Sarah Olney MP: speeches

Speeches

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

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  The hon. Member is exactly right. An assessment of whether somebody should qualify for assisted dying needs to be based on objective criteria. If those are not met, the only way that a second independent doctor should have a role is if either the circumstances have changed or, for whatever reason, the first doctor is unable to reach a conclusion. There must not be a situation in which the first doctor has made one decision and a second doctor arrives at a different decision, because that would imply a variability in the way the objective assessments are made. Not tightening this loophole would imply that we are prepared to allow such a variability across the medical profession, and I do not think we should allow that. My final amendment in this group is amendment 460. I am concerned that the word “particular” in clause 10(3) negates the subsection’s purpose of ensuring that only one second opinion from the co-ordinating doctor can be sought, because a person could withdraw their first declaration, make a new one and start the process afresh; that declaration would then not be the “particular” first declaration. By removing “particular”, the loophole would be closed, and the safeguard would be made more effective. This concern was brought out well in Disability Labour’s written evidence: “We are concerned that whilst 10(3) only allows for one second opinion to be sought, there appears to be nothing in the bill that stipulates a waiting period before a new application can be made. This risks applications being repeated until a supporting opinion can be obtained, thus negating the purpose of 10(3).” I hope the Committee will accept my amendments.

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

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  Will the hon. Gentleman give way?

• 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 will speak to my amendments 458 to 460, which would tighten the process around seeking a determination from a second independent doctor if the first has refused to say that the criteria are met. The amendments relate to clause 10, which I will say more about when we come to it, but they have been selected for debate in this group. The risks of abuse in seeking a second independent doctor’s opinion are well illustrated by the evidence we have received from Dr Sharon Quick, the president of the Physicians for Compassionate Care Education Foundation, who tells us about the experience of Dr Charles Bentz, who refused to provide a second opinion for a physician-assisted suicide for a patient he had referred to an oncologist for cancer treatment. The co-ordinating doctor persisted and clearly found a compliant second opinion, as two weeks later his patient was dead. Dr Charles Bentz said in his testimony: “I was caring for a 76 year-old man who came in with a sore on his arm. The sore was ultimately diagnosed as a malignant melanoma, and I referred him to two cancer specialists for evaluation and therapy. I had known this patient and his wife for over a decade. He was an avid hiker, a popular hobby here in Oregon. As he went through his therapy, he became less able to do this activity, becoming depressed, which was documented in his chart. During this time, my patient expressed a wish for doctor-assisted suicide to one of the cancer specialists. Rather than taking the time and effort to address the question of depression, or ask me to talk with him as his primary care physician and as someone who knew him, the medical oncologist called me and asked me to be the ‘second opinion’ for his suicide. She told me that barbiturate overdoses ‘work very well’ for patients like this, and that she had done this many times before. I told her that assisted-suicide was not appropriate for this patient and that I did not concur. I was very concerned about my patient’s mental state, and I told her that addressing his underlying issues would be better than simply giving him a lethal prescription. Unfortunately, my concerns were ignored, and approximately two weeks later my patient was dead from an overdose prescribed by this doctor. His death certificate, filled out by this doctor, listed the cause of death as melanoma. When I reviewed his chart, the radiation oncologist documented a clear diagnosis of depression. My patient did not die from his cancer, but at the hands of a once-trusted colleague who failed to recognize and treat his depression. This experience has affected me, my practice, and my understanding of what it means to be a physician. What happened to this patient, who was weak and vulnerable, raises several questions that I have had to answer.” I appreciate that, under the Bill, Dr Bentz could not have been the independent doctor as he already knew the patient and was treating him, but in that case that contributed to enhanced safety. Dr Bentz’s example illustrates the real risks of abuse in a person being able to seek the opinion of a second independent doctor. The starting point is that the task of the independent doctor is not that of a normal doctor. It is not to cure the patient or to provide advice about medical treatments: it is to check whether the eligibility requirements are met. It is a decision-making function, not a medical one—albeit, of course, a decision-making function that is informed by medical expertise. In the light of that function, it is not appropriate for someone to seek another decision simply because they do not like the answer that has been given. The independent doctor is asked to apply an objective set of criteria against the evidence in front of them in order to make an assessment. It is not the case—or it should not be—that a different doctor would come to a different assessment based on the same criteria and the same evidence. If we are doing our job properly in the Committee, we should not expect that a second opinion could be arrived at. I have no objection to provision being made for a person to see a second independent doctor if the first did not manage to finish the task. Nor do I object in respect of cases in which there is a change of circumstances—for example, if the patient’s condition deteriorates to such a degree that although the first independent doctor thought the six-month prognosis test was not met, it becomes clear that it is met—which is the point of my amendment 458. In such circumstances, it would make sense to allow the patient to go to a second independent doctor. Although my preference in such a situation would be to go back to the original independent doctor and ask them to reconsider in the light of the change of circumstances, that may not always be possible. Amendment 458 is an attempt to find a middle ground. Amendment 459 seeks to reduce the possibility of abuse by ensuring that the second independent doctor has available the reasons why the first independent doctor concluded that the person was not eligible. That would allow the second independent doctor to approach the assessment with open eyes. Such a report would be particularly useful when it comes to the detection of coercion or pressure, as the first independent doctor might have spotted something that the second independent doctor might not easily see. Let us consider the evidence of Dr Tim Howard, who has been deeply involved in end-of-life palliative care and assisted dying for many years. He has been a non-exec director of a health authority, a member of an ethics committee, a postgraduate teacher and, finally, chair of the General Medical Council fitness to practise tribunals, dealing with complex medico-legal principles and decisions in public. He also helped to set up the Medical Practitioners Tribunal Service, which separated medical standard setting and investigation from adjudication. Dr Howard says: “I remain uncomfortable that when either doctor, the assessing doctor or the independent doctor, declines to agree with a request for” assisted dying, “they take no further action. I feel that the reasons for their refusal should, as well as being given to the patient, be recorded in the patient’s notes, and given to any ‘second opinion’ independent doctor. This is not an attempt to bias; it is a value judgement that criteria are not being met, and as such, is sharing an early warning to be extra careful.” The Committee should note that he has, in his own words, “been a strong proponent of medical assistance in dying…and a member of Dignity in Dying for many years.”

