Rebecca Paul MP: speeches

Speeches

• 17 Jun 2025 · Crime and Policing Bill · Hansard source

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  I rise to speak against new clauses 1 and 20, and in support of new clause 106, tabled by my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson). First, it is important for me to say that I fully support women’s reproductive rights. I think that we generally get the balance right here in the UK, and protecting that is a hill I would die on. However, I am disturbed by new clauses 1 and 20, which would decriminalise abortion up to birth. If they become law, fully developed babies up to term could be aborted by a woman with no consequences. The reason we criminalise late-term abortion is not about punishment; it is about protection. By providing a deterrent to such actions, we protect women. We protect them from trying to perform an abortion at home that is unsafe for them, and from coercive partners and family members who may push them to end late-term pregnancies. I have great respect for the hon. Member for Gower (Tonia Antoniazzi), who has tabled new clause 1. We share many of the same objectives on other topics, but in this case I think she is trying to solve a very real issue—the increased number of prosecutions—with the wrong solution. These amendments are driven by the case of Carla Foster, among others. Carla Foster is a mum who was prosecuted under UK law for carrying out an illegal abortion in May 2020, during the covid pandemic. She carried out the abortion at 32 to 34 weeks of pregnancy after receiving the relevant drugs through the pills-by-post scheme introduced during lockdown. This is a terrible case that harshly demonstrates the flaws with the current process, but the issue here is not the criminalisation of abortion after 24 weeks; it is the fact that Carla Foster was given the pills without checking how far along she was in the first place. She was failed by people here in Parliament who voted to allow those pills to be sent out by mail during lockdown without an in-person consultation. That was an irresponsible decision; and one that might have been forgiven in the light of a global pandemic if it had remained temporary. However, in March 2022 the scheme was made permanent. If we want to protect women from knowingly or unknowingly acquiring abortion pills after 24 weeks of pregnancy and inducing an abortion at home, we must put an end to the situation in which those pills can be acquired without a face-to-face consultation at which gestational age verification by medical professionals can take place. These drugs are dangerous if not used in the right way, as we saw when Stuart Worby spiked a pregnant woman’s drink with them, resulting in the miscarriage of her 15-week-old baby. Make no mistake: the pills-by-post scheme enabled that evil man and his female accomplice to commit that crime. It is also important to note that prior to the pills-by-post scheme, only three women had been convicted for an illegal abortion over the past 160 years, demonstrating the effectiveness of the safeguard. However, since that scheme was introduced—according to Jonathan Lord, who was medical director of Marie Stopes at the time—four women have appeared in court on similar charges within an eight-month period. Criminalisation of abortion after 24 weeks is not the problem; the pills-by-post scheme is. If new clause 1 passes while the pills-by-post scheme remains in place, here is what will happen. More women will attempt late-term abortions at home using abortion pills acquired over the phone, and some of those women will be harmed. Many of them will not have realised that they are actually going to deliver something that looks like a baby, not just some blood clots—that is going to cause huge trauma for them. Many of those women genuinely will not have realised how far along they are, due to implantation bleeding being mistaken for their last period, and on top of all of this, some of the babies will be alive on delivery. We in this place need to get away from this terrible habit of only considering issues through a middle-class lens. What about women who are being sexually exploited and trafficked? What about teenage girls who do not want their parents to find out that they are pregnant?

• 3 Jun 2025 · Topical Questions · Hansard source

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  As of 1 May this year, there were seven biological males in HMP Downview, a women’s prison in my constituency. Can the Secretary of State confirm when they will be moved out?

• 30 Apr 2025 · Gender Incongruence: Puberty Suppressing Hormones · Hansard source

