Rebecca Paul MP: speeches

Speeches

• 19 May 2025 · Pubs and Community Funding · Hansard source

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  I thank the hon. Lady for that contribution. I would welcome any clarity from the Minister about that. In Redhill, we have an amazing pub called the Garibaldi, which is a community pub—a not-for-profit pub—that gives back to the community in so many ways. On walking in, you feel the warmth straightaway from Shiv, Juliette and the other volunteers, who are always there to give a welcome with a smile. There is always something going on: quizzes, karaoke, Bhunnys street food—even a book club. My personal favourites are the forces fry-ups for veterans on a Saturday morning—sometimes I go along to help serve the tea, coffee and toast; I normally do it quite badly—and the music bingo. Out back, there is the community garden, which has been transformed with the help of the Garibaldi gardening group volunteers. It is now accessible to everyone, including young adults with special needs who visit with YMCA East Surrey. Every bit of profit the Garibaldi makes gets ploughed back into things that benefit the community. It is there for the benefit of Redhill residents, not for any other reason, and it is extremely good at what it does. That is incredibly clear whenever I visit. People from all walks of life are sitting side by side with friends and neighbours enjoying a chat and a drink, all part of making the Garibaldi the special place that it is.

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

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  The evidence is clear that palliative care does not get better when assisted dying is introduced; we heard that in the Bill Committee. We should absolutely look to address palliative care, because that will benefit more people. I will come to that point later in my speech, so I will not discuss it any further now. I do not want to get ahead of myself. There are many helpful amendments in this vein—namely, new clause 16, new clause 9 and amendments 80, 14, 38, 81, 24, 30 and 31. In simple terms, they seek to tighten and refine the eligibility criteria for an assisted death by setting out when and for what reasons an assisted death should be allowed, and by ensuring that those who are vulnerable are protected from something that may not be in their best interests. Interestingly, on Second Reading the argument put forward for assisted death was that those who are dying should be spared unbearable pain. This is an argument that everyone understands and has full sympathy with. No one in this place wants people to endure pain as they come to the end of their life; I certainly would not want that for my loved ones or indeed for myself when my time comes. But then the arguments being put forward changed. There was less emphasis on pain, and more on choice and autonomy. The word “autonomy” came up again and again in Committee—and autonomy is important, of course, but up to a point. From a proposal to provide a humane end to someone’s pain when it cannot be relieved in the last months of their life, we have moved to a proposal to provide an assisted death service to those who choose it for any reason, even if the pain can be alleviated by palliative care. This approach, however, comes with a cost to others: family, clinicians and broader society. This really is momentous. There is no going back from such a massive shift. A move to autonomy trumping everything else changes everything.

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

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  I thank my right hon. Friend for making that point; he is absolutely right. I have tabled amendment 80, which would bring the Bill back to its original intentions. It would require that in order to be eligible for an assisted death, the pain and discomfort experienced or expected from a person’s terminal illness could not be reasonably relieved to their satisfaction through palliative care. It seeks to limit assisted death to the very small group of people who may benefit from it, not the larger group who just need adequate palliative care to give them the comfortable, dignified death they deserve.

