Lewis Atkinson MP: speeches 2025

Speeches

• 11 Mar 2025 · Prison Capacity · Hansard source

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  The prison capacity crisis that this Government inherited has resulted in persistent offenders not feeling the deterrent effect of a custody option being realistically available. Can the Minister tell us how this Government’s prison building plans will restore a level of deterrence to the system and ensure that capacity is available in time to remove active offenders from the streets?

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

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  rose—

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

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  I welcome the hon. Lady’s speech, which she made with her customary dignity and force. I feel we are repeating some of the discussions we had on earlier clauses regarding capacity, and it is for the reasons I articulated then that I believe we need to stand by the Mental Capacity Act—and not deviate from it by introducing language such as that proposed in the amendment—because that is where safety lies.

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

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  I take the hon. Lady’s point, and I was about to come to that. The Mental Capacity Act already explicitly states that “a person lacks capacity in relation to a matter if at the material time he is unable to make a decision for himself in relation to the matter because of an impairment of, or a disturbance in the functioning of, the mind or brain.” The language around an impairment in respect of the mind or brain is already set out in that Act. As has been acknowledged, the Court of Protection has repeatedly found that people lack capacity, and such people would therefore not be eligible under the Bill in some of the circumstances the hon. Lady set out. By introducing a new, undefined concept of “impaired judgment”, which as I understand it is not a term that exists anywhere else on the statute book, we would be clouding the Mental Capacity Act.

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

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  Indeed, and that is why I support amendment 6, which we have just debated, to mandate referral for psychiatric assessment in cases where there is any doubt whatever. I think we have incorporated those safeguards and more but, fundamentally, as Chris Whitty said in evidence, for this legislation to be as secure as possible, we have to base it on the Mental Capacity Act, which has been tried and tested through the courts for more than 20 years. The insertion of language talking about impairments of judgment clearly deviates from that Act, where an impairment test is already set out. I do not feel that is appropriate. I absolutely applaud the sentiments behind the amendment, but I feel we have sufficiently strengthened the Bill elsewhere and that the MCA and other provisions give the safeguards and the reassurance that we need on these issues.

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

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  As I am sure the hon. Lady knows, there are gradients of mental health issues, from low mood to suicidality and so on. We should not prevent anyone from accessing an option merely because of a mild element of, for example, depression, which they have lived with for their entire lives, if they have then been diagnosed with a terminal condition. The key point, as my hon. Friend the Member for Spen Valley made out, is that the idea that eligibility will be conferred as a result of mental health illnesses is not correct. As we have discussed, the definition of “inevitably progressive” in clause 2, which is at the heart of the Bill, clearly protects against such instances. I also highlight the amendments we have made that help to clarify some of this. Members have pointed out the amendment from the hon. Member for East Wiltshire on removing medical conditions from the Bill, which was very helpful in this regard. I do not want to fall foul of Standing Order No. 42 on repetition, but I feel like with this issue we are repeating some of our discussions on capacity. In particular, my hon. Friend the Member for Penistone and Stocksbridge highlighted significant elements of the relevant legal framework in her speech at that point. In my view, setting out a test that is separate to the Mental Capacity Act, particularly in respect of the impairment of judgment, which is not then defined in any way, would undermine that Act, which has to be the cornerstone of the Bill.

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

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  My hon. Friend is absolutely correct. There are clearly further safeguards in those provisions, and also in the training provisions that we have already discussed. When the Secretary of State makes provision on training and assessment in respect of capacity and related matters, it is clear to me that they will do so with reference to some of the mental health conditions that the hon. Member for Richmond Park and others have referred to. Yesterday we agreed to amendment 275—which I was honoured to move—to ensure that people have had discussed with them “all appropriate” care, including psychological support, which further covers capacity. I would be absolutely horrified if there was any suggestion that people with mental health conditions should not have full access to all the support that may be beneficial.

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

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  Thank you, Mrs Harris—you really are giving the Minister some exercise during these long sittings. Amendment 14 likens assisted dying to organ donation. I understand that an organ donor, before the point of independent assessment, has had no other independent assessment, which is in stark contrast to this Bill. The idea that, by failing to support this amendment, we are somehow adopting a weaker framework than for organ donation is patently false. As the Bill sets out, there are already at least two assessments by independent doctors. As per the amendments we have already agreed, those doctors must have training, as specified by the Secretary of State, on the assessment of capacity and coercion. The rationale behind this amendment is already met, and it is significantly more strenuous than the framework for independent assessment in the event of organ donation.

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

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  I disagree with the hon. Gentleman’s reading. The amendment talks about the co-ordinating doctor, as in the first independent assessor, and that is the case in the provisions we have already adopted. Clearly, the co-ordinating doctor may consult—and must consult, as per the amendment we are about to get to—psychiatric or other expertise, if there is any doubt in their mind. Amendment 14 would not bring forward that assessment earlier than elsewhere. I urge hon. Members to bear in mind that the idea that this proposal is somehow weaker than the current human tissue regulations is absolutely false. On the point made by my hon. Friend the Member for Bradford West, the amendment does nothing to address coercion by a medical professional who knew the person beforehand. Under the amendment, it is by definition an independent person who has no prior relationship with the person.

