this morning whose mother had a horrible death, having had ovarian cancer and mouth cancer; she had to have her tongue removed, so she could not eat and drink, and she essentially starved to death. We have to be careful not to dismiss those cases, because they are real stories of real human beings, and we have to acknowledge the limitations of palliative care.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Twelfth sitting) · Hansard source

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  But it does not say that at all. It actually says that they have to refer, and that they have to consult with other people. That is part of the process. That is exactly what happens now. Professor Aneez Esmail, who is the emeritus professor of general practice at the University of Manchester and who has been a practising GP for over 30 years, told us in his evidence to the Committee: “In terms of holistic care, currently when I look after dying people I never do it on my own; I am with district nurses, Macmillan nurses, or on call to a palliative care consultant. There is already a team of people looking after dying people…palliative care…works very well and it works in a multidisciplinary way. I think that this legislation will allow a much more open discussion and proper monitoring. It will improve training, guidance and everything else. People say that it will enhance palliative care, and that is what I think will happen.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 171, Q219.] Indeed, as was referred to by the hon. Member for Solihull West and Shirley, if we consider the training included in the Bill, which doctors will undergo as part of the introduction of assisted dying, evidence from other jurisdictions shows that these are very detailed conversations where health professionals work together in the same way as they do at the moment in end of life care and decision making. As I have said repeatedly, the training is fundamental. I agree absolutely with Dr Rachel Clarke, who told us: “If there is one thing that I would say to the Committee regarding making the Bill as robust, strong and safe as possible, it is: please consider seriously the matter of education and training”. –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 71, Q85.] I agree 100% and I have embedded that in the Bill.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  On a point of order, Mr Dowd. If something is said that we know not to be correct, what should we do?

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  Just to clarify, my understanding is that it is between 600 and 700 people who take their own lives; it is suicide.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  Does the hon. Member agree that if we were to reduce it to one month, there would be absolutely no way to have the robust process set out in the Bill—or, indeed, I would argue, to have any sort of robust process?

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  I will keep my comments brief, because we have had a very thorough discussion today. I will first speak briefly to amendment 123, tabled by my hon. Friend the Member for Broxtowe. Amendment 123 would change “an inevitably” progressive disease to “a typically” progressive disease. [ Interruption. ] Is that the next grouping? Oh, I am peaking too soon—my apologies, Mr Dowd. I will come back to my hon. Friend the Member for Broxtowe, but let me turn to amendments 399, 400 and 401, on the exclusion of “medical condition”, which the hon. Member for East Wiltshire submitted a few days ago, before the end of the recess. I looked at them over the weekend and was very interested to hear his reasoning for them today. This is the purpose of the Committee; I have listened carefully to what the hon. Gentleman has said, and he has made some valuable points. All along, I have taken the view that this legislation must not only be the strongest anywhere in the world, but be very clear in its intentions and leave no room for ambiguity regarding who is entitled to request assistance under its provisions. I am very comfortable with the definition of terminal illness in the Bill, but across the world—I have done lots of research into this, as I know other colleagues have—some jurisdictions use the term “medical condition” or, actually, just the term “condition”, and others do not. Many in Australia do, but in New Zealand, for example, which has a similar law to what is being proposed here, “medical conditions” do not feature, nor do they in a number of states in America. While I do not necessarily think that it would definitely be problematic to include the term “medical condition”, I appreciate the argument that the hon. Gentleman has made. We have to be as cautious as possible to ensure that the Bill achieves its purpose but does not create a lack of clarity. That point has been very well made. The advice that I have received from officials is that, as the hon. Gentleman suggested, “medical condition” does not have a clear legal definition and could therefore be seen as imprecise. That does worry me. The purpose of the Bill is clear—it is in the title. It is to give choice to terminally ill adults at the end of life. They must have a clear, settled and informed wish, and be expected to die within six months, in circumstances that are inevitably progressive and cannot be reversed by treatment. The hon. Gentleman has, I believe, helped to make that even clearer, and I am grateful to him for doing so.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  Actually, I have not said that.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  My hon. Friend is making a powerful speech and it is good to have this debate. May I ask her opinion on two things? One is that, as my hon. Friend the Member for Stroud has alluded to, the research around the world shows that between 30% and 40% of people who sign up for assisted death never actually do it, because they do get better or because the treatment makes their condition manageable—or because they have a death in a different way. What are her thoughts on that? The other thing to point out is the number of people who we know, sadly, are taking their own lives because they are terminally ill at the moment. I go back to the point that I make quite regularly: no one is monitoring that—