• 23 Apr 2025 · Hospitals · Hansard source

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  I am grateful for the chance to speak in today’s debate and to be able to give voice to so many of my constituents’ frustrations about how their right to access quality healthcare has been deprioritised by this Labour Government. Many of my constituents, especially those in the north of my constituency, are served by the Epsom and St Helier university hospitals NHS trust. To be blunt, the situation at the trust today is simply not sustainable—clinically, financially or structurally. The trust currently operates two acute hospitals, in Epsom and St Helier, with duplicate services spread across both sites. The arrangement, while a product of historical necessity, today places considerable pressure on clinical teams. Allocation of staff members between sites is challenging and service delivery is stretched. No matter how committed the staff—their dedication is beyond question—they are constantly being asked to do more with less, in buildings that are often quite literally falling apart around them. To give just one brief example, earlier this year St Helier was forced to cancel scheduled blood tests because of widespread flooding in the phlebotomy section. We simply cannot go on like this. Indeed, time is not a luxury we have, with the estate now deteriorating faster than it can be fixed. The trust is spending millions every year simply to keep the most urgent problems at bay: patching leaks, coping with flooding, and addressing the worst outbreaks of damp and mould. I think we all agree that these are not the conditions in which 21st-century healthcare should be delivered. That is why it was so disappointing to learn earlier this year that the planned specialist emergency care hospital in Sutton—a long-standing scheme under the new hospital programme that was carefully conceived to address the very issues I have mentioned—has been delayed to the point that work will now not even begin until 2030 to 2035, with opening coming in 2037 at the earliest. The new hospital will consolidate emergency care into one state-of-the-art facility, delivering world-class treatment, faster access to care, and safer outcomes. At the same time, it will allow for major investment at Epsom and St Helier hospitals, helping to modernise crumbling buildings, improve planned care pathways and ensure that most services remain close to home. Under the trust’s plans, 85% of services would remain on the Epsom and St Helier sites, including out-patient care and diagnostic appointments. Local people would continue to receive the vast majority of their care where they always have done, but would benefit from shorter waiting times and access to better facilities, particularly for surgery. I passionately believe that the new hospital at Sutton is a once- in-a-generation chance to overhaul healthcare provision and ensure that my constituents receive the high-quality care they deserve in a timely fashion.

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

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  I rise to support new clause 34, which clarifies that assisted dying is not a medical treatment—not only because of the principle behind it, which I have talked a lot about already, but because of the unintended results. We need to recognise that many laws, rules and regulations have been written using the word “treatment” that never envisaged assisted dying being included. Every bit of law that refers to when treatment can be given, with or even without consent, such as section 63 of the Mental Health Act 1983, will become a potential problem if assisted dying is technically viewed as a medical treatment. New clause 34 is therefore essential to protect the meaning and integrity of the current law and to protect patients in future. In written evidence, Professor David Jones points out that there are dangerous consequences to classifying death as a medical treatment. As a general principle, he observes: “If an effective medical treatment cannot be self-administered orally then other routes should be considered, including those administered by a healthcare professional.” We can immediately see the problem that will arise if assisted dying is a treatment. The view that such a treatment can be administered by a healthcare professional suddenly moves us into euthanasia territory, which is clearly not the intention of the Bill. Professor Jones goes on to say: “If a treatment effectively reduces distressing symptoms in one category of patient (adults at the end of life), then it should be considered for treating other categories of patient”. If we substitute the word “treatment” with “assisted dying”, we get a wholly unacceptable approach that could open the way to offering assisted dying to under-18s, as in Belgium, or to people whose psychological suffering is unbearable, as we have seen in Belgium and the Netherlands with the euthanasia of people with mental health conditions. Finally, Professor Jones says: “Where a patient does not have capacity to consent to medical treatment then doctors should provide whatever treatment is ‘of overall benefit’ to the patient.” If we substitute the same words, we can see that once again it leaves us with a big issue. The Bill already has requirements relating to capacity, age and physical illness, and a requirement for self-administration, but the point is that by classifying assisted dying as a medical treatment we are making those requirements less stable and introducing the potential for conflict within the existing law. We are inviting future Parliaments to question why they are there in the first place. Why arbitrarily restrict this medical treatment when we do not restrict other treatments in the same way? If we do not rule out assisted dying as a medical treatment, we are potentially opening the Bill up for challenge by the courts when assisted dying treatment is limited to certain groups. That is one reason why the Association for Palliative Medicine has explicitly backed the principle represented in the new clause. It has said in written evidence that defining death as treatment would be “contrary to all prior medical practice and public expectation, and laden with risks of unintended consequences.” The Bill may look set in stone, but the law can easily be amended in future, for instance by amending a major health Bill. What we decide in this Committee could have major consequences in a few years’ time. I urge that we future-proof the Bill now by explicitly declaring in it that assisted dying is not a medical treatment, so that the issues I have set out will not arise at any point.

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

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  I apologise to my hon. Friend; I probably should not have used him as an example in that way—it is getting late. I actually think that this clause would benefit more those organisations that support assisted dying. It would ensure that they have the right people who support it working in there. We want patients to get the support and everything that they need.