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

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  I am grateful for amendment 6 and to my hon. Friend the Member for St Albans for tabling it. I put on record, however, that I do not think that the panel that we are discussing addresses my earlier concerns. I wanted to make that absolutely clear by highlighting the further evidence from the Association for Palliative Medicine. The panel proposed by this group of amendments does not address its concerns, or the concerns of many other people who were saying that there needs to be a multi-professional team.

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

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  I will speak briefly about an important point that the hon. Member for Spen Valley made. I want to get it on the record that I disagreed with something that she said. We heard a lot in the evidence sessions about the desirability of a multidisciplinary approach or a multi-professional team, and I listened particularly carefully to Dr Sarah Cox, who gave oral evidence to the Committee on 28 January on behalf of the Association for Palliative Medicine of Great Britain and Ireland. She made important and interesting points regarding the desirability of the involvement of multidisciplinary teams in relation to her area of expertise: palliative care. I am anxious that the panel that the hon. Member for Spen Valley is now proposing is being presented as a response to the comments of Dr Sarah Cox in relation to multi-professional teams, when it is clear that she meant something quite different. My interpretation of what she said was that the initial assessment should be done by a multi-professional team; what is being proposed here is something that happens much later in the process.

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

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  I am not used to my amendments being accepted. The hon. Gentleman is, of course, absolutely right. Dr Matthew Doré, the palliative medicine consultant and honorary secretary of the Association for Palliative Medicine, said in written evidence: “Allowing patients to seek multiple opinions undermines procedural integrity. Furthermore, allowing the coordinating doctor to seek multiple opinions even further undermines the selection of doctors willing to provide AD”— that is, assisted dying. He goes on: “The lack of a centralised tracking system facilitates ‘doctor shopping’.” Notwithstanding the fact that amendment 459 has now been accepted, there is still grave concern about the possibility of doctor shopping. We should take steps to avoid it. That is why I am speaking against clause 10 in its entirety. Under clause 8, the independent doctor has five matters to verify: that the person is terminally ill; that they have capacity; that they have a clear, settled and informed wish to end their own life; that they are acting voluntarily and without coercion or pressure; and they are over 18. The last requirement is unlikely ever to be in any form of doubt, so I will focus on the other four. The effect of clause 10 is to allow someone to be assisted to die when one out of three doctors who examined them had concluded that they were not terminally ill, that they lacked capacity, that they did not have a settled wish to die or they were coerced. It therefore raises a real risk that someone not actually eligible for assisted dying would none the less be so assisted. In such matters of life and death, we ought to proceed with great caution. Doctors can get things wrong, of course. If the first independent doctor did get it completely wrong, I would have no objection to the second independent doctor effectively acting as a form of appeal—or, to borrow the test from the law of medical negligence, if the first independent doctor reached a conclusion not supported by a reasonable body of medical opinion, of course it would be right for that opinion to be disregarded. But that is not what the Bill provides for, which is not an appeal or reconsideration but picking a new referee simply because the first answer was not desired. I still have misgivings about clause 10 notwithstanding the fact that it has been amended. I urge other Committee members to vote against it. I appreciate your indulgence, Ms McVey.