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  Colleagues will be pleased to know that, despite my copious notes, I do not intend to speak for very long, because I believe we have had a very thorough and robust debate on these issues. The Minister makes a valuable point on amendment 402, which I do not think anyone else raised. Coincidentally, it relates to the person in the Public Gallery this morning, whose mum had a horrible form of cancer and had to have her tongue removed. She would have stopped eating or drinking, but it was not a choice; it was an inevitable result of her condition. She would have been excluded from having an assisted death, which I am sure is not the intention of my hon. Friend the Member for Bradford West. We have had an excellent debate and covered a lot of ground. I do not intend to add anything more on this group of amendments. I will only say that if we get a move on, we might be able to get through clause 2 before we close at 5 o’clock.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  We need to be fair to the hon. Member for Harrogate and Knaresborough, who has said that he will not press the amendment to a Division. Indeed, it would not be something that I would support if he did do so, for the reasons that my hon. Friend has stated. I also think that we need to give him credit for ensuring that the voices of people with neurodegenerative conditions, such as MND, Parkinson’s and Huntingdon’s, are heard. They are an important part of this debate, whatever our views might be on the tightness that is needed in the Bill.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  My hon. Friend makes an interesting point, but the purpose of the Bill is that a person with a terminal cancer diagnosis and six months left to live would have the choice of assisted death. As we have heard, they might have seen the suffering of relatives with a similar cancer, and they might have seen what their death looked like. I understand that people might disagree, but that is the purpose of the Bill.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  It is people taking their own lives.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  Just before the hon. Lady moves on, we may actually have come to a very sensible position based on the other amendments we have been discussing—amendments 399 to 401. I have done a little bit of googling, and diabetes generally is referred to as a “condition”. It might be referred to in other ways as well, but maybe that would be another reason for us all to support amendments 399 to 401.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  My apologies; I am speaking to amendments 399, 400 and 401. I will be happy to come back to that point at the appropriate time, but I first want to finish my comments on those amendments. As I have said, the hon. Member for East Wiltshire has done a good job this morning of improving the clarity of the issue. That shows that the Committee is doing its job and working effectively. I am therefore open to supporting those amendments.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I am certainly not being dishonest, which is the hon. Lady’s implication. I refer back to the complexity of those conversations, and the fact that safeguards will need to be in place to check for coercion, dishonesty and pressure. Ultimately, it comes down to a question of autonomy, dignity and choice for patients, but they are not simple conversations. I think it would be very unusual if the conversation looked how she is describing.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  Returning to the amendments before us, I will try to keep my comments brief, as we have had a thorough debate this afternoon. On amendments 95 to 104, I have spoken to the right hon. Member for Braintree and I know that these amendments seek to stimulate discussion, and I am very pleased that they have done that this afternoon. I also know that they come from a good place. I have already discussed the additional safeguards around training that would be added to the Bill through new clause 8, which states that the Secretary of State must consult “persons appearing to…have expertise in matters relating to whether persons have been coerced”. That would consolidate the existing measures in the Bill and, I hope, relate to the concerns expressed in the amendment to some degree. More broadly, the reasons that someone might choose an assisted death may well include sparing those they love the pain of seeing them suffer, as we have heard this afternoon. That is certainly something that members of my family and people I have spoken to say would matter to them. That should not prevent the provision of assistance. It is surely for that person to decide. During oral evidence, we heard powerful testimony from Liz Reed about her brother Rob, who had an assisted death in Queensland, Australia. Rob was 39 years old and had a young family when he was diagnosed with stage 4 terminal lung cancer. He was fit, young and healthy, and did not smoke. As well as taking back control at the end of his life, one of his main reasons for choosing an assisted death was so that his young family could remember him as the man and the dad he was. He was not afraid of death, but he was afraid of dying in an undignified and painful way; he was afraid of not getting to say goodbye to his wife and children, or them having to find him after his having had a massive heart attack. Surely we should not decide that that is not acceptable and understandable. It is a perfectly understandable reason for choosing an assisted death. Liz told us that Rob “was able to change his mind, which he did, in terms of dates and when it would happen. His views and the views of his family were also taken into account and, through the process, he was treated like a person with autonomy whose choices were being respected.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 254, Q328.] If relatives were implicitly or explicitly coercing or pressuring someone, that would of course be very different—and that is covered by the Bill—but to prevent someone from wanting to consider their loved ones in their final weeks and months of life does not seem at all reasonable to me. I have talked about training, which is important and feeds into the debate about the assessment of coercion and pressure—here, I refer again to my new clause 8. As we heard during the oral evidence, who is involved in that training is important. We heard from the Association of Palliative Care Social Workers. Its position statement on assisted dying states: “As social workers we bring a distinctive perspective and skill set. Our focus is on helping people to get practical needs met; to enable them and their families cope with the impact of serious illness and dying and to plan ahead”.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I, again, refer the hon. Gentleman to my previous points; we are oversimplifying a really complex conversation, which would take into account lots of different factors for each individual. That is all I will say on that point.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I am concerned that the hon. Member did exactly what we are in danger of doing by saying, “Whether it’s under influence, whether it’s pressure, whether it’s coercion, whether it’s other things.” We are in danger of using these words interchangeably, as he just did. That is not what the law needs. The law needs certainty, with clear expressions. I think that the hon. Member also said that encouragement is a broader form of pressure, but who is saying that? Is he saying that? Is the hon. Member for Reigate saying that? Is that a legal summation? I am not entirely sure where encouragement fits in with these other points.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I am not quite sure I understand the point. My point is that there is no law that is checking people’s motivations for ending their lives when they are terminally ill, and that is what this law would do. I will make some progress, and come to amendments 235 to 245. As we have heard from witnesses, choice at the end of life is not just about physical pain, be it current or potential. It can also be about psychological suffering and mental torment as a result of being terminally ill —and it is of course about taking back control, bodily autonomy, dignity and choice. What about patients who are in severe mental torment and fear as a result of their condition, and terminally ill people who want the autonomy and dignity of taking back control at the end of their lives? Who are we to ask them to prove their level of physical pain or desire to avoid physical pain, and to deny them the choice in their final few weeks or months?