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

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  I have real sympathy for that situation, because no one wants to see that. That is why it is really important to be clear up front. I would like care homes and hospices to be clear with their policy, so that when people make decisions about where to have their care or where to live, they can take it into account. I totally recognise that in the situation we have, if the Bill went through in two years’ time, there would be some people who were already settled in care homes where they did not know the policy, because it was not relevant at the time they moved in. I totally take the point that there are downsides to the provision, but it is important to include it to get this right in the long run. I hope Members will agree that amendment 481 seeks to make it easier for hospices and other institutions to deliver on their policy, whatever it may be, by ensuring that they can require their employees to comply. It would also leave space for palliative care to flourish by not imposing burdens on people who work in the sector. Let me turn to new clause 23. I have talked about one challenge for the hospice sector, but it is not the only challenge. The past few years have been a challenging time, given the rising cost of living and rising demand for hospice services. Hospices play a vital role in local communities by providing high-quality, compassionate care at the end of life, and I pay tribute to their work. They face huge financial pressures that put their essential work in jeopardy and could lead to unprecedented closures. In oral evidence, Dr Cox said: “The first thing to say is that palliative care is currently inadequate. Not only do we need to ensure that it does not decline, but we need to massively improve it so that this Bill offers patients a real choice. We know that effective palliative care can change a terminally ill person’s point of view from wanting to die to wanting to live. We also know that 25% of people who die in this country do not have the palliative care they need. That is more than 100,000 people a year. Providing palliative care, which might make their lives better, reduce their suffering and even change their perspective on whether they would want assisted dying, should be our priority in reducing suffering in this group.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 70, Q84.] I also remind the Committee of what Dr Clarke said: “There are hospitals, and mine is one currently, where we do not even have a 24/7 palliative care service face to face. Every night in my hospital, and every weekend from Friday to Monday, you cannot see a palliative care nurse or doctor, despite the fact that for a number of years that has been an NHS standard. That is an absolute disgrace and it shows how little people who are dying are truly cared for in a civilised society. It does not necessarily have anything to do with assisted dying, except that if we do not address that simultaneously, some of those people will “choose” to end their life, because we as a society do not care about them enough to give them the care that might make life worth living. Surely that is a travesty for Britain.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 76-77, Q94.] I remember being quite moved when she said that. Although we are limited in what can be done through the Bill to rectify funding for palliative care, we can ensure that it is not further impacted detrimentally by the introduction of assisted dying. New clause 23 seeks to protect hospices from further funding pressures arising specifically from the Bill, because there is a risk that public funding becomes dependent on offering assisted dying. The new clause would ensure that public authorities could not make funding conditional on the provision of assisted dying, and could not subject care homes or hospices to any other detriment merely on the grounds that they do not permit such assistance to take place on their premises. The new clause reflects a serious concern in the hospice sector. St Gemma’s hospice in Leeds warns in written evidence: “If compliance with assisted dying provision becomes a condition for NHS funding, institutions like St. Gemma’s may have no alternative but to cease operations entirely given its reliance on NHS funding for its financial sustainability. Such closures would have devastating consequences for the communities we serve, eliminating high-quality palliative and hospice care options for thousands of terminally ill patients annually. If patients in our catchment area could not be cared for by St Gemma’s, this would, at a minimum, reduce the degree of choice for many and put at risk the availability of palliative care across large parts of the city. Patients would be admitted to hospital or would die at home in a way that is difficult to reconcile with the palliative care ethos of choice, quality of life and quality of dying. This would increase demand on a health and care system that is already under unprecedented pressure, leading to devastating outcomes.” That is a real possibility, as shown by the fate of the Irene Thomas hospice in British Columbia. It was known as a sanctuary for dying people who did not want to be in a setting offering assisted dying, but the province adopted a policy that required hospices to provide assisted dying if they had over 50% funded beds. After the hospice board voted not to offer assisted dying, its 1.5 million Canadian dollars of public funding was cut, its clinical staff were laid off and it was taken over by the regional health authority. We should be honest about the possible threat to palliative care. This is a much-debated subject, so I will lay out in some detail the evidence that assisted dying may be detrimental to palliative care. It is true that the Health and Social Care Committee concluded that palliative care did not deteriorate where assisted dying was introduced, but a recent report by Professor David Jones looked at the issue more forensically and found: “This conclusion, however, was based on the selective evidence that the Committee received from respondents, much of which was irrelevant, outdated, or speculative. In contrast, a more complete review of better and more recent evidence shows ‘clear indications in several jurisdictions of palliative and end-of-life care deteriorating in quality and provision following the introduction of AD / AS, and a negative impact on some healthcare professionals.’” In his study, Professor Jones found that some of the evidence on which that Committee based its conclusions was highly unreliable. For instance, it was partly based on Canada committing to spend 6 billion Canadian dollars on palliative care and home care over 10 years at the time that assisted dying was legalised. The money was not ringfenced, however, so five years later, only 184 million Canadian dollars could be shown to have been allocated to palliative care. Other evidence was also out of date. For instance, Belgium’s spending on palliative care was cited, but that covered only 2002 to 2011, and that spending appears not to have been sustained. In his lengthy analysis, Professor Jones cites a wealth of evidence for his conclusion. He examines the data and finds that, between 2012 and 2019, European countries without assisted dying increased palliative care provision more than three times more than countries with assisted dying. Between 2015 and 2022, Belgium, Canada and the United States fell out of the top quartile in the world ranking for quality of death and dying, while the United Kingdom remains in first place. Between 2015 and 2019, the number of palliative care teams in hospitals increased by 3.2% in US states with assisted dying, but by 9.4% in non-assisted dying states. Clearly, there is a competition for resources between palliative care and assisted dying. In 2023, for instance, New South Wales cut spending plans by 249 million Australian dollars after increasing palliative care spending.