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

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  I beg to move amendment 461, in clause 11, page 7, line 15, leave out “or otherwise”.

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

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  I reiterate the concern I raised when speaking to my amendments this morning: as far as I can see, seeking the second opinion of a second independent doctor allows the person seeking assisted suicide to have a second bite at the cherry if their first independent doctor has not granted permission. I do not think anyone has an objection to going to a second independent doctor if the first independent doctor has been unable, through either death or illness, to complete the task; nor is there any objection if there has been a material change of circumstances, which my amendment 458 sought to add. However, the possibility of seeking the view of another doctor simply because the first one did not give the desired answer is a troubling one. There is no objection to patients seeking a second, third or even fourth opinion in medicine when it is about what different treatment pathways might be available, but there is a crucial difference between seeking different appropriate treatment options and what is being proposed in the Bill. In the Bill, the function of the two doctors is not primarily diagnostic or advisory; it is a safeguarding role. The doctors will have been entrusted by Parliament to make sure that the criteria for assisted dying are met. Their determination makes the difference between a lawful act and the commission of an act that, as per clause 24, Parliament would still regard as sufficiently serious to be a crime. Their role is therefore that of a decision maker, and in no other setting can someone go to a different decision maker if they do not like the answer given by the first. Even in appeals before our courts, an appellate judge would not interfere with a decision simply because they would have reached a different conclusion; the appellate judge must consider that the decision was in some way incorrectly reached. It is also true that in some settings one can ask a decision maker to reconsider a matter, but that is not what is being proposed in clause 10 either. Instead, the clause allows the person to try again with a different referee if the first one did not give the desired answer. It is true that there is an added layer of protection from the High Court or the possibility of a panel, but under the Bill as it currently is there is no procedure whereby the High Court or the panel will hear from the first independent doctor. That is concerning. They would have to go simply on the basis of the second independent doctor, without any awareness of why the two disagreed.

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

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  I am glad to have had that clarification; however, it is really important to reflect on the fact that Dr Sarah Cox said that it would be considerably preferable to have the input of a multidisciplinary team at the earliest possible stage. That is not what is being proposed with these new clauses.

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

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  I thank the hon. Member, but I think she is responding to a slightly different point from the one that I made. There was further written evidence from Dr Doré, the honorary secretary of the Association for Palliative Medicine, on 25 February. He wrote: “To clarify any misunderstanding, the current Bill does not align with the standard multi-professional team…decision-making process used across the health service. Under the Bill, patient assessments are conducted solely by two doctors without input from a wider MPT. While an amendment proposes the involvement of a panel—including a social worker and psychiatrist—this panel is introduced only at the end of the process and does not participate in the patient’s direct assessment. We wish to make it clear that the point that Dr Cox was making in oral evidence was that having two independent doctors, working alone, is not an adequate model to safeguard either patients or professionals, and that stipulating that the initial assessments must be carried within a multi-professional team model would strengthen the Bill.”

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

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  I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Amendment made: 206, in clause 11, page 7, line 24, leave out subsection (3).— (Kim Leadbeater.) See the statement for Amendment 188. Clause 11, as amended, ordered to stand part of the Bill.

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

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  The amendment would remove the phrase “or otherwise” in the clause. All I am proposing is for the wording to be consistent with amendment 205 to clause 10, which has just been agreed. It does not specify “or otherwise”, but simply uses the words, “the practitioner dies or through illness is unable or unwilling”. What might “otherwise” incorporate? It indicates that there might be a range of reasons beyond death or illness why the co-ordinating doctor would drop out. In many ways, I am trying to probe what the other reasons might be. If there are no other reasons, and consistent with amendment 205 that we have just agreed, we should drop the phrase “or otherwise”.

• 6 Mar 2025 · Cyber-security: Local Government Resilience · Hansard source

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  The US Defence Secretary, Pete Hegseth, has this week announced the stepping back of US counter-cyber measures against Russia. This incredibly concerning decision by the Americans threatens not only their cyber-security, but our own. The Russian Government have been accused of orchestrating a widespread campaign of interference and disinformation that seeks to undermine the global order. In 2020, the UK Parliament’s Intelligence and Security Committee stated that the Government had underestimated the response required to the Russian threat. Can the Minister tell us what further measures the Government are taking to protect British democracy, and will he commit to publishing the full, unredacted Russia report?

