Kim Leadbeater MP: speeches

Speeches

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I will just finish this point, because it is very important. I acknowledge the concerns that colleagues have expressed around this issue, and I believe they are the motivation behind amendment 14. As I have set out, I think that risk is negligible. I have taken advice, and there is some concern that clinicians might have difficulty assessing with certainty that the decision to stop eating and eating was the only reason for a person’s terminal prognosis; as such, some further drafting changes may be required in the other place if this amendment should pass. With that in mind, however, and to ensure there is no sort of loophole, no matter how small the reality is of there being one, I am happy to support this amendment today.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I will keep going, if I may, because I think I have been fairly fair. Amendment 78 ensures that all three members of the panel must agree before a certificate of eligibility is issued, so abstentions cannot result in approval. The amendment came about as a result of discussions in Committee. It is really important to clarify that when the panel of experts is doing its work, its decision must be unanimous for a certificate of eligibility to be granted and for the patient to proceed. If a panel member abstains, no certificate of eligibility can be granted to the person. Schedule 2 also sets out that the panel must give reasons for its decision in each case. This is really important. Amendment 79 ensures that those reasons—the reasons for the panel’s decision—are communicated in writing in a document to the person to whom the referral in question relates, the co-ordinating doctor and the commissioner. This creates clear channels of communication and will enable those people to fully understand the expert panel’s decisions.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I thank my hon. Friend for that intervention. That was a very powerful point, if slightly long. There are people who face these really traumatic and difficult decisions every day, including Louise Shackleton, who I believe is also with us today.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I do indeed, Mr Speaker; you are absolutely right. The amendments that we are discussing today build on some of the work of the Committee, and I think that is important. We took a lot of steps to strengthen the Bill in Committee, and I was pleased to work collaboratively with colleagues in that way. As I come on to the amendments, which have been tabled in my name, let me say that the Government are, of course, neutral on the issue of assisted dying, but have always been clear that workability is essential if the Bill is to pass. I have worked closely with an outstanding team of civil servants from the Department of Health and Social Care and the Ministry of Justice, and it is with their technical advice on making the Bill workable and giving coherence to the statute book that I propose these amendments today.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  The hon. Gentleman makes an important point. The amendment is not specifically about eating disorders; there is a broader context. I will come to that later. It is with that experience in mind—my own personal experience and having spoken to many colleagues on this issue—that I say now, as I said in Committee, that under the Bill as it stands, having anorexia would not qualify a person to be eligible for an assisted death. The Bill is clear that a person cannot be considered terminally ill on the basis only of a mental disorder. Clause 2 makes it clear that a person must have an inevitably progressive illness or disease that cannot be reversed by treatment. Anorexia is a serious mental health condition that is not inevitably progressive and can, thankfully, be reversed by treatment. Of course, at every stage of the assisted dying process the patient must be found to have capacity to make the decision, and this is checked repeatedly throughout the process. Someone with severe anorexia would be highly unlikely to be assessed to have capacity to make a decision on assisted dying. The other tragic reality is that if a patient was so ill as a result of not eating and drinking for whatever reason, they would die before the process of assisted dying was able to take place, as it could take up to two months to complete all the stages of the process as set out in the Bill, and the latest clinical guidance states that the general range of survival once voluntary stopping of eating and drinking has begun is between seven and 21 days. Stopping eating and drinking also leads to a range of symptoms that would make meaningful conversations, as required by the Bill, impossible. Having said that, I know that some people have expressed concerns that the severe physical consequences of a decision to stop eating or drinking could still enable someone to claim eligibility for assisted dying when they would not otherwise be able to do so, and I believe that is the motivation behind amendment 14.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I will just make some progress, if I may. It is about not just patient choice but choice for professional people, too. We know there are a range of views on assisted dying across a range of professions. I have always been clear that no one who is uncomfortable taking part should have to, and nor should there be any detriment to anyone, whatever choice they make in whatever role they have.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I thank my hon. Friend for that intervention. I have not seen those comments, but it is absolutely right that whatever our views are on this issue, we must remain respectful. I also want to thank colleagues here in Parliament—MPs and indeed staff—who have shared their personal stories of loss with me over recent months. This is a really important point: these are real people with real stories, and they must always be at the heart of the debate. Public support for assisted dying in this country has been consistently high for a long time now, and we have seen movement in jurisdictions around the world, including just this week in Scotland. I congratulate colleagues in Holyrood, particularly Liam McArthur MSP, for holding such a compassionate and respectful debate, which I hope we can emulate today. It is right that we consider this change with great care, as we are doing today. But we should also remember, as with other big social changes such as giving women bodily autonomy on their reproductive rights or allowing gay—