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  It is really important to remember that, at the moment, there is no legal framework that checks terminally ill people’s reasons for ending their lives or shortening their deaths. That is why having this legal framework is so important. During the oral evidence sessions, Sir Max Hill told us that in his experience of working as Director of Public Prosecutions, he oversaw a number of cases to do with people travelling to Dignitas. He said: “In each of the 27 cases I considered, the deceased individual was already dead, and that is when the scrutiny started. The major advantage of the Bill…is that that will be reversed, and scrutiny will be before death.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 86, Q111.] The same applies to terminally ill people who have taken their own lives in this country. The only time that anyone checks for coercion, either internal or external, is when the person is dead. The Bill provides a robust legal framework, which is a significant improvement on things as they stand. Dr Aneez Esmail, who changed his position on assisted dying as a result of his work as a professor of general practice, said in his oral evidence, “How is the law protecting anyone at the moment?…we don’t have a legal framework…it is actually very unsafe…a law…which produces safeguards, is a huge improvement on where we are at the moment.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 166, Q211.] I also worry about the subjectivity of this amendment. We know that the law likes certainty, rather than abstract concepts, such as doing something for one’s “own sake”, which seems somewhat abstract.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  We are oversimplifying a complex situation and a difficult conversation. We have talked about coercion and pressure a lot. If someone says, “I just want it all to be over, because I feel like a burden”, that is the sort of conversation that doctors acknowledge would be a red flag. Those are complex, difficult conversations; we need the expertise that we would get by providing serious amounts of training around this issue so that those conversations can take place in a sensitive way.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  Very few cases are as straightforward as that, and that is where conversations with doctors and professionals are really important. I think it was the doctor from California who said that if someone said to him, “I am doing this because I am a burden,” that would be a red flag. There would have to be a much more detailed, complex conversation with patients about what their motivations were, and it is important that we acknowledge, as medical colleagues have, what those conversations might look like.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I will speak briefly because we have had a thorough discussion about these issues. I completely understand the sincere intention behind these amendments. It is clear from the fulsome discussion we have had that colleagues across the Committee agree that undue influence and manipulation should be covered by the Bill—as should all types of coercive behaviour. The question is, “How?” I feel reassured by comments from legal colleagues and the Minister that the language currently used in the Bill—“coercion” and “pressure”—covers these additional concepts, as those terms appear in existing criminal offences, and the statutory guidance from the Home Office in 2023 along with the Crown Prosecution Service legal guidance cover the broad range of coercive behaviours. It is up to hon. Members to decide whether to push these amendments to a vote. I am understanding of the intention and appreciative of the comprehensive debate that we have had.