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  I beg to move, That this House has considered the potential impact of puberty suppressing hormones on children and young people with gender incongruence. It is a pleasure to serve under your chairmanship, Ms Lewell. I am pleased to have the opportunity to shine a light on this important topic, one that impacts the health and wellbeing of some of the most vulnerable children in our country. This debate must be led by science, data and evidence, not by ideology, bias or belief. I will do my best to do that today. The number of children and young people presenting to the UK NHS with gender distress has increased year on year since 2009, with an exponential rise in 2014. What is behind the increase among Generation Z is unclear and the reasons are likely to be multifaceted. It is speculated that the factors may include 24/7 internet access, increased acceptance of trans identities, or even peer, social and cultural influences. Over the last 20 years we have seen groups such as Stonewall and Mermaids call for better access to treatment and increased rights for trans people. Large corporates have gone big on diversity and inclusion to boost their brands, impactful TV dramas centring trans stories, such as “Butterfly”, have been widely viewed, and the public sector, from the NHS to the police, has been flying the progress flag at every opportunity. So it can be no surprise that gender identity is at the front of young people’s minds in a way that it simply was not when I was growing up. In 2009, only 51 patients were referred to GIDS—the NHS gender identity development service for children—of whom two thirds were male. In 2016, there were 1,766 referrals and two thirds of them were female. That is quite the change. There has been an overall surge in the number of children suffering gender distress, but the increase is especially notable among girls; we also see over-representation of neurodiversity, mental health issues and trauma in this group. To put it another way, these children are much more likely to have been in care, to suffer with anxiety and depression, to be autistic and to have been abused. It is a group of incredibly vulnerable children. GIDS was established in 1989. Its main approach to treatment at that time was therapeutic—referred to as watchful waiting. Early studies from the 1980s showed that in around 85% of cases, the gender incongruence or distress ceased in the child after going through puberty. Later studies reached a similar conclusion, with between 67% and 90% desisting after puberty. Only a small cohort of children continued to experience gender dysphoria or incongruence after puberty, and it was that small group who would likely adopt a permanent trans identity in adulthood. Everything changed with the emergence of the Dutch protocol, which involved the use of puberty blockers from early puberty. Puberty blockers are gonadotropin-releasing hormone analogues, which supress oestrogen production in girls and testosterone in boys. They are licensed for use in children with precocious puberty—when puberty starts much too early and it is beneficial to suppress it until a more normal developmental time and age—but in the case of gender dysphoria they are used to delay or even indefinitely stop natural pubertal development and maturation, and it is important to note that puberty blockers are not licensed for that purpose. The original rationale for using puberty blockers to treat gender dysphoria was to press pause on puberty and give children time to think, but for some the aim was also to increase the chances of a child passing as a member of the opposite sex in adulthood. GIDS started trialling puberty blockers in the UK after 2011. The preliminary results in 2015-16 did not demonstrate psychological benefits, with some of the females suffering a worsening of symptoms, including higher incidence of wanting to hurt or kill themselves. The results of the study, which were not formally published until 2020, demonstrated no statistically significant improvement in gender dysphoria or mental health outcomes. It is also important to remember the early studies that told us that in the majority of cases, going through puberty could relieve gender distress. It follows, therefore, that stopping or delaying puberty using medication could derail that natural desistence, essentially locking in or prolonging the gender distress, rather than allowing it to naturally resolve. One would think that, in the absence of any evidence of benefit from puberty blockers, the NHS would have stepped back from using them after the trial. Furthermore, the high numbers of autistic, traumatised, mentally unwell and same-sex attracted youth in the group of children referred should have rung alarm bells loudly, but no; instead, puberty blockers and cross-sex hormones were routinely made available to an even broader group of children, including those with neurodiversity and complex mental health presentations. An independent systematic review of published studies on puberty blockers, of which there were 50, was undertaken by the University of York as part of the Cass review. It was found that puberty blockers do indeed suppress puberty effectively. It was also found that, given that most children progress on to cross-sex hormones after starting puberty blockers, the main objective of pausing development is not achieved. No reduction in gender dysphoria or improvement in body satisfaction was demonstrated, and there was limited evidence of positive mental health outcomes. Worryingly, bone density in those taking puberty blockers was compromised, and height gain may lag behind normal. In the case of biological males, it can make vaginoplasty more difficult in future, due to insufficient penile growth, forcing the use of gut tissue instead. The Cass review reports: “There seems to be a very narrow indication for the use of puberty blockers in birth-registered males…in order to stop irreversible pubertal changes. Other indications remain unproven at this time.” I take that to mean that those drugs have been given to young girls, not because they benefit them specifically, but because they might benefit a very small group of males. Professor David Bell, a retired consultant psychiatrist at the Tavistock, and Dr Sinead Helyar, a clinical trial nurse, also warned of the potential harms in a recent article. “Current known and potential harms of puberty blockers are multi-fold and include a reduced bone density and early-onset osteoporosis, brain swelling and concerns around impairment of future sexual functioning and ability to form emotional relationships. A recent review of the impact of suppressing puberty on neurological function highlighted that adolescence is a critical window of neurodevelopment and puberty plays a critical role in this process. The author concluded that suppression of puberty impacts brain structure and the development of social and cognitive functions, in which the effects are complex and often sex specific.” The over-representation of same-sex attracted girls and boys in the group of children being treated with puberty blockers is particularly worrying. In a study in the Netherlands of 70 patients given puberty blockers between 2000 and 2008, 89% were same-sex attracted, and most of the rest were bisexual. The same pattern was seen in most of the other trials, with the majority of the children growing up to be same-sex attracted adults. A paper from GIDS in 2016 reported 89% of the biological girls being either same-sex attracted or bisexual. Why would same-sex attraction be over-represented in that way? Could gender distress be symptomatic in some cases of struggling with sexuality? Is sufficient emphasis put on reassuring those young adolescents about their sexuality, to establish if the gender distress is linked or separate; or is our society’s hyperfocus on gender identity and gender conformity putting them on an unnecessary medical pathway to change their body? Keira Bell, who has now detransitioned, says, “I became attracted to girls. I had never had a positive association with the term ‘lesbian’ or the idea that two girls could be in a relationship. This made me wonder if there was something inherently wrong with me. Around this time, out of the blue, my mother asked if I wanted to be a boy, something that had not even crossed my mind.” The Cass review received several reports from parents of biological females that their child had been through a period of trans identification before recognising that they were, in fact, a lesbian. That begs the question: why are so many young lesbians being medically transitioned? Before I move on to my questions to the Minister, it is important to note that almost all the children and young people who take puberty blockers go on to take cross-sex hormones. I raise that because it links the two treatments. The impact of puberty blockers cannot be looked at in isolation, because cross-sex hormones may lead to further surgeries, lifelong medication, and loss of fertility and sexual function. These are catastrophic impacts. How can a prepubescent child really understand what never experiencing an orgasm means and the impact that could have on their future relationships, or indeed what losing the opportunity to have children could mean? It is very apparent that the lack of solid long-term data on outcomes for patients who are treated with puberty blockers is problematic. No doctor should prescribe something in the absence of strong evidence of its effectiveness and a clear understanding of the side effects. In May 2024, the previous Government temporarily banned the use of puberty blockers for the treatment of gender incongruence and gender dysphoria in under-18s, following the Cass review’s findings of insufficient evidence to show they were safe and effective, and this ban was made permanent by the current Secretary of State for Health and Social Care in December 2024. In the light of everything that I have set out today, I fully support that decision: it is sensible, has full regard to the data, and puts the safety and wellbeing of children first. It is also important to note campaigners’ claim that suicides among young patients with gender dysphoria increased due to puberty blocking drugs previously being restricted, following the High Court decision in the Bell v. Tavistock case, has been disproved by Professor Louis Appleby’s investigation and report, published on 19 July 2024, in which he confirmed that the data did not support such assertions. He concludes that: “The way that this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide. One risk is that young people and their families will be terrified by predictions of suicide as inevitable without puberty blockers.” At the same time that the Secretary of State announced the permanent ban on puberty blockers, he announced that a clinical trial would be set up in 2025 to examine the use of puberty blockers, in order to establish a clear evidence base for the use of this medicine in gender incongruence. The £10.7 million trial, called Pathways, will be carried out by a team at King’s College and is due to run until 2031. Over two years, it will track: “the physical, social and emotional wellbeing” of young people who want to delay puberty, and whose parents and the gender service agree with this treatment option. I will be grateful to the Minister for an update on the trial and how she intends to ensure that children are not physically or psychologically harmed. A trial of this nature of a drug that is unlicensed for gender incongruence raises many ethical concerns. In the words of Professor David Bell and Dr Sinead Helyar: “The first duty of any clinician inside or outside of a clinical trial is to ‘do no harm.’” Can there ever be a situation where it is ethical to run such a trial when the harms could be significant? It is important to remember that the children who would participate in this trial are physically healthy children who stand to have worse health by the end of it. This trial is in no way similar to a clinical trial for a cancer drug, where the patient is seriously unwell at the beginning of the trial. Secondly, approximately 9,000 children and young people were treated by GIDS over the years, which provides a plentiful supply of data about the long-term outcomes for those who took puberty blockers and those who did not. Would the Minister please clarify matters and explain why a new trial is needed, given this abundance of data? Will she please provide an update on the exercise that is currently under way to obtain more data? Thirdly, the current trial only proposes to look at outcomes over a two-year period. To put that into context, a child who starts puberty blockers at the age of 13 will only have their outcomes followed and assessed until the age of 15. That is not long enough to understand medium and long-term outcomes. A positive result for a 15-year-old might look very different for a 25-year-old, when physical health, sexual function and fertility are likely to be more important and relevant to them than when they were 15. Does the Minister agree that two years is not a sufficient timeframe to properly evaluate the impact of puberty blockers on physical and mental health? If this trial goes ahead, will she commit to funding and ensuring that there is long-term follow-up of these children into adulthood? Fourthly, how many children will the trial be limited to, and what criteria will be used to determine which children are eligible and which are not? Is it possible that all eligible children will be included and prescribed puberty blockers as part of the trial? How many children in total does the Minister expect to take part in the trial over its duration? How will the trial establish an appropriate control group? Fifthly, given that gender nonconformity sometimes correlates with same-sex attraction in adulthood, how will the trial safeguard those children who may simply be uncomfortable with their sexuality rather than experiencing true gender distress? Sixthly, given the high rates of progression to cross-sex hormones following puberty blockers, will only children who agree not to progress to cross-sex hormones be accepted on to the trial, so that the impact of the puberty blockers on outcomes can be seen in isolation? If the answer is no, given the corresponding likelihood of impaired sexual function and loss of fertility, which are monumental ramifications, how will the children taking part in the trial be able to give consent? Finally, will the Minister please provide details of other trials that have been approved for paediatric medical interventions with equivalent or similar diagnostic uncertainty, to reassure the public that moving forward with a trial in this situation has precedent? I look forward to hearing the Minister’s answers and thank everyone for attending this debate.

• 22 Apr 2025 · “For Women Scotland” Supreme Court Ruling · Hansard source

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  I welcome the clear ruling from the Supreme Court, and I thank the Minister for her statement, but I am really disappointed that there was no mention of schools at all in the statement. Many schools are teaching gender ideology as if it is fact and are not providing single-sex facilities or single-sex sports teams. How will she ensure that schools now comply with the ruling and the law as it has always been?