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  My hon. Friend is absolutely right. We keep coming back to the word “choice”. It is about choice for patients and terminally ill people, but it is also about choice for medical professionals and others. Because of the unintended consequences, I cannot support amendment (a), but I am confident that new clause 10 and new schedule 1 provide robust protections for employees, regardless of their choices about participating in the provision of assisted dying services.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I will make some progress, if I may. This is essentially about providing flexibility for doctors while ensuring continuity of care for patients, and I hope colleagues can support new clause 11.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I beg to move, That the clause be read a Second time.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  The patient could request information, but so could doctors and other healthcare professionals. It would be wrong if people were not allowed to share that information if it was requested, even if their employer did not want them to do it. I turn now to new clause 11 and consequential amendments 64 and 65, which will ensure that the Bill is workable by making provision about the replacement of the co-ordinating doctor or the independent doctor where they are unable or unwilling to continue to carry out their functions in the Bill. The doctor may be ill or on holiday, retire, or have a change of personal circumstances.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I thank my hon. Friend for that intervention. The Royal College of Psychiatrists has a neutral position on the issue of assisted dying. If we refer to the impact— [ Interruption. ] Yes, it does.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I will take one final intervention.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I thank the hon. Lady for her intervention. Given her background, she knows what she is talking about. Regulations will set out the level of expertise required by the doctor, but there will also be training for every single doctor taking part in the assisted dying process. That is done well around the world, so there is work we can build on in that regard. Amendments 57 and 61 are essentially tidying-up amendments that modify the wording of the Secretary of State’s duty to set out training requirements in clauses 7 and 10. That fits with the intervention from the hon. Member for Sleaford and North Hykeham (Dr Johnson). Training is of paramount importance within the assisted dying process, and there will be a period of years in which anyone who opts in to be part of this process will have thorough and robust training. Due to amendments made in Committee, with very good intention, the current wording suggests that the regulations themselves must include details about training. That obviously does not make sense and would be unworkable, as it would have to be done separately. Similarly, amendment 58 removes unclear drafting as a result of changes made in Committee that could have the effect that the regulations have to contain training about training, which obviously does not make sense. Amendments 59, 52, 74 and 62 are also tidying-up amendments that are necessary as a result of the introduction of compulsory training for all doctors and panel members in domestic abuse and coercive control, following amendments tabled by my hon. Friend the Member for Lowestoft (Jess Asato), which the Bill Committee voted unanimously to accept. Amendment 74 ensures that the term “domestic abuse” in the Bill has the same meaning as in the Domestic Abuse Act 2021. It clarifies the definition of “domestic abuse” and ensures that the term is consistent with existing legislation. It provides for a very broad definition to capture the full range of behaviours, including physical or sexual abuse, violent or threatening behaviour, controlling or coercive behaviour, economic abuse, and psychological, emotional or other abuse. It does not matter whether the behaviour consists of a single incident or a course of conduct. These really important amendments address concerns about coercion and provide additional layers of safeguarding within the Bill. As such, I hope colleagues support them. Amendment 60 makes provision, corresponding to the provision in clause 12 about the death or illness of a doctor from whom a second opinion is sought, for a further referral to be made where, before reporting, the independent doctor dies through illness, or is unwilling or unable to act. The amendment once again ensures continuity of care and is an important detail to add to the Bill. Amendments 67 and 68 clarify the provision of clause 23 in cases where an approved substance requires administration via a medical device. The current drafting of the clause is not clear about whether it is allowable to administer the approved substance via a device, which it is. The amendment provides clarity for clinicians.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I thank my hon. Friend for that intervention, and I agree that we must be respectful, but we must also be honest with each other. Amendment (a) to new clause 10 was tabled by the hon. Member for Reigate (Rebecca Paul), who I thank for her work on the Bill Committee. I understand the thinking behind the amendment, but I worry about unintended consequences for patient care and protection. I have been advised that that is the case, and I think the Minister will speak to that. I think there is consensus across the House that, in the interests of patient safety, it is vital that there is clear and open communication, and sharing of information, between healthcare professionals in the assisted dying process. If an employer can stop their whole workforce participating in any sort of assisted dying services, it could prevent the sharing of information or the recording of information in a patient’s records. That could relate to safeguarding, and it could put patients at risk as a result of the employer’s decision. Terminally ill patients may be receiving different treatment at different places and from different healthcare professionals, and it would potentially be harmful if they were not able to transfer information or records. There are also workability issues with amendment (a) to new clause 10. It is not clear how it would work with regard to the requirement in subsection (7) for professionals to provide information to an assessing doctor about a patient—someone whom they may have previously treated—or in relation to information about a specific condition that they may specialise in. That information would need to be provided in the interests of patient care. An employee will always be bound by their contract of employment, but flexibility is needed, as many health and care professionals work for multiple employers. It is not uncommon for clinical staff to have more than one employer—for example, a doctor may be employed by the NHS but also work for a hospice—so it is not a straightforward scenario. Just as it would be wrong for anyone to be compelled to be involved in the process, it would be wrong for anyone to be prevented from doing so, particularly if there was an impact on patient safety.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I thank my hon. Friend for her passionate contribution, but this is exactly how we make law. We take evidence and have discussions— [ Interruption. ]