• 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.

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

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  It is a pleasure to serve under your chairmanship, Sir Roger. I rise to speak to my amendment 468 to clause 9, which would ensure that the assessing doctor must “ask the person why they are seeking an assisted death.” We have heard a lot in this Committee about the importance of the patient-doctor relationship. My hon. Friend the Member for Solihull West and Shirley said that we should be “trusting in the judgment of clinicians, who know their patients well” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 26 February 2025; c. 634.] He also said that patients “may want to speak to their GP because they have had a relationship with them over 30 or 40 years” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 25 February 2025; c. 481.] It is therefore worth asking how the Bill shapes the patient-doctor relationship. The Bill asks doctors to do many things to and for patients. It asks doctors to consider whether to raise the subject of assisted suicide; personally, I wish we had agreed to the amendment that would have ensured that it was the patient who brought the subject up first, but we are where we are. The Bill asks doctors to explain the patient’s diagnosis and prognosis and to lay out options for treatment and palliative care, if there is any available; if there is not, the doctor can only state that point and move on. Nevertheless, we are asking the doctor to look into the matter and lay out possibilities. The Bill asks doctors to check for capacity and for coercion, to ascertain whether the patient has a clear, settled and informed wish to end their own life, to witness declarations and, eventually, to give the patient a substance and oversee the patient taking it. In other words, it makes doctors absolutely central to the process, as the facilitators of the process, as the people who accompany the patient and as the professionals with the biggest responsibility for ensuring that the safeguards are followed, yet it never asks doctors to make a simple but vital inquiry: why? That is all that my amendment would add. It would simply require the assessing doctors to ask the person why they are seeking an assisted death. I hope that the Committee will agree that that would be a reasonable and not overly burdensome change. Some hon. Members have suggested that certain amendments embroider the Bill too much, but in this case, the patient-doctor conversation is already embroidered. The Bill makes some very specific demands of the doctor as to what the conversation should cover. Surely it is only natural, amid all the conversations, for the doctor to take a moment—perhaps more than a moment, but a moment at the very least—to help the patient to talk through their reasons. This is a very vulnerable moment in somebody’s life. The simplest of questions can often unlock the most information. In some cases, for the small number who would benefit from the Bill, the answer would probably reassure the doctor, but for those others we worry about, the question would provide another important safeguard. It would be another opportunity to check that this really is in the best interests of the patient. How would the conversation go? I do not think that we can generalise. It might be the briefest exchange or it might lead to a really searching discussion. Doctors know how to take their cue from the patients in these things. Crucially, the doctor’s role is not just to offer advice or information. Even if the doctor says nothing, it may make all the difference for the patient to be able to speak aloud their concerns, their confusion and their hopes and fears. I absolutely accept that many doctors, if not most doctors, would ask the question why anyway, but given its importance, I still urge the Committee to set that out in the Bill. In doing so, we would be affirming that this is more than a bureaucratic exercise; it is about a person and about getting to the truth of what they want and need. I do not think we should not make the mistake of assuming that every doctor has the time, or will take the time, to have the in-depth conversations needed to really understand what is driving a patient’s request. It is up to us to make legislation that keeps standards high at all times. There is currently nothing in the Bill that will guarantee an in-depth conversation. I am afraid that not all doctors believe that that is even a likely outcome. In written evidence, the GP Edward Tulloch states: “To conduct the required assessments outlined in 7.2 and 8.2 of the Bill within a standard GP appointment (lasting 10-15 minutes) is completely unrealistic. It will require multiple appointments to properly carry out such detailed discussions and complete the associated legal paperwork.” We all know what pressure the NHS is currently under. Many of us cannot get a GP appointment. So, how certain are we that adequate time can be allocated to the assisted dying process to ensure the criteria are truly met? By putting the “why” question on the face of the Bill, my amendment would bring us closer to the possibility of real, serious and honest conversations about a patient’s reason for seeking an assisted death. That would be especially helpful for those who have just received a terminal diagnosis. We have received some important written evidence from six palliative care doctors, who state that “our experience is that many patients experience a period of adjustment to ‘bad news’ and may say that they cannot live under these conditions. However, after a period of reflection and adjustment, the majority come to find peace and value in their altered life circumstance, in a way they would not have believed possible.” The consultant psychiatrist Jennifer Bryden provides an especially interesting perspective, as someone who has seen this from both sides: “Having gone through several long episodes of illness, I now know that feeling entirely useless and a burden to everyone is a phase that will pass. For many people a terminal diagnosis will be their first time through the cycle and they will believe those thoughts represent reality. In coming to terms with a severe illness, depression is an expected phase and learning to accept all humans need each other takes time”. Dr Bryden goes on to say that the current cooling-off period is not enough time for people to come to terms with such a diagnosis. Clearly, people may need all the help they can get to understand their new situation. Asking the patient for their reasons is only the beginning of that process, but one that may help them come to terms with their situation and validate, or not, their initial inclination. Finally, asking why can identify those patients who are being coerced or pressured. Nobody should think that that is easy to spot. According to the charity SafeLives, which counters domestic abuse, it takes the average person who experiences violent abuse 2.3 years to access effective help. In the year before they finally get help, 85% of victims will have sought help of some kind from an average of five professionals. Often, sad to say, those who missed the signs will have been healthcare professionals. That is for physical abuse; psychological abuse will be far harder to spot. We cannot put in enough safeguards to ensure that doctors have all the tools they need and all the opportunities they can, to spot those signs.