• 22 Apr 2025 · Standard Determinate Sentences: Early Release · Hansard source

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  Last month, the Prisons Minister said that the longest time that an early-released prisoner had been left to wander the streets without an electronic tag was 53 days. However, just over a week ago, it was reported that prisoners have not been tagged for up to 78 days. Can the Secretary of State please clarify this apparent inconsistency?

• 8 Apr 2025 · Easter Adjournment · Hansard source

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  I am pleased to rise today and speak in my first Easter Adjournment debate. I also pay tribute to Sir David Amess, whom unfortunately I never had the pleasure of meeting. Today I wish to speak about neighbourhood policing and tackling town centre crime—we were due to debate that important topic yesterday, so I thought I would take the opportunity to raise it today. It is particularly relevant to Redhill in my constituency, which has been suffering from increased levels of antisocial behaviour and crime in recent years. Redhill is an amazing town that is the cultural epicentre of our local area. It has undergone significant transformation over the past decade, with new developments such as The Rise, which includes The Light cinema. As a result, I am pleased to say that more people from further afield are visiting and enjoying all that Redhill has to offer. That is a positive thing for our local economy, but at the same time we have seen an increase in antisocial behaviour. To address the real issues faced, the Safer Redhill initiative was established. That is a partnership between Surrey police, the office of the police and crime commissioner, Reigate and Banstead borough council and East Surrey YMCA to cut crime and foster pride in the town. The project adopts the College of Policing’s “Clear, hold, build” framework, which is a three-stage approach where offenders are cleared from the area, and then partners work together to put in place interventions to keep it that way. From drug operations at Redhill train station to plain-clothes officers out at night looking for suspicious behaviour, huge amounts have been achieved as part of the Safer Redhill initiative. There have been 155 arrests, with a combined prison time of 25 years for local offenders, 86 drug seizures—including 10 kg of suspected cocaine—£89,000 of cash recovered and weapons taken off the streets. I take this opportunity to thank Surrey police, especially Jon Vale, the borough commander, and Lisa Townsend, the police and crime commissioner, for ensuring that Redhill got the additional police focus it needed at the right time. However, making Redhill safer is not all about police action; it is also about prevention, and that is where East Surrey YMCA has come in. With its qualified youth workers, it has been supporting local young people at risk of offending or becoming NEET—not in education, employment or training—by giving them the support they need and helping them to thrive and flourish. With their Y bus, the YMCA has been getting out and about in Redhill to engage with the young people, and I thank it for the important part it has played in making Redhill safer and ensuring a more positive future for the next generation. Safer Redhill is an inspiring example of what can be achieved by the police, the local council and the charity sector working hand in hand, with all partners bringing different skills and expertise to the table, but with the same ultimate goal. I thank and pay tribute to everyone involved. It is wonderful to see the local community starting to feel safer in the town centre and businesses feeling more confident about their future in Redhill. However, there is still much to do, and I will speak briefly on some of the other challenges faced in Redhill town centre. The first is pavement parking. Redhill has a fantastic pedestrianised shopping area, but some people mistake it for a car park and even use it as a cut-through. That behaviour by motorists is disrespectful and downright dangerous. There used to be physical bollards in place to prevent access by cars, and those need to be fixed, as that would go a long way towards addressing the issue. But we in this place also have a role to play. We must ensure that unnecessary and antisocial pavement parking, as in the case of Redhill town centre, is tackled and routinely enforced. That type of parking affects wheelchair users, people with visual impairments and those with pushchairs, making it difficult for them to get around safely. Redhill residents have been raising this issue for years, and we must tackle it. Currently, it is not a criminal offence for a car to park on the pavement, which is to ensure that traffic continues to flow on narrow roads where pavement parking is the only option, but it is an offence if the vehicle creates an unnecessary obstruction. The problem here is what constitutes an unnecessary obstruction, and that ambiguity makes it incredibly difficult for the police to successfully prosecute offenders. As a consequence of the low success rate, we see few instances of the police enforcing it. I therefore urge Government Ministers to look at how we can make it clearer which types of pavement parking are prohibited and which are not, so that effective enforcement can be deployed by the police or even the local authority, creating the necessary deterrent effect. Thank you, Madam Deputy Speaker, for allowing me to talk for so long about the wonderful town of Redhill and the huge amount of work that has been put into making it safer. I will now bring my remarks to a close so that others may contribute.

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

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  It is a pleasure to serve under your chairmanship, Sir Roger. I rise to speak about amendments 518 and 520. As we have said, it is important that we understand what coercion means in a legal sense, and I am really grateful to the hon. Member for Penistone and Stocksbridge for trying to set that out, because it is not an easy task. Like her, I am concerned that defining it in this way may make it harder to prove coercion and may undermine the safeguards in the Bill. Under the amendments, the assessing doctors and the panel are meant to look not just for evidence of coercion but for evidence of intent to induce assisted suicide, and they will have to show that the applicant is requesting assisted suicide against their will. That could make the law powerless against many kinds of behaviour that we want to prohibit. To start with the point about intent, coercion and pressure take many forms, and they do not always involve a clear intent. Amendment (b) to amendment 518 and amendment (b) to amendment 520, in the name of the hon. Member for Lowestoft, very reasonably draw attention to family relationships. On Second Reading, the right hon. Member for Hackney North and Stoke Newington (Ms Abbott) said: “people do not generally write letters to sick relatives urging them to consider assisted suicide and then put those letters on file. Coercion in the family context can be about not what you say but what you do not say—the long, meaningful pause.” —[ Official Report , 29 November 2024; Vol. 757, c. 1030.] But even in more blatant cases, we cannot necessarily prove intent directed towards assisted suicide. Sue Smith, a clinical psychologist, said in written evidence that coercive control often ramps up when the abused partner receives a cancer diagnosis: “The seriousness of the cancer diagnosis may be systematically and actively denied or minimised, claims can be made by the male partner that she is attention seeking, or she is accused of making up the effects of treatment, and can be left isolated and alone when in physical need…a woman learns to doubt her reality and experience, and is extremely isolated. This can lead to heightened anxiety, hopelessness and helplessness, and abject despair, which can lead to a person wishing they were dead.” That could be seen as coercion towards assisted suicide, but in that scenario does the abusive partner demonstrate clear intent? I am not sure the doctor or panel could demonstrate that in that instance, especially as they need to be satisfied only on the balance of probabilities that there is no coercion. If the panel think that there is a 45% chance that there is intent, but no more than that, they have to grant the application. The harrowing story of Ryan Wellings and Kiena Dawes shows that even when coercion can be proved, proving that an abuser intends someone else’s suicide is a completely different matter. After Kiena Dawes took her own life, Wellings was convicted of coercive control and assault. The judge told him: “from May 2020 until her death you abused, assaulted, exploited, controlled and demeaned her. When she died it is clear that she had begun to believe your lies to the effect that she was deranged, physically disgusting, friendless, worthless and an unfit mother. You had persuaded her that she had no one to turn to.” Before her death, Dawes wrote a note saying, “Ryan Wellings killed me.” Although he was convicted on other counts, Wellings was acquitted of manslaughter. That demonstrates that coercive control, even if it is followed by suicide, does not always mean that intent can be demonstrated. It is really tricky. Similarly, people may pressurise a relative without intending to override their will. The barrister Ruth Hughes KC, who has been quoted before, said: “It is surprisingly easy for a relative, whilst completing a variation on ‘the classic asset strip’, to persuade themselves that they are actually acting in their aunt Dorothy’s best interests or in accordance with her wishes”. In other words, someone can pressurise a relative into assisted suicide without intending to. Again, including intent here could actually muddy the waters. I have a similar concern about the phrase “against that other person’s will”. That sounds very straightforward, but in practice it can be much less clear. Part of the effect of coercion is that people lose confidence in their own will and adopt that of others. In written evidence, many frontline workers pointed out that coercion does not always clearly appear as someone acting against their will. Janet Reiss, a specialist doctor in palliative care in Wolverhampton, says patients will not “even necessarily be aware of being coerced”. Dr Jennifer Hardes Dvorak, a senior lecturer at Canterbury Christ Church University specialising in medical law, states that the Bill “does not consider how people internalise feelings of coercion and…act on this.” If someone has internalised a feeling that they would be better off dead, that may be their will, even if we hope we could change it. Anni Donaldson, a domestic abuse expert at the University of Strathclyde, said: “Decades of work examining the impact of coercive and controlling behaviour has shown that ‘coercive control’ is not merely persuasion, but a complete change in the perspective of the victim so that she truly believes that she is worthless, a burden to her partner or wider family, and would not be missed should she die…Women are regularly humiliated, demeaned, and told they would be ‘better off dead’, or, that they are a ‘useless mother’, or that the children would be better off without them. This abuse erodes women’s confidence, autonomy, and self-esteem. Cut off from support, women often come to believe these lies, fearing reprisals from their partner if they report the abuse, many choose to tell no one. This long term, relentless, dehumanising process can result in a woman believing that she is ‘disposable’.” Similarly, the writer and campaigner Sarah Ditum warns that the Bill may not protect “the patient who, through lengthy cruelty and coercion from a partner or carer, becomes genuinely convinced that she (or sometimes he) is a burden who would be better off dead. Such a person may even refuse treatment, causing a curable disease to become terminal and placing them within the purview of the bill.” So we might not believe that assisted suicide is in someone’s best interests, but there is no best interest test in the Bill or the amendments—just a reference to the person’s will. If a victim of coercive control truly believes they ought to die, it is not clear how the doctor or the panel can refuse their application, unless coercion can actually be proved, and proving it is not always easy, as we have just discussed. My hon. Friend the Member for East Wiltshire has tabled amendments to remove the phrase “against that other person’s will”. Obviously, that is all academic now, as we are not pressing the amendment to a vote, but I would support doing that, because that phrase does more to narrow the definition than anything else. On another point, amendments 518 and 520 refer to pressure and coercion from organisations. I do not know exactly what the hon. Member for Penistone and Stocksbridge has in mind with that. I guess an example might be the cases we have heard about in other jurisdictions where a health insurer or provider tells someone that they cannot fund a treatment but can fund assisted dying options. It could be that the hon. Lady had other things in mind there. That would possibly count as pressure under some circumstances, but it would be very hard to show that there was intent on the part of the organisation. It is not clear that the amendments help us to identify and avoid coercion and pressure in that sense. Before I finish, I would like to point out something else that might be missing from the amendments: it is my favourite topic, the question of undue influence—my apologies to the Justice Minister, because I know we have gone over it a few times.

