Naz Shah
MP for Bradford West · Labour · United Kingdom
“Outside of this conflict, I have stood shoulder to shoulder with the minority Christian community in Jaranwala in Pakistan against their persecution. The justice that I believe in means that I have a moral duty to stand with them too.”
“There is also a fundamental question about Israel’s legal authority to take that action. It is not the British embassy in Israel; it is the British consulate general, which represents the United Kingdom in Jerusalem, the west bank and Gaza, and conducts our relations with Palestine.”
“What is it like to live in a conflict zone where someone who is a journalist, like Hamza al-Dahdouh, can be killed in an Israeli airstrike, or, like Shireen Abu Akleh, can be shot dead while doing their job? Years later there is still no accountability to bring about justice for their families.”
“We also have a particular historic and moral responsibility when it comes to Israel and Palestine, given the Balfour declaration, the British mandate and our country’s historical role in the region. But even putting that history aside, whether we like it or not, conflicts elsewhere affect the lives of people right here in Britain.”
“I also want to bring to the House’s attention today’s report by B’Tselem, an Israeli human rights group. It is the most comprehensive report to date on the west bank, gathering evidence from over three decades of Israel’s human rights violations and 2,000 testimonies since October 2023. The report is called “The Elimination Project”.”
“Their deaths show the extraordinary danger faced by aid workers trying to feed civilians in a warzone. Israel acknowledged serious failures in the strike and dismissed two officers, yet the families of the World Central Kitchen workers have called for independent accountability—that call is falling on deaf ears.”
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“Is the hon. Member aware that in nine of the 10 cases that went before the Court of Protection, the young ladies were deemed not to have capacity, but the judge still decided that it would not be in their best interests to feed them, and they were put on palliative care pathways?”
“Apologies, Mrs Harris: I was late returning to my seat earlier and missed the opening remarks from the hon. Member for Richmond Park on this amendment. I am happy to be corrected, but my understanding is that, as it is, if somebody has anorexia—we are not talking about capacity, which I referred to in the cases of the nine girls I spoke about—that is an accepted mental health condition and the amendment is trying to exclude those people from having an assisted death. In the nine cases I spoke of, the court found that those girls with anorexia had capacity and ruled that they had a terminal illness.”
“Sorry—they did not have capacity, but the Court of Protection still ruled that they would be taken down the route of palliative care. This is not just a matter of capacity; in this instance, when we talk about mental health—before we even get to the capacity question—the issue is that anorexia is a recognised mental health condition. I beg to differ from my hon. Friend the Member for Sunderland Central on whether we have enough provision. We keep coming back to this issue time and again.”
“For me, the crux of the issue is that if someone has a mental health condition that then, by definition, becomes a terminal illness—regardless of the capacity conversation—this amendment surely strengthens the safeguard for them. By and large, this involves women who experience anorexia so this conversation is very gendered. I am happy to be corrected. That is all I have to say on the matter.”
“I thank the right hon. Gentleman for his intervention. When I came to this place, somebody said to me, “There’s the letter of the law and there’s the essence of the law.” As lawmakers, we make indications, and so do judges. By not opposing something, does that mean that by default we are supporting it? That is the question here for me. In those cases, those judges accepted—as he says—that those girls would inevitably die. Although the judges did not state that they put the girls on a palliative care pathway, by default, in my understanding, that was a palliative care pathway because it was accepted that those young girls were going to die by not being fed. It is just a matter of semantics for me. I come back to the debate that we have just had.”
“I rise to speak to amendment 21, tabled by my hon. Friend the Member for Lowestoft, which is about the second, independent doctor. We debated amendment 20 earlier, and I am genuinely very pleased that the promoter of the Bill accepted that amendment. Some of what I would like to say now will be repetition, because it is a similar amendment, but I will try to keep my remarks contained and shorter. I am not sure whether the promoter of the Bill is planning to accept amendment 21 as well as amendment 20 —for both doctors. I will be happy to give way if she wants to clarify that now.”
“Only this afternoon, I came across some research from the Kent and Medway NHS trust. In addition to research from last year, it has been found that women will kill themselves when they experience domestic abuse. For the first time, the number of women killing themselves as a result of domestic abuse has overtaken the number of women who are killed from domestic violence in intimate partner relationships. Bear with me—I will return to the research from the Kent and Medway trust in a moment, because I cannot seem to locate the statistics I wanted to point out. Either way, I want to support my hon. Friend the Member for Spen Valley to get this Bill right.”
“From a safeguarding perspective, the Bill’s impact is very gendered. It is International Women’s Day this week, and this is a very heightened issue. We celebrate women in this place because we do not have equality for women in our systems, across the globe and in this country. From the research and evidence we have had, we know that this Bill would impact more upon women, so it is important that we extend the training. As I suggested earlier, I would be happy to work with my hon. Friend the Member for Spen Valley to look at tabling another amendment and strengthening this safeguard, because I really want to get this one right. Although I talked about this earlier, there are some statistics on suicide that I did not mention, which is why I want this training.”
“Oh, perfect. I am really pleased that my hon. Friend will accept both amendments 20 and 21, tabled by my hon. Friend the Member for Lowestoft. Amendment 21 is about training. Although I welcome the amendments being accepted, my concern is that the amendment for training does not go far enough. We are talking about repeated coercion here, and my hon. Friend’s intention with the amendment was for people to be trained in picking up repeated coercive control. That is very different from domestic abuse, in terms of its manifestation and how it is picked up. From lots of evidence we have received, both written and oral, we know that coercive control is hard to detect. When it is repeated coercive control, it is even harder. I want the Bill to be strengthened, especially when it comes to minoritised communities and older people.”
“When it comes to women from ethnic minorities who have cultural differences, potentially including language barriers and different understandings of coercion, it is even harder to tease out their experience in any assessment from the first doctor or second doctor. I would therefore welcome any strengthening of the amendments.”
“I thank my hon. Friend. I agree with his previous point, as well as the point made by the promoter of the Bill that the training that will be provided under this Bill should welcome that conversation with women, especially those who are victims of domestic abuse. I have now found the research I wanted to share. Tim Woodhouse is a suicide prevention expert from Kent and Medway council, and he carried out research over five years until 2024. He estimated that about 30% of all suicides in that sample of people, largely women, experienced domestic abuse. Woodhouse estimates, in the UK as a whole, that “over 1,800 lives are being lost in domestic abuse related suicides every year.” He described that as “a scandal, and national tragedy,” and I