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

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  I will come to that exact point shortly. Members of the Committee will recall that I previously tried to get “undue influence” and “encouragement” added to the Bill explicitly to deal with more subtle forms of influence and pressure, as opposed to those that are more obvious to third parties. When objecting to my amendments, the Minister said that they were unnecessary, because “coercion or pressure” already covered them. I hope that the Minister is proven to be correct. The key point is that those forms of behaviour are not always easily discernible. Dr Mullock told us in oral evidence that “the kind of undue influence that might occur might be very subtle. More needs to be done to recognise that and the subtle encouragement that might take place, where a relative might frame their support for the person seeking to die in terms of, ‘This will be better for you,’ and, ‘Have you considered this?’ That is not necessarily an example of clear abuse, so when the person seeking to die then consults the doctor, they are not going to characterise what has happened to them as coercion or abuse. More needs to be done to discuss with the person whether or not they have been encouraged by the people around them.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 162, Q204.] These are the very real consequences of this clause, which undermines the independent doctor safeguard. In written evidence, Mr Michael Vidal hits the nail on the head: “It seems to negate the purpose of having a second opinion if the second opinion can be ignored and a fresh second opinion obtained.” I recognise and welcome the fact that amendment 459 has been accepted. It would mean that the second independent doctor would have the benefit of the report of the first independent doctor. However, this is not a failsafe protection and cannot be relied on entirely. First, the report of the first independent doctor is required to be made available to the patient. In a case such as this, would the first doctor want to spell out exactly what led to that conclusion, knowing that it could place the patient in harm’s way if her husband saw it? Also, he is not 100% sure; does he want to make such accusations in writing without hard evidence? Secondly, even if the report was detailed and available to the second independent doctor, he would still need to make his own assessment, and he might not agree. Or it could be that although he recognises signs of coercion over a long period, he may truly believe that, to the best of his knowledge, the decision made by the patient has not been coerced in that moment. I am afraid therefore that clause 10 is a loophole that will be exploited by domestic abusers, and it is largely women who will pay the price. For that reason, I cannot support it.

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

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  I thank all Members for their contributions. I echo the hon. Member for Spen Valley when I say that this is one particular case where we all agree on what should be happening functionally and practically. We have had some quite technical arguments today about the meanings and definitions of certain words and how they would apply. It has been a constructive and interesting debate. As a first-timer to a Bill Committee, it has been a great experience. It is clear from the evidence received and the contributions from Members that subtle coercion is something we are all concerned about and recognise needs to be dealt with. We have heard powerful stories today and from witnesses in recent weeks, so it is incumbent on us to listen and take action. One of the points that resonated with me yesterday was that made by the hon. Member for Bradford West. I am now paraphrasing a little bit: essentially, she said that we are not legislating for a perfect world where everyone is treated equally; that our society is filled with inequality, and we must legislate for the reality, not for the rose-tinted version that we would all prefer. Coercion and undue influence does happen more commonly than we might think, and it is hard to detect. It is therefore vital that when we go through this Bill, we always have the most vulnerable at front of mind. It is not about when everything works perfectly, as intended, for the very small group of people who would benefit from the Bill, but what happens when it does not work, and the impact on a potentially bigger, more vulnerable group. That is the crux of our roles here today. I thank