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

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  I beg to move, That the clause be read a Second time. The new clause would make the advertising of services by a co-ordinating and/or independent doctor by a person in the course of a business an offence with a sentence of up to two years in prison or a fine or both. As we have discussed previously, we will likely see private provision of assisted dying services, if the Bill is approved. That will create a potentially lucrative opportunity for private businesses, particularly if provision on the NHS is not consistent across the country or is overwhelmed. “Advertising” means the techniques used to bring attention to a product or service with the aim of presenting it as something a potential customer might need or want. The overarching aim of advertising by a business is to ultimately sell more of a product or service. We must keep that overarching reason in mind when considering the amendment. It would be incredibly inappropriate for such services to be advertised on billboards, public transport or daytime telly, targeting those who may be approaching the end of their life, with ads run repeatedly along with those for stairlifts and life insurance. Such advertising could also undermine our national suicide prevention strategy by normalising suicide in certain situations. It becomes much harder to say to people that suicide is not the answer if we are content to say that it is in certain situations. I can only imagine some of the difficult conversations that could be generated from an advert seen by a young girl or boy already battling with suicidal thoughts. How does a parent or guardian explain why suicide is not right for them? Imagine the potential impact on men, too. As we all know, suicide is a leading cause of death in men in this country. In 2022, for males between the ages of 20 and 34, one in four deaths was categorised as “intentional self-harm” or “event of undetermined intent”. That is a shocking statistic. That is why banning the advertising of such services is so important.

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

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  I rise to speak briefly on clause stand part. As I noted a few weeks back—it feels a long time ago—when we debated amendment 82, the clause leaves the law in a strange position. I hope that we will now have the opportunity to explore that and make sure that we are comfortable with the position and have identified whether any changes are needed. Section 2(1) of the Suicide Act 1961 criminalises both assisting and encouraging suicide: “A person (‘D’) commits an offence if— (a) D does an act capable of encouraging or assisting the suicide or attempted suicide of another person, and (b) D’s act was intended to encourage or assist suicide or an attempt at suicide.” It is a single offence, but can be committed in two ways: either through assistance or through encouragement. Clause 24(3), both as drafted and as amended by amendment 505, would make an exception from criminal liability under the Suicide Act, but in respect only of assistance, not of encouragement. It would cover: “(a) providing assistance to a person to end their own life in accordance with the Terminally Ill Adults (End of Life) Act 2025, or performing any other function under that Act in accordance with that Act, or (b) assisting a person seeking to end their own life in accordance with that Act, in connection with the doing of anything under that Act.” In other words, it is strictly limited to assisting suicide. It only covers the actions in the Bill around conducting the preliminary discussion, assessing the applicant, giving the applicant the approved substance and so on. What happens to the other half of section 2 of the Suicide Act: the offence of encouraging suicide? I will not rehash the debates that we had over amendment 82, but I must point out that as that amendment was rejected, the law does not dovetail. Encouragement would still be very much an offence under the Suicide Act, as it has not been excepted under the Bill. Because my amendment was not agreed to, we will have the absurd situation in which somebody can commit the crime of actively encouraging someone to take their own life, yet that will not be looked for or taken into account when assessing someone’s eligibility for an assisted death. On the flipside, there is a very real risk for families and friends of loved ones who could inadvertently overstep the mark and move from support of a loved one to encouragement. It does not take much imagination to realise that that could lead to accusations and potentially even to prosecution if the law is not sorted and clarified at this stage. We already know how difficult it has been for family members who want to accompany loved ones to Dignitas but fear that they could face prosecution; the hon. Member for Spen Valley has made that point so eloquently. No one wants that, so it is important that we ensure that the Bill does not create a similar situation in which someone could be unfairly prosecuted for encouragement, which is still very much a crime under the Suicide Act.

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

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  I am absolutely reassured by the hon. Lady’s amendment, and I welcome it, but it is worth drawing attention to the fact that the sentence is important but identifying coercion and pressure can be difficult too. In written evidence, a social worker called Rose has cast doubt on the workability of the Bill. She was writing when the High Court safeguard was still part of the Bill, so we need to bear that in mind, but what she said applies to the panel too. She wrote that “based on lived experience…there is no authentic provision mechanism or route that cheaply and swiftly would allow an approved palliative care professional…or social worker to act to protect a vulnerable person under the grounds of coercion….Place yourself in a position of being sick or older, coerced by family for financial gain or by a practitioner wanting to save public costs to pursue assisted suicide, the social worker senses it by body language, a squeezing of their wrist, a sharp silencing look. Can you see a judge saying: ‘the social worker sensed a tension in the air and a look’. Do you think that would serve to reach the threshold to override a request for assisted suicide in a court of law? In practice, what would happen would be, the social worker will record her concerns on the system, share them with her manager who will go to her manager who will say we do not have funds to consult legal and your evidence provided does not reach threshold anyway.”