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

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  The holistic assessment is already set out elsewhere in the Bill, so the amendment is not required. Amendment 275, which we made to clause 4, requires “all appropriate” psychological support to have been discussed with an individual in advance of the first declaration. I clearly supported that amendment, and I am very grateful that the Committee did. From a practical point of view, amendment 271 talks about six months from the point of diagnosis, but if I had prostate cancer, I might have had prostate cancer for absolutely years—so is it six months from the point of being diagnosed with prostate cancer or six months from the point of being told that that is terminal? There are a huge range of practical issues with the amendment as currently written, but there are also issues regarding the principle as well.

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

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  I will be brief. I am pleased to hear my hon. Friend the Member for Spen Valley confirm that she is minded to support amendment 341. It is incumbent on all of us, but perhaps particularly those in favour of the Bill, to place on record our appreciation and recognition of the fact that many people who work in our health services have strongly held religious beliefs, or beliefs of conscience—however they are motivated. As is the case for a range of other procedures and medical interventions, the law has to allow them scope to continue to practise. They make a valuable contribution to our health service and national life, and we should not do anything to impinge on that. There is already strong guidance from the General Medical Council about personal belief, and that applies, as the hon. Member for Reigate mentioned, to the Abortion Act, as well as to the Human Fertilisation and Embryology Act 1990, the Female Genital Mutilation Act 2003 and other procedures. It is not for any of us to second-guess someone’s conscience.

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

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  I do not disagree with my hon. Friend. I gently say that the GMC guidance specifically references that Act, so that is what I was referring to. I am pleased to see amendment 341, which I believe would bring the legislation into line with that GMC guidance, ensuring that removing the duty to refer would absolutely not be a licence for people to be left without access to care. The GMC is very clear, as the hon. Member for Reigate said, that people must be given sufficient information and be empowered to seek the options and information that they need. Therefore, I am pleased to support the amendment.

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

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  I rise to speak against the amendment; there are significant issues with it both in practice and in principle. In terms of practice, I draw Members’ attention to the fact that the amendment does not mention a psychosocial assessment; it mentions mandating “a psychosocial intervention”. As defined by the World Health Organisation, a psychosocial intervention can be as brief as five minutes. I know that it is a brief intervention: I used to manage services delivering psychosocial interventions. Nowhere in the amendment is the type of psychosocial intervention or its purpose specified. If Members hope that the amendment will lead to a psychosocial assessment—

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

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  I accept that that is a risk factor, but it is by no means determinative. Therefore, that risk factor has to be considered in the round with other risk factors such as levels of family and social support. As set out, the amendment does not distinguish between someone receiving a terminal diagnosis by themselves without any support network, and someone who expects to receive a terminal diagnosis at the end of a very long illness. As a point of principle I do not accept that we should mandate psychosocial interventions or that people must receive a level of healthcare in order for them to access other options related to their care—let alone the practicalities, which I have laid out, about when the provision would apply in relation to diagnosis and the fact that it is an intervention, which is in no way an assessment or any such thing.

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

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  I will be brief, as I am conscious that the Committee needs to make progress. I will speak briefly to amendment 275 in my name, which, as others have said, amends the current reference of “any available” to “all appropriate”. Listen—people at the end of their life deserve the best. They deserve to know about and have the option to access all appropriate care. In my experience of the NHS, that is exactly what clinical teams ensure patients get. But we need to guard against any suggestion that the information given should be somehow filtered around availability, which I know is not the intention of my hon. Friend the Member for Spen Valley. In my experience, views on availability are often incorrect anyway, so ensuring that “all appropriate” options are offered in information is the best thing to do. If nothing else, it creates a level of societal pressure to ensure that all appropriate care is available, which I hope we can all support.

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

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  With reference to amendment 8, and further to the intervention from the hon. Member for East Wiltshire, can my hon. Friend reflect on the provisions as set out in clause 4(1) and (2), which say that the issue relates to doctors’ professional judgment and that doctors are under no obligation to raise those issues in any situation?

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

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  Does my hon. Friend agree that the provision of a further independent doctor assessment—both one and two—in addition to the doctor conducting the initial discussion, would provide a further safeguard for a diagnosis, if terminality could not be supported by other professionals?