the Minister for her very informative and helpful speech setting out the Government’s position on legalities of the various definitions. There will, however, be different legal opinions on this. I sought advice from former Attorney General Victoria Prentis KC, who takes a different view. I am very aware that when it comes to going through the courts, there will be different interpretations and views. I am not a lawyer, so I do not know which is right, but I do know that if I put this amendment on the face of the Bill, it is there and it is safer. That is where I am coming from on this. I reiterate that we do see these terms “coerced”, “pressured” and “unduly influenced” in various bits of legislation. Those words are chosen for specific reasons. It is important to note that. On encouragement, I am going to talk again about the purpose of the amendment. Right now, under the Suicide Act, assisting someone to commit suicide is a crime, but encouraging someone to commit suicide is also a crime. Clause 24 of the Bill decriminalises the assistance piece to allow legalisation of assisted dying, but it does not decriminalise the encouragement piece. I have tabled amendment 82, because we need to address that. The clause is limited to the provision of assistance and does not include the encouragement of a person to end their own life. I understand the concerns of my right hon. Friend the Member for North West Hampshire about how “encouragement” could be interpreted, which is a really good point. I also take the point that although it is referred to in the Suicide Act, there is no clear definition, so we are relying on case law. If we all came to this with a blank bit of paper, we might come up with different laws. However, we have laws that are already in place, and that is why I have tabled this amendment. The reality is that encouragement of suicide is a criminal activity right now, which is why we need to address it here. On undue influence, the Minister set out that the amendment is not legally necessary. The hon. Members for Rother Valley and for Penistone and Stocksbridge gave interpretations of this point, but I gently point out that they contradicted each other, which shows how complicated the situation is. Different people will have different views. The hon. Member for Penistone and Stockbridge said that “undue influence” is a term in equity, and that it is not proper to have it as part of the criminal offence of coercion in clause 26, but the hon. Member for Rother Valley said that coercion in that provision does not include undue influence. Does that not show that the legal meaning of the Bill is unclear and would benefit from some clarification? Amendment 23 on undue influence first appeared on the amendment paper on 21 January, almost three weeks ago. My understanding from those who were previously in government, including at the Ministry of Justice, is that when an MP tables an amendment that is legally unnecessary, the Government would seek to meet them, together with Government lawyers, to explain why the Government believe the amendment is legally unnecessary and to give them time to reflect. It is my understanding that, with respect to the amendment in the name of my hon. Friend the Member for South Northamptonshire (Sarah Bool), that was not done. She met the Bill’s promoter, the hon. Member for Spen Valley, on Monday, but they did not discuss the amendment on undue influence. Similarly, my amendment 82 on encouragement appeared on the amendment paper on 4 February, over a week ago, and I have had no communication from either the Government or the Bill’s promoter about it. The first time I or my hon. Friend the Member for South Northamptonshire have heard that our amendments might be legally unnecessary or problematic is today. When formulating my amendment, I had the benefit of advice from former Attorney General Victoria Prentis KC, who has written a letter to The Times endorsing it; the Minister will appreciate that I would not want to withdraw my amendment without the benefit of further advice from her, so I will press it to a vote. However, if there are any points of technical drafting relating to the amendment that the Government would like to deal with through tidying-up amendments, I would very much welcome that. What has come out of this conversation is that it is not straightforward or clear; there are some things that need to be thought through, including the interactions between clause 24 and clause 26 and the various definitions, so that we are being really clear. I am open to doing that in the most suitable and appropriate way.