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

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  I will be fairly brief. I welcome amendment 508, which would ensure that conviction for the offence leads to a necessarily serious result. However, it is not just the strength of the sentence that we need to think about; there is also a question about how difficult it can be to detect and demonstrate coercion in the first place. Domestic abuse prosecutions have followed an overall downward trend over the past decade, according to Women’s Aid. A report from the Domestic Abuse Commissioner in January found the criminal justice system unfit to hold abusers to account and safeguard domestic abuse victims. Domestic abuse victims are being failed by the criminal justice system at every stage, from police to probation. Victims seeking safety in justice routinely face a lack of specialist service referrals, poor enforcement of protective orders, court delays and early release of abusers. The commissioner also found that just 5% of police-recorded domestic abuse offences reached conviction and that less than a fifth of victims have the confidence to report to the police in the first place. Within the police workforce itself, only 4% of alleged domestic abuse perpetrators are dismissed. Women’s Aid says that trust in the criminal justice system is at an all-time low, with domestic abuse survivors not feeling that they will be believed and supported when reporting abuse. That is even more challenging for black and minoritised survivors, who face additional barriers and poor responses when they seek help.

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

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  I thank the Minister for those helpful clarifications. Was any consideration given to also exempting encouragement as an offence under the Suicide Act? I am interested in why it was not exempted in the same way as assistance, particularly given that if it did fall within coercion and pressure—based on what the Minister said—it would get picked up as a criminal offence anyway under the Bill. I appreciate that the Minister will write to me on some of this, but the issue comes back to what is encouragement. As the hon. Member for Spen Valley set out—

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

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  We are saying that when an employee is employed by the hospice or the clinic, they are employed to deliver services as directed by the employer. I think the answer is that if an employer is really clear that they do not want to offer a service, an employee should not have a right to then offer the service that the employer does not want to offer. It is like saying, “We are a shop that sells sofas, but I have this employee who wants to sell an oven. I’m worried I will end up in court if I do not allow them to sell an oven.” It is a perfectly reasonable ask for employees to respect what the employer wants to do on this matter, and I am trying to put that clarity in the Bill. As I say, we will save no end of issues down the line if we are really clear on this now.

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

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  I completely agree. Some of the amendments were tabled because there is not a best-interest component in the Bill. In an ideal world, I would have liked it to have included a best-interest component; that would have given me some reassurance. Some of the amendments that I will discuss today were tabled because other amendments were voted down. I would not have tabled them had we taken different decisions earlier. I am trying to put the safeguards in somewhere, although we can have an argument about whether they are in the right place. They were ruled out when we debated earlier clauses, so I have been left in this situation. We can hope that the events I have described were exceptional, but they are the kinds of situation in which a panel may have benefited from a family perspective or, as my amendment (a) would allow, for second thoughts from one of the assessing doctors or any of the other people whose expertise the panel calls on. The amendment would protect not just the family but the doctors. If a family member suddenly became aware of something, there would be another avenue by which they could appeal the decision, so the amendment would be positive for the co-ordinating doctor, the independent doctor, social workers, psychiatrists and anyone else who had been involved throughout the process. I would like briefly to outline two additional practical benefits to my amendment. First, it would resolve issues before legal disputes arise. In Belgium, the long-running case of Tine Nys has been pursued in both criminal and civil courts after her family argued that she did not meet the eligibility criteria for euthanasia. In Canada, a man’s family launched a legal challenge after he received medical assistance in dying while on a day pass from a psychiatric ward. They claim that he lacked mental capacity. It is all too easy to imagine similar cases coming to court here, but if there were a chance to challenge the decision earlier, that might allow families to come to terms with the decision before having to launch legal action. Secondly, my amendment could help families to come to terms with grief. There are several stories from other jurisdictions about the grief felt by relatives at being cut out of the assisted dying process. In written evidence, the National Bereavement Alliance said: “We believe that as currently drafted, the Bill overlooks the needs of families and friends…While it rightly includes safeguards to protect people against coercion, it does not include reciprocal clauses to address the health, welfare and wellbeing of the family and friends who will be bereaved…As drafted, the Bill prioritises the autonomy of the person who is choosing to access an assisted death. This is appropriate: however, it does not mean that the Bill should not also address the needs of family members and friends in relation to the decision.”

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

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  My hon. Friend makes a good point; I completely agree with him on that front. This goes back to being clear on the face of the Bill about what the panel does and the powers it has in order to avoid ambiguity. It is important that we set that out now, during this process, rather than finding ourselves in a position in two years where it is all starting to happen, if the Bill is approved, and the questions starting at that point. Let us try to answer them now and be really clear about it. Where a panel does not hear directly from a patient, it may be forced to rely on second-hand accounts. In law, second-hand evidence is known as hearsay and is always handled with a lot of provisions and warnings across our criminal and civil legal systems, because it can be inaccurate or of lower quality than evidence directly from a source. However, the panel is open to depending on such evidence. We must be clear-eyed about the risks that come with that. In summary, I do not believe that new clause 21 gives sufficient clarity on how the panel will perform its role and what evidential standard it would apply. We do not know if it is an administrative task or a judicial one. We do now know that the panel is inquisitorial—I thank the Bill’s promoter for that—but we do not know how much it will rely on hearsay evidence in practice. I will say this again, because it is really important: the panel is required to hear from only one doctor and does not need to question them. Under the Bill, would it be legally acceptable for the doctor to turn up, say, “No concerns”—and that’s the end of that? I am here to tell Committee members who think that that will not happen if the Bill allows it: somewhere, with some panel, it absolutely will—particularly as our society gets desensitised and more comfortable with the concept of assisted dying. I urge the Committee to be precise with the legislation it is passing for the sake of the statute book and, more importantly, for the sake of all the people who may find themselves being assessed by such a panel.

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

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  Again, I am not sure I agree that that is what I am here to do today. I think my job is to set out the strengths and weaknesses of the proposed amendment, and I do think that the High Court judge safeguard, on the face of it, was probably safer. I appreciate, value and truly welcome what the new clause attempts to do by bringing in psychiatrists and social workers, but it has come in at the wrong phase of the process. I am not sure we are really getting the value of that expertise at the judicial point; we would have got that value at the clinical stage. I ask Members to take what I am saying in the good faith that it is meant. My intention is to make sure that the Bill is as safe as possible. I do not profess to have all the answers, but I do have questions, and sometimes it is useful to ask questions, because there are others here who can answer them. I hope that, by asking questions when we are uncertain whether something is the right way forward, we will get a stronger piece of legislation.

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

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  This is a really important opportunity to share all these examples. I have to be honest that I am not sure I see the relevance of how a case is funded, and I cannot speak on that person’s behalf. I am going to talk about some of the inequalities that come from this, because there will be people—we will come to this when we discuss judicial review—who will rely on legal aid to challenge a decision. If we do not get this right, we are in danger of creating a situation in which poor families cannot appeal and rich families can. That could give rise to the less than ideal situation the hon. Gentleman has raised. If we get this right and make sure that an appeals process is available on an equal basis to everyone in the country, that will prevent the kind of situation the hon. Gentleman has raised. I thank him for that, because he has helped to support the case for my amendment.