• 6 Mar 2025 · Political Finance Rules · Hansard source

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  I thank the hon. Member for South Dorset (Lloyd Hatton) for his work in securing this important debate, and Members from across the House for their contributions this afternoon. The Liberal Democrats support this motion, which aligns with our long-standing stance on political finance reform and protecting democracy from foreign influence. We have long called for reforms to prevent foreign interference and increase the transparency in political donations. We support strengthening the Electoral Commission by restoring its independence and increasing its enforcement powers, including higher fines for breaches of political finance laws. Our democracy should never be up for sale to foreign billionaires, oligarchs, or hostile states and, as such, we support this motion, which acknowledges some of those risks. The Liberal Democrats will continue to push for strong measures to protect our political and electoral system. We want to take big money out of politics by capping donations to political parties. I am proud that my hon. Friend the Member for Stratford-on-Avon (Manuela Perteghella) presented a Bill in this House to do just that. And we want to enhance regulatory powers to protect British democracy from the unprecedented threat posed by foreign interference and attacks on our democracy. Liberal Democrats will make protecting our democracy a national security priority. We are seeing record levels of disillusionment with the political process, with citizens becoming increasingly disengaged. Research from the Electoral Commission highlights a significant drop in the rate of public confidence in political finance transparency, falling from 37% in 2011 to about 15% today. It has also recently pointed out the threat of foreign influence on social media, highlighting the rise in misinformation and artificial intelligence deepfakes in the run-up to the general election in July last year, as well as new issues arising from the changes to fact checking on popular websites. Public trust in our electoral process was not helped by the disastrous record of the former Conservative Government. It was not just their successive sleaze scandals, which created a crisis of democracy in this country, or their exorbitant voter ID scheme, which disproportionately disenfranchises the young and those from ethnic minority communities, but their shameful decision to weaken the independence of the Electoral Commission, and that is a decision that will go down in ignominy. If we are to strengthen our democratic safeguards, and correspondingly strengthen public trust in our democracy, that has to start with empowering the Electoral Commission. That is why we need to reverse the Conservatives’ changes. We want to strengthen the Electoral Commission by repealing the Government’s power to designate a strategy and policy statement for the commission. The former Conservative Government also failed to take the threat posed by Russia seriously. They were content to allow Russian money to flood into the UK and also to allow Russian money to flow into the coffers of their own party. And the manner in which Boris Johnson let the Russia report sit on his desk was shocking. When that report was finally published, it laid bare the extent to which Russia is a threat, including to our democratic institutions. The report said: “The UK is clearly a target for Russia’s disinformation campaigns and political influence operations and must therefore equip itself to counter such efforts.” It called Russian influence in the UK “the new normal” and said that the Government had underestimated the response required to the Russian threat. We continue to call for the full publication of the unredacted report. The Russian Government have been accused of orchestrating a widespread campaign of interference and disinformation that seeks to undermine the global order. In September 2024, the heads of MI6 and the CIA jointly warned that the international order is under threat in a way not seen since the end of the cold war, accusing Russia of a “reckless campaign of sabotage across Europe”. I hope that the Minister shares my concern that this week United States Defence Secretary Hegseth has announced the stepping back of US counter-cyber measures against Russia. That is an incredibly concerning decision by the Americans, which threatens not only their cyber-security but our own. Will she update the House on what measures the UK is taking to step up our defence of our democratic institutions? We will continue to urge the Government to designate protecting our democracy as a national security priority. Turning to foreign oligarchs, it would be remiss of me not to mention Elon Musk. Let us recall that just weeks before Musk became a US Government official, he suggested that America should liberate the people of Britain and overthrow the UK Government. I hope that other parties will join the Liberal Democrats in unequivocally condemning such remarks. That incident further proves that we urgently need to tighten up political funding. That includes a cap on big donations. We must prevent foreign oligarchs from being able to interfere in our democracy. The Liberal Democrats want to take big money out of politics by capping donations to political parties, and we support the motion. A fair cap will ensure that politics serves our constituents and not big money. Over two thirds of the British public support a cap on political donations. We must deliver the reforms that people are demanding.