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

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  My hon. Friend is very knowledgeable about these things and is well qualified on the legal side. I value his contributions on this matter. The reason I want to include “unduly influence” is because it deals with those more subtle forms of coercion. Arguably, it could be included in “coerced or pressured”, but by including “unduly influence” in the Bill it becomes more explicit that a clinician has to be looking for it. In the absence of the language, clinicians will not be required to look for those more subtle forms of influence. The provision is something that is included in the assisted dying laws of other jurisdictions. We have the opportunity here to learn and benefit from jurisdictions that have already implemented it. We heard various witnesses give us very useful evidence during the sessions. For example, California includes “undue influence” in the law. We should recognise that there is value in including it here. It is a well-established legal term that is used in myriad situations, so it is relevant that we include it.

• 29 Jan 2025 · Terminally Ill Adults (End of Life) Bill (Fifth sitting) · Hansard source

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  Q I have a quick follow-up. What you said about palliative staff generally being against assisted dying was very interesting. Briefly, what are the drivers or key reasons for that? Toby Porter: I am conscious that two palliative care doctors are sitting to my left, but I would say that it is quite constitutional. The World Health Organisation definition of palliative care talks about neither hastening nor prolonging death. There tend to be very strong feelings about that, but others might be better placed to answer. Dr Hussain: I would echo what Sarah Cox said yesterday. For the vast majority, it is the worry about how it impacts all those other people. In principle, the majority of people I have spoken to—we see the patients who want it and would benefit. It is everyone else and the Pandora’s box of risk we are opening that is mainly our worry. Dr Neerkin: People are worried that palliative care is going to lose funding based on this—that is one aspect. There was an interesting article in The Lancet last month by my colleague Libby Sallnow about the risks. Palliative care in the UK is gold standard relative to the rest of the world. If we start to change what we are doing here—introduce assisted dying and say that that is potentially a preference—that may therefore be replicated elsewhere without implementing palliative care. Those are some of the worries that people have, but that is not to say that, individually, people are not supportive.

• 4 Sept 2024 · Engagements · Hansard source

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  Q12. I am new to this House, but I know that we all want our pensioners to live with dignity and security. In my constituency around 17,000 pensioners are expected to lose their winter fuel payment this year. Of most concern are those just above the pension credit threshold, who will be hardest hit. Will the Prime Minister consider broadening eligibility for the winter fuel payment, so that those low-income pensioners who rely on it to stay warm can continue to benefit?