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  Thank you, Mr Speaker. I will move on to the amendments. If I may, I want to acknowledge the work of the Bill Committee in relation to the amendments, because a huge amount of work was done by Members from all parties, with a range of views—

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I will just finish this point. If we refer to the impact assessment, the number of people who will access assisted dying in the first few years will be very small. I think there are around 4,500 psychiatrists in the country, but there is also a period of time of a number of years to do the training required for psychiatrists taking part in the process, so I would not anticipate any problems there.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  Thank you, Mr Speaker. If I may just finish that point—

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I thank the hon. Gentleman for that intervention and he is absolutely right that there are a range of views on this issue, and I am deeply respectful of that. I take all those points into consideration as we embark on this debate again today. Perhaps most importantly, Mr Speaker, I have spoken to terminally ill people themselves over recent months. It is impossible to know what it must feel like to receive a terminal diagnosis and I have nothing but admiration for people who have bravely spoken about their personal situations, some publicly—including, of course, Dame Esther Rantzen—and others who have done so privately, many by emailing their MP. I know mine is not the only inbox full of such emails.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  This is not about eligibility; it is about the doctor’s change of circumstances, rather than the patient’s. If the doctor decides that the person is not eligible, they will reject the application. They would record that in the patient’s records, so it would be transparent.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I will make some progress, if I may. I am trying to be very open to interventions, but I do need to crack on. The report must set out why the co-ordinating doctor is not satisfied and must contain an explanation of why the patient cannot proceed with the assisted dying process. The co-ordinating doctor must give a copy of the report to the person, to the person’s GP practice if they are not a practitioner within that practice, and to the voluntary assisted dying commissioner. That reflects the thorough and robust reporting and monitoring mechanisms throughout the Bill. I turn to the other amendments in my name. I will try to keep my comments succinct, as many colleagues wish to speak. Amendment 56 ensures that the co-ordinating doctor gives the commissioner a copy of the patient’s first declaration. That enables the commissioner to carry out their monitoring responsibilities under clause 45. Amendments 57 and 61—

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  That would not be an issue, because copies of the report would be given to the patent, the co-ordinating doctor if they are not in the patient’s GP’s practice, and the commissioner, so that information would be recorded, and it is very important that it is. The report must set out the reasons—

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I reject the assertion that patients will shop around. Bearing in mind that we are talking about dying people, they are not in a position to start shopping around for services, but I also agree that the Bill is strict in that regard. There are very strict protocols that doctors will have to follow.

• 16 May 2025 · Terminally Ill Adults (End of Life) Bill · Hansard source

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  I will make a little more progress, if I may, because a lot of people want to speak. New clause 12 ensures that there is thorough reporting of instances where the co-ordinating doctor concludes that the patient does not meet the strict eligibility criteria set out in the Bill. It is very important that this data is recorded, but at present there is no requirement for the co-ordinating doctor to produce a report when they are not satisfied about all matters set out in clause 23(5) and will not provide the person with the approved substance. That lack of a reporting obligation does not align with the rest of the Bill—hence new clause 12, which I am sure colleagues will feel it is important to support.