• 6 Mar 2025 · Relations with the EU · Hansard source

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  Two weeks ago, I was glad to read reports in The Times that the Government intend to introduce a youth mobility scheme between the UK and the EU. That would be good for our economy, while providing young British people with the opportunity to work and study abroad. That is what the British public want, with new polling showing that more than two thirds of the UK population are in favour of such a scheme, but last week the Home Secretary ruled it out. Will the Minister do the right thing, remove the unnecessary barriers facing young people in the UK and commit to negotiations on an EU-UK youth mobility scheme?

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

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  We need to consider the possibility that somebody is suffering from a terminal illness as a comorbidity with an eating disorder; they may be suffering from an eating disorder alongside something that can be considered a terminal illness—there are such cases. However, it is not unknown—and Chelsea Roff, an expert on eating disorders, who has given evidence to the Committee both orally and in writing, has uncovered a number of occasions in jurisdictions where assisted dying is already legal—for an eating disorder to be defined as a terminal illness. It is really important that we understand that there remains a risk that an eating disorder could be a terminal illness.

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

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  I am grateful for that intervention and, dare I say it, for the one from the right hon. Gentleman. That is the whole point about eating disorders: there is a very fine line to be trod between people who have capacity, people who lack capacity and people who have capacity but who can still be allowed to make an unwise choice, which is obviously a huge risk for people with eating disorders. I find that risk very much magnified in the Bill as it is currently drafted, which is why it is of the utmost importance that it provides specifically for the possibility that somebody is suffering from any kind of mental health illness, and particularly from an eating disorder—but I do not see such a provision at the moment. I heard the arguments that were made when I raised this issue in earlier sittings, and I very much welcome amendment 6, but it deals only with capacity; it does not talk about mental illness. To conclude, amendment 363 is a crucial safeguard that would prevent assisted dying from becoming an unintended route for people suffering from mental health conditions, such as eating disorders, to end their lives prematurely. It would ensure that requests for assisted death are based on genuine, rational decisions, rather than symptoms of a treatable disorder. By aligning with best practice from other jurisdictions and addressing a critical gap in the UK’s current approach, it would strengthen the ethical foundations of the assisted dying Bill and better protect vulnerable individuals.

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

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  I believe I repeated several times in my speech that this is not about capacity; it is about mental illness.

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

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  Let me just reply to the hon. Member’s original point. It is so important—and this is why we need the amendment in the Bill—that if there is any doubt at all that someone is suffering from a treatable mental health condition, they are not allowed to proceed with their request for an assisted death until all avenues of treatment for that condition have been explored. Eating disorders are treatable: people can recover and can, in the fullness of time, recover their zest for life. They can move beyond the stage where their decision whether to eat or not is their entire world. They can rediscover their friends, their employment and their education, and they can look forward to a full life again. But it is imperative that while they are in the grip of that eating disorder, they are not offered the option of an assisted death.

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

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  I beg to move amendment 363, in clause 7, page 4, line 7, at end insert— “(ba) is not seeking assistance to end their own life because of an impairment of judgment arising from a mental disorder or other condition,”. This amendment would require that the coordinating doctor is satisfied that a person is not seeking assistance to end their own life due to an impairment of judgement arising from a mental disorder or other condition. It is linked to Amendments 364, 365, 366 and 367.

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

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  Does the hon. Gentleman assert that it is therefore impossible for anybody with a mental illness that might affect their ability to make a decision about an assisted death to be judged to have capacity?

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

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  The hon. Member is absolutely right. The Court of Protection has described eating disorders using language typically reserved for terminal illnesses. It has described an eating disorder as being in “the terminal stage”, talked of “all treatment options” having “been exhausted” and used words such as “incurable”. It is immensely regrettable, but nevertheless the case—even though eating disorders are always treatable—that if a person suffering from an eating disorder is deemed to have capacity and is refusing treatment, there may well be nothing that can be done to stop them choosing that path, which may ultimately lead to their death.

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

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  Will the hon. Gentleman address the point that the requirement to refer for specialist psychiatric support is a requirement in similar legislation in other parts of the world—in Oregon, in California, in the state of Victoria in Australia, and in other jurisdictions that we heard evidence from? It is written into their legislation and provides a crucial extra safeguard, which is separate from the judgment about capacity because it is deemed to be so important.