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

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  I rise to speak to new clauses 17 and 21 and to the four associated amendments. There is a lot to say, so please bear with me, but I will do my best not to repeat myself. How exactly will the panel operate and function? I appreciate some of the explanations provided by the hon. Member for Spen Valley, and I look forward to hearing from the Minister on the point, but I have concerns about exactly what the panel will do and how it will do it. I will do my best not to repeat what others have said, but I reiterate the concerns as to whether it is indeed a better safeguard than the High Court one that was originally envisaged, given that it will have no full judicial role. On a practical level, I question whether it is even feasible to find sufficient numbers of psychiatrists and social workers who are able and willing to perform this very burdensome role. As we all know, social workers do an incredibly important job, but people with their skillset are in extremely high demand. The hon. Member has made it clear that she is removing the High Court safeguards not because of the capacity concerns raised in oral evidence in January, but because she believes that this is truly a better and safer model. I am also concerned that something that was originally meant to bring judicial oversight into the process has been replaced with something that is not judicial. I welcome more involvement from psychiatrists and social workers, who have a key role to play in the process, but I have concerns about whether the panel is the right place for it. Its expertise would be more valuable earlier in the process, when the co-ordinating doctor and the independent doctor are performing their assessments, rather than at the stage with the legal oversight component. A panel’s involvement in a truly multidisciplinary approach during the clinical stage of the assessment process would have been a gold-standard safeguard, but unfortunately that approach was not put on the face of the Bill. How the panel will operate is an issue of great significance. If we do not flesh out the detail now, when will we? We must have this conversation. I have looked for this information in the new provisions. According to new schedule 2, “The Commissioner may give guidance about the practice and procedure of panels.” That is all there is. I cannot see any further information. Disappointingly, it is not even that the commissioner “must” give guidance—it “may”—so the operation of panels may change depending on who is in the role of commissioner. Given that this is a new approach and process, I urge the promoter and the Government to ensure that it is adequately fleshed out to avoid ambiguity. When I imagine the panel, I am not sure what I am supposed to be imagining. Is it an administrative process—three people checking the papers—or is it more like a court, calling in evidence? Yesterday, the hon. Member for Banbury eloquently set out the practical realities of the new provisions with regard to witnesses. According to new clause 21, the panel “must hear from” at least one of the doctors, but it does not need to question him or her, so what is it exactly that the panel is required to hear? What does “hear” mean, and does it cover anything specific? Does it cover all the items in new clause 21(2), or just some? The new clause does not specify. It is the same for the patient. The panel just needs to “hear” from him or her; it does not need to question them. As I will come to shortly, in exceptional cases, even the patient will not need to be heard from. Again, I would be grateful to the Justice Minister for clarity on what “hear” means and what she would expect would be covered. We do know that the panel must be “satisfied” of the relevant matters, yet how it is to be satisfied, and even what that means, is not clear. The only person who must be heard from is either the co-ordinating doctor or the independent doctor—just one person. That may be fine, or it may not, but I put it on the record here, because it is important that we are clear-eyed about it. Compare the process with an employment tribunal. Someone litigating an employment claim would know well in advance the rules that the tribunal would apply, what test the tribunal would apply to the facts, the legal representation they can have, and how and on what basis they can appeal. That kind of clarity is essential, but I cannot find it in the new clause. I also do not know whether the panel is inquisitorial or adversarial.

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

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  I thank my right hon. Friend for raising that point, because it gives me a wonderful opportunity to draw everyone’s attention to subsection (3) of my amendment, which states: “The Commissioner may consider the application without a hearing if they consider it in the interests of justice to dispense with a hearing.” My right hon. Friend is absolutely right that time is of the essence and that there will be situations in which it is right that things move as quickly as possible. I hope that that goes some way towards reassuring him that I am trying to come up with amendments that are balanced. I am aware that we have two different examples here; I am genuinely trying to make sure that I do not make it harder for those genuine cases, because I totally understand how important it is and I understand that there is a lot of pain and suffering, for all the reasons that have been set out. I hope that I am getting the balance right, but I am always happy to have further discussions. Sir James Munby was one of the first to criticise the High Court safeguard; the hon. Member for Spen Valley says that she has taken those criticisms on board. His criticisms of the panel seem similarly acute. I hope that the Committee will agree that my amendment answers a real need and recognises the important role of family in the death of a loved one in most situations, although I accept not in all. It has a profound and long-lasting impact on them too, and their needs should not be entirely disregarded in the name of autonomy. The hon. Member for Rother Valley gave a very powerful speech yesterday on the subject, setting out that the amendment is not required because any decision could be judicially reviewed. I am not qualified to opine on whether judicial review would be relevant with this panel, but I look forward to the Minister covering the matter in her closing remarks. We need to be clear on that front. Judicial reviews are a challenge to the way in which a decision has been made, rather than to the rights and the wrongs of the conclusion reached. It is important that this is understood. A judicial review just checks that the process was followed, not whether the right decision was made. That is why our role in setting the process is so important. If the new clause remains unchanged and there is no requirement for a panel to accept relevant evidence from a family member, there will be no avenue for appeal under judicial review if such information is not taken into consideration when making the decision, because the process will have been followed. Our role on this Committee is a heavy one. It is about getting it right and setting the process for judicial review to work as it should. We have an appeal process in the new clause for when a panel wrongfully turns down an application, but not for when it wrongfully approves one. Why not, if judicial review is available and suitable? I suspect that it is because, as the hon. Member for Rother Valley is aware, the judicial review is not the best way to do it. It is a long, onerous process involving application for permission and, in some situations, the securing of legal aid, which is fraught with difficulty. I say gently to the hon. Member that if judicial review is not suitable when the panel has wrongfully turned down an application, then why is it suitable when they have wrongfully approved someone for an assisted death? I think it is clear that my amendment is needed as a safeguard to prevent wrongful deaths under the Bill. It is a helpful safeguard. No panel will ever want to see someone assisted to die who should not have been, just because it did not have all the information. I suggest that the safeguard will help to secure panel members, because they will feel reassured that a process is in place to avoid mistakes. If my amendment is not agreed to, and if wrongful approvals have to rely on judicial review for a remedy, I suggest that the impact assessment will need to take into account the likely impact on socioeconomic groups that rely on legal aid for funding. I suspect that, owing to a lack of funds, they will find themselves with no avenue at all to appeal. I do not think that any of us wants a two-tier system in which rich families can intervene and poor families cannot.

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

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  I thank the hon. Member for sharing that. It is useful to have these debates and conversations, but I would suggest that the panel needs to be sure off the back of the information that it has been given and the witness testimony, which goes back to why it is so important to ensure that we have that coverage and the right things feeding into the panel so it can get to that high threshold. I would expect the threshold to be at court level, given the huge, significant ramifications of this decision for that person.

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

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  I am making a point regarding if a person fitted the diagnosis in that they are terminally unwell, but it is actually the fact that they have got nowhere to live that is really driving the decision rather than the terminal illness. My apologies if that was not clear. In Oregon there was the case of Barbara Wagner, who had recurring lung cancer. She had been prescribed a drug, Tarceva, which had an excellent record. It increased patients’ one-year survival rate by 45%. Oregon’s state Medicaid provider sent Wagner a letter saying that her insurance plan would not cover the drug, but would cover other options, including assisted dying. Wagner said: “I got a letter in the mail that basically said if you want to take the pills, we will help you get that from the doctor and we will stand there and watch you die. But we won’t give you the medication to live.” Those are her own words, not my words. Recently in Australia, similar cases have been reported of people choosing assisted dying because they were put on too long a waiting list for a home care package. One man said of his mother: “Her pride wouldn’t allow any of her boys to take care of her or to bathe her so she got approved for the assisted dying”, and a few months ago proceeded with it. There are many other situations where everyone would benefit from the panel having broader discretion. Think of one of the cases I talked about earlier—and have done throughout the various Committee sessions—where somebody appears to be a possible victim of coercion, or a case where someone with diabetes, for instance, wishes to bring themselves within the six-month definition by stopping treatment, or someone with anorexia brings themselves within the definition by stopping eating and drinking. The capacity safeguard would not defend them. The courts have found that people have capacity to refuse lifesaving treatment, even if their decision is strongly influenced by other factors. Hon. Members may worry that giving the panel discretion is too open-ended. The truth is that, in our legal system, discretion is the norm. Whether in sentencing guidelines or in custody cases, the law nearly always recognises that sometimes a general rule has to be departed from. If the panel is compelled to make its decisions only by a checklist with no other option, the Bill is saying that the panel is less trustworthy than the courts. If this panel is to be a safeguard, we should be clear about how it functions. It needs to be open to correcting mistakes. It needs to have a clear standard of proof, which will protect people and not just hastily steer them towards assisted death, and it needs a wide degree of discretion if it is truly to be more than a tick-box exercise. I hope the Committee will agree and support these amendments.