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

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  No, I am going to make some progress because I am conscious of the time, and we want to get through these provisions. I want to speak in favour of amendments 108 and 183. Those two amendments, taken together with amendment 275, create additional safeguards and assurances on the points made by colleagues on Second Reading that this is not cannot be raised in isolation—as my hon. Friend the Member for Spen Valley has made clear should not be the case—and that referral should always be offered to specialists in palliative and wider care. As others have said, those patients will almost undoubtedly be in touch with a variety of different multidisciplinary healthcare teams. The suggestion that there must be a further referral to another multidisciplinary team under the Bill, regardless of which teams an individual is seeing, is therefore not appropriate. I also refer Members to amendment 6 to clause 9, which states that a referral to a psychiatrist “must” be made. My hon. Friend the Member for Spen Valley has indicated that she is in favour of that amendment. That reinforces the fact that there will be a multidisciplinary approach, including psychiatric input, where there is any doubt before the third-tier stage of the panel. For those reasons, I do not feel the other amendments—285, 343 and so on—are necessary. By accepting amendments 275, 108 and 183, we will be able to strengthen the Bill in the way that was set out to the House, and as we heard in oral and written evidence.

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

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  My hon. Friend will recall that we heard evidence from doctors from Victoria, which has a so-called gag clause; I think it was Dr Furst who said that that was “really problematic”. What does my hon. Friend make of the guidance from the Victoria Government? It states that under that clause a patient who asks a doctor, “Can you give me all the options?” is not allowed to discuss assisted dying; indeed, if a patient says, “Isn’t there something you can do to help me put an end to this?” the doctor cannot discuss assisted dying either. Does my hon. Friend agree that that is an example of a gag clause being deeply unhelpful to doctor-patient discussions?

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

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  I accept that clause 4(1) rightly sets out that no medical practitioner is under an obligation to raise the subject of assisted dying, but that is not what amendment 50 is about; it is about the information that someone has about the likely effects of taking this course of action, if a patient is to pursue it. In that case, it is entirely right that the GMC guidance would apply, as it would with any other procedure, including very sensitive procedures. Of course, the benefit of having, as set out on a statutory footing, proper medical regulation through the GMC is that it can be updated by the GMC. The question came up previously of why it would be more complicated or burdensome to have some of this set out in primary legislation. When doctors know that they have to refer to the GMC guidance, they are more likely to follow it. If they think, “Oh, hang on. I need to think about what the guidance is in this bit of primary legislation”, where does that stop? Do we start putting in slightly differently worded bits of guidance for information about different areas and procedures? That is a recipe for absolute confusion and less adherence.

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

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  The right hon. Gentleman makes a good point. For the reasons that I have outlined, I will not support amendment 50. However, I would hate for any of us who do so to be characterised as disagreeing with the provision of relevant and available information about care and treatment. I certainly believe, as do some colleagues, that that is best done through existing regulatory routes, and primarily through the GMC. That is why I am unable to support amendment 50.

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

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  I was not intending to, but I will speak very briefly to follow my hon. Friend the Member for Ipswich. I agree that what is set out in amendment 50 is entirely sensible and I support such provisions. However, I will not vote for it, and I want to explain why. We will go down a very difficult route if we set out the regulation in primary legislation for every individual area of medical practice in this country. We do not have an equivalent version for how doctors should talk to their cancer patient and what information they should provide. We do not have the equivalent in various other sensitive acts, such as the Abortion Act 1967, the Human Fertilisation and Embryology Act 2008 and so on. The reason is that we rely, as set out in statute, on regulation through the General Medical Council. I want to read into the record some of the existing General Medical Council guidance for doctors on giving information to patients. Of course, this covers any doctor-patient interaction, and it would apply in this case as well: “The information you give patients 10. You must give patients the information they want or need to make a decision. This will usually include: a. diagnosis and prognosis b. uncertainties about the diagnosis or prognosis, including options for further investigation… c. options for treating or managing the condition, including the option to take no action d. the nature of each option, what would be involved, and the desired outcome e. the potential benefits, risks of harm, uncertainties about and likelihood of success for each option, including the option to take no action.” That is already set out by the General Medical Council.

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

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  My hon. Friend and I may need to agree to disagree on this point. Clearly, I agree that this is a significant landmark legislation, which is different from many other forms of treatment, but that is reflected in the safeguards and provisions elsewhere in the Bill. I do not believe that the Bill needs to set out the way in which information is given. The difference in its nature is set out elsewhere in the Bill with the safeguards. The drafting of amendment 50 essentially repeats what is already in place and is regulated through the GMC, entirely rightly. There is much more likelihood that that will be adhered to, as we would all wish to be the case, if amendment 50 is not accepted.

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

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  No, I do not agree. The GMC guidance in many ways talks about not accepting treatment. It is equally as useful in situations involving the withdrawal of treatments and the end of life. Fundamentally, it goes back to the point that I made in my speech yesterday on informed decision making and the autonomy of the patient. They have to be informed, whether they are seeking treatment, the withdrawal of treatment or no treatment at all.

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

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  I share the concerns of my hon. Friend the Member for Bexleyheath and Crayford about the use of DNRs—what happened during covid to people, particularly those with disabilities, was a disgrace. Does my hon. Friend the Member for Bradford West accept that this is an entirely different situation, however, in that people must actively seek it, be tested multiple times, and express a wish for it? The situation with DNRs involved medical professionals making decisions on behalf of a patient without their input.