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

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  Although this is not specified in any of the amendments—which are in the name of my good friend, my hon. Friend the Member for Bath (Wera Hobhouse) —they are very much informed by the work she has done over a number of years as the chair of the eating disorders all-party parliamentary group. This is a subject about which she has a great deal of knowledge, and that is what has prompted this group of amendments, which follow on from the debate we had just before the break. It is important to remember that although amendment 6 —in the name of another good friend, my hon. Friend the Member for St Albans (Daisy Cooper)—talked specifically about people’s capacity, this group of amendments very much returns to a topic I have spoken on at length in previous sittings: how a person’s capacity to request an assisted death might well be impacted if they are suffering from mental health difficulties. Amendment 363 would require a mental health assessment if there is any indication that a person’s judgment may be impaired by a mental disorder or other conditions. We have debated this topic at length— [ Interruption. ] I see the right hon. Member for North West Hampshire nodding, but it is worth returning to the issue, because a principal concern of mine is that we have not yet dealt adequately with this risk in the Bill. We have talked about how the Mental Capacity Act might be applied and about psychosocial interventions, but I am keen to see amendment 363 agreed to, because it would deal with many of the objections raised in those other debates. It is an important safeguard that still needs to be included in the Bill. The Bill has been described as having the strongest safeguards in the world, but it lacks this critical safeguard, which is seen in many similar laws around the world, including Oregon and California, which require that in addition to establishing mental capacity, doctors must ensure that a person’s judgment is not impaired by mental illness. In fact, in the American state of Hawaii, every patient who requests an assisted death is required to see a mental health professional, who can determine whether the patient is capable and appears not to be suffering from under-treatment or non-treatment of depression or other conditions that may interfere with their ability to make an informed decision. It is provided for specifically and clearly in the legislation that governs assisted dying in other jurisdictions that assessments of the state of people’s mental health—and not just their capacity—must be made properly. The absence of any such safeguard in the Bill represents a clear risk. We know that mental health conditions can impair decision making and lead to suicidal ideation, particularly when a person lacks adequate social support. Without this provision, individuals experiencing a treatable mental health crisis may be given life-ending medication instead of the care and treatment that could alleviate their suffering. Professor Allan House made the importance of that clear in his written evidence. He wrote: “Simply checking mental capacity and asking about coercion is not adequate.” He emphasised that National Institute for Health and Care Excellence guidelines in other areas already require a comprehensive psychosocial assessment that explores “thoughts about life not being worth living” and considers “current and recent personal and social circumstances, recent adversities, psychological state beyond merely assessing mental capacity and the presence of severe mental illness.” Professor Louis Appleby, the Government’s adviser on suicide prevention—I have referenced him on many occasions in previous sittings—has also raised concerns that the Bill could undermine suicide prevention efforts. Speaking to The Guardian , he said: “You have a number of potentially remediable risk factors like isolation, for example. Do something about isolation. Depression, treat depression. It should be the offer of supporting people through the remediable elements of a sense of despair.” That highlights why a safeguard is necessary to ensure that individuals receive proper assessment and treatment, if needed, before making an irreversible decision. If a person qualifies for assisted dying but is also experiencing impaired judgment due to a psychiatric condition, how can we be confident that their decision is truly autonomous? Amendment 363 would require the co-ordinating doctor to assess whether a person’s request for assisted dying is influenced by a mental health condition. If there is any concern that impaired judgment due to a mental disorder is a factor, the doctor must refer the individual for a psychiatric assessment. The amendment would explicitly protect individuals with mental health disorders, including eating disorders, from accessing assisted dying when their desire to die is a symptom of their illness rather than a rational decision deriving from a terminal illness. Do not ask me how I know this, but eating disorders really scramble a person’s brain. They leave them entirely incapable of making any kind of rational decision. The lack of nutrition really affects the brain: it has a physical impact that means the brain simply cannot function as it is supposed to. That is a direct cause of a person not ingesting the nutrients they need. When that happens to somebody, their behaviour completely changes: they become anxious, fearful, irrational and aggressive. It is not just that they believe their life is not worth living; the entire span of their life has shrunk down entirely to the question of how they can avoid eating. What is the next meal? What is the next stage in their life when someone is going to try to get them to eat, and how can they avoid that? What tactics can they employ? When a person is in the grip of that kind of eating disorder, if someone comes along and offers them the possibility of an assisted death, there is every chance that they will choose that as a way of avoiding eating. As I say, do not ask me how I know this, but I have seen it, and for me it is beyond comprehension that we could possibly allow young people, and young women in particular, to put themselves in the position where they are being offered an assisted death and no one is taking those extra steps to treat their eating disorders—and eating disorders are always treatable. That is why I want to press the amendment.

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

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  That is why we need to ensure that people with eating disorders get the treatment they need, instead of being offered an assisted death. That is why we need the amendment.