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

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  I thank the hon. Member. I would just clarify that currently there is no legal right for a family to provide information to the panel, which is part of the issue. I turn to my amendment (c) to new clause 21. New clause 21 includes provision that, among other things, the panel’s function is to determine whether it is satisfied that the person has capacity, that they have a clear, settled and informed wish to end their life, and that they have not been coerced or pressured. However, it is not entirely clear what “satisfied” means in the new clause. My amendment assumes that, as in a civil court, it means “on the balance of probabilities”. As I understand it, the leading case on the meaning of “satisfied” is a 1964 House of Lords case, in which the court held that “satisfied” meant “on the balance of probabilities”, rather than the tougher test of “beyond reasonable doubt”. In a later amendment, I will propose that we adopt that tougher standard, but this amendment assumes that the current wording will stand. My view, as we have already established in lengthy debate, is that the capacity bar is low, because the doctor need only be 51% sure. On the clear, settled and informed wish and coercion test, the standard is only “to the best of the doctor’s knowledge”, which is not a particularly high bar to meet. We are therefore applying a low bar to a low bar. That certainly leaves us with a highly accessible process, but I suggest that that is not a positive or safe thing. My amendment would bring in a further safeguard. As I have said several times, I would have preferred to see such safeguards in clauses 1 to 3, but as they were not accepted there, I am forced to propose them here, because it is better to have them than not. The amendment would give the panel the ability, if there is a “real risk” that the criteria have not been met, to pause and make further enquiries. They would not be obliged to give a decision that day, but would be obliged to look into the matter further, ask for more testimony, request more documents and consult experts. The real risk test is taken from the jurisprudence of the European Court of Human Rights. Doctors will already be familiar with it, as they are already required under the Human Rights Act to assess when there is a real risk of suicide. It is not a strange novelty. The objection has been raised that introducing a real risk test to the doctors’ assessments would complicate matters, but the panel stage is a distinct stage with a distinct set of rules. I hope that the amendment will be seen not as introducing a complication but as filling a gap, particularly as this stage is meant to be more akin to a judicial stage. Difficult situations will not necessarily be as rare as we hope. On coercive control, those with decades of experience of working with the most vulnerable have warned us time and again what the Bill could mean. Jane Monckton-Smith, one of the leading academics in the area, has said: “Unless we do take this incredibly seriously, this Bill is going to be the worst thing, potentially, that we have ever done to domestic abuse victims.” The consultant clinical psychologist Sue Smith, who specialises in cancer and palliative care, has submitted written evidence from which I will quote at length, because it vividly brings out the scale of the risk of coercive or controlling behaviour: “In my clinical experience working with people who have cancer, a cancer diagnosis and treatment effects can amplify CCB…A woman asking for her needs to be seen and met alongside her increased physical and psychological vulnerability creates a change within the couple, which can lead to violent acts or CCB. The seriousness of the cancer diagnosis may be systematically and actively denied or minimised, claims can be made by the male partner that she is attention seeking, or she is accused of making up the effects of treatment, and can be left isolated and alone when in physical need, e.g. managing treatment effects like nausea or pain that restrict the ability to wash, dress and where she is reliant on others for help. At the same time a male partner may also state, ‘You are better off dead anyway,’ ‘Your children don’t care, and no one else in your life cares about whether you die.’ They may also threaten to leave. This pattern is extremely confusing, harmful and threatening. It continues over time, and a woman learns to doubt her reality and experience, and is extremely isolated. This can lead to heightened anxiety, hopelessness and helplessness, and abject despair, which can lead to a person wishing they were dead. The confidence and ability to know what one needs and wants is severely compromised when her reality is continually minimised or denied and will impact informed decision making.” We can hope that the existing safeguards will catch some of those cases, but they will not catch all cases, so my amendment would go a little way towards improving the safeguards. Amendment (a) to new clause 21 tries to pin down a missing detail, namely the standard by which the panel makes its decision. In a criminal trial, a jury is sent away to consider its verdict. The members of the jury know that they must be certain, beyond reasonable doubt, of the defendant’s guilt. It is not enough to think it likely on balance, nor is it enough that they have an opinion that they can justify with good reasons. It must meet a high threshold. Why is there such a high standard? Because we have to be sure about the decision, given the grave consequences. We are now considering a similar question: what is the right standard for a decision that will make the difference between life and death? I turn to subsections (2) and (6) of new clause 21. We are told that the panel must be satisfied that the eligibility criteria have been met. The word “satisfied” is doing a lot of heavy lifting in the Bill. If a question subsequently comes to court, as has happened in Belgium where there was a wrongful assisted suicide, we will be asking the court to rule on whether the panel should have been satisfied. That raises an obvious question, which my amendment is designed to answer: what does “satisfied” mean? I turn to a real-life example. In a famous case in Oregon, an elderly woman called Kate Cheney sought assisted suicide. She had a terminal cancer diagnosis; she also had dementia, so she was referred to a psychiatrist to establish whether she had capacity. She was accompanied to the appointment with the psychiatrist by her daughter Erika, who seemed extremely assertive about the assisted death. Kate Cheney denied that she was being pressured. However, the psychiatrist noticed that the daughter was coaching her mother. Referring to Kate, the psychiatrist wrote in his report: “She does not seem to be explicitly pushing for this.” He concluded that she did not have capacity to make the decision. The daughter was, in her own word, “incensed” that the psychiatrist was casting such a judgment on her mother. Kate applied for a second opinion and was assessed by a clinical psychologist. He found that Kate did have capacity, but he added that her “choices may be influenced by her family’s wishes, and her daughter, Erika, may be somewhat coercive”. Nevertheless, he gave the green light to the application and Kate received the go-ahead. I ask members of the Committee whether they would be satisfied that Kate Cheney was eligible for an assisted death. Are they confident that colleagues would share the same judgment about being satisfied? Can they be sure that every social worker, legal figure and psychiatrist would be satisfied in the same direction? After all, the psychiatrists in Oregon were divided on it. In written evidence, the most experienced clinicians have urged us to recognise that abuse is difficult to pick up. Sarah Grove, a consultant in palliative medicine, says: “Over my years in practice, I have witnessed families acting for financial gain and not in their loved one’s best interests but in this kind of situation, this has always been impossible to prove.” Dr Kathryn Myers, a retired palliative medicine consultant, says: “I have seen coercion in the contexts of decision-making around the best place of care for patients and of money and property. Perpetrators are usually family members…Occasionally it has been overt and easy to detect, for example, threatening or manipulative words or actions. Most frequently it has been very subtle, one might even say, gentle. It can take skilled clinical nurse specialists highly trained in communication skills and in detecting coercion, who know the person well and who have a relationship of trust with them, several conversations over several days if not weeks to uncover that coercion has occurred.” In such a case, with limited time, a panel may not be certain whether to give the green light to an application. That uncertainty will be even greater if it does not know what evidential standard to employ. My amendment would clarify that grey area. It would bring in a standard that has been tried and tested and is well understood. To be clear, “beyond reasonable doubt” merely means that the panel is sure. The courts have said that the two phrases are equivalent, as has the Judicial College in its guide to judges, “The Crown Court Compendium”: “What is required is a clear instruction to the jury that they have to be satisfied so that they are sure…if an advocate has referred to ‘beyond reasonable doubt’, the jury should be told that this means the same thing as being sure.” The Crown Prosecution Service says: “the magistrates or district judge in a magistrates’ court or the jury in a Crown Court must be sure that the defendant is guilty. Sometimes you’ll hear this described as ‘sure beyond a reasonable doubt’ or ‘satisfied so you are sure’. Importantly, the word “satisfied” by itself is not enough. Juries must be not just “satisfied”, but “satisfied so you are sure”. The wording in the amendment would be equally strong. It opts for “beyond reasonable doubt” because it is a better known phrase and more widely understood than “satisfied so you are sure”. I do not want to get too hung up on which of those phrases to use. The point is to adopt the tried and tested standard that has worked in the courts. We want the Bill to have the highest standards and to protect people. Amendment (a) to new clause 21 would help to achieve that. Members will all be delighted to know that I am moving on to the last amendment.

• 11 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty First sitting) · Hansard source

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  I rise to speak against clause 10 as it allows doctor shopping in the event that someone does not qualify for assisted dying. “Not happy with the verdict? Just find another doctor!” How many times are we happy for a patient to try again with a different doctor? It is inevitable that at some point the patient will find someone willing to make the statement and put them on their way to an assisted death, even if their eligibility is in doubt. When I put forward the amendments tabled by my hon. Friend the Member for West Worcestershire (Dame Harriett Baldwin), which requested residual discretion for doctors, they were challenged by Committee members on the basis that the whole point of having defined criteria was so that they determined whether a patient was eligible. I run the same argument now: if the process is followed to the hilt and the independent doctor refuses to issue the statement, why on earth would we allow another bite—or even multiple further bites—at the cherry? Surely that is to allow abusers a way to push their victims into an assisted death by re-running the process again and again until they find a less attuned doctor. Imagine the case of an elderly woman who has spent a lifetime under the coercive control of her husband. She is completely done with it all, and sees death as a welcome way to escape this man, who has made her life a misery. The abuse has escalated since she has become ill: because of her ill health, she cannot cook or clean any more, and he hates that. But no one sees. She never wanted the kids to know; she is really good at hiding it. Now, he wants to seek an assisted death, because it is better for them all. She agrees. When asked by a doctor, she is unlikely to say, “My husband is pressuring me into this, and I’m afraid of not doing what he wants,” particularly if she has suffered abuse over many years. Let us say that the first independent doctor does a really thorough job—the kind of job that we hope all doctors would do. Perhaps the doctor manages to discern that the patient is very much controlled and unduly influenced by her husband. The trouble is that it can be very difficult to find hard evidence of coercive control. According to recent figures, only 3.7% of recorded cases of controlling or coercive behaviour result in a charge, and more than half of cases are dropped because of evidential difficulties. The doctor therefore cannot get the police to intervene; his only lever is the power to reject the application. So that is what he does. But the patient does not give up; she is still absolutely sure that the best thing is an assisted death, and her abuser is still whispering in her ear, telling her she is right. The second independent doctor does not have the same emotional intelligence as the first, and he does not see what the first doctor saw. He approves the application.

• 11 Mar 2025 · Prisons: Urgent Notifications · Hansard source

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  I thank the Minister for that answer. Prison officers do an important job, and I thank every officer at Downview Prison in Banstead. It is extremely concerning that the number of assaults on staff at Downview more than doubled between 2023 and 2024. What steps is he taking to ensure that officers are protected in their day-to-day jobs?

• 10 Mar 2025 · Crime and Policing Bill · Hansard source

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  Thank you for giving me the opportunity to speak, Madam Deputy Speaker. I want to thank Surrey police for all they do to keep us safe in Reigate and Banstead. I welcome much of what is in the Bill and I will not repeat what has already been said. Instead, I will focus my remarks on what I believe is required to tackle the scourge of commercial sexual exploitation in this country. It is easy for people to think that sexual exploitation does not affect them and that it does not happen in their neighbourhood, but it is more common than many realise. It is happening behind closed doors on very normal, everyday streets. Sexual exploitation, often of young women, is an awful crime that destroys lives before they have barely had a chance to begin. Exploited repeatedly, day in, day out, those young people are treated as merchandise, with the sole purpose of turning a profit for pimps and traffickers. It is incumbent upon us to break the business model, starting by outlawing the advertising of individuals for prostitution. Classified ad sites, like Vivastreet, are rife with it. They are the Etsy of sexual exploitation, fuelling sex trafficking by providing a convenient centralised platform for sex buyers to access what they want in their local area. Buying sexual services can be as easy as ordering a pizza. Although prostitution is legal, pimping, which is the provision of a prostitute to perform a sex act with a customer for gain, is not. There are often tell-tale signs on the adverts, like the same phone number being used for multiple ads, that the women are not acting freely and willingly, and that they are under the control of a pimp, who is profiting from their exploitation. Such sites have had years to get to grips with it, but still not enough is being done to weed out those adverts. However, we must take some responsibility too. Hon. Members will no doubt be staggered to hear that such advertising of prostitution is entirely legal, because legislation has not kept pace with technology. Advertising prostitution in a phone box is illegal under section 46 of the Criminal Justice and Police Act 2001, yet when the same advert is online, it is not illegal. That is utterly absurd. In 2023, the Home Affairs Committee cited evidence in its report on human trafficking that 75% of victims of trafficking for sexual exploitation are advertised online. The cross-party group concluded: "Websites advertising prostitution significantly facilitate trafficking for sexual exploitation.” I strongly urge Ministers to take this opportunity to close that loophole. There is a similar issue with the regulation of online pornography compared with offline pornography. Our current laws have not been updated quickly enough to recognise the huge shift online and the need to apply the same standards across the board. A survey by the Children’s Commissioner in November 2022 found that one in 10 children had seen pornography by the age of nine, with half having seen it before they turned 13. The impact of that travesty can be clearly seen, with 47% of young people between the ages of 16 and 21 stating that girls “expect” sex to involve aggression. Huge damage is being done to young women and men by this damaging content, which normalises and sexualises the choking and strangling of women during sex—illegal in offline pornography but not online pornography. Although not illegal per se, degrading acts, like spitting on women, are commonplace in online porn, so is it any wonder that we are seeing such disdain for and poor treatment of girls in our society? If we are serious about tackling the issue and halving violence against women and girls, we must crack down on online porn and ensure it is regulated to the same standards as that which is offline. The independent pornography review, led by Baroness Bertin, recommended that there be parity of regulation between online and offline pornography, which I very much welcome. The main statutory regulator of offline pornography is the British Board of Film Classification. It is responsible for classifying pornographic content before it can be published and ensuring it does not contain illegal content. Any such offline illegal content cannot be sold or supplied in the UK, and the same rule should apply online. That simple change could be transformational if effectively executed and properly enforced, although I recognise the technical and practical challenge of trying to regulate the worldwide web. I thank the Secretary of State for listening to my two asks. I look forward to hearing from her whether she is receptive to accepting amendments to ban online prostitution adverts, and to bringing the regulation of online pornography in line with that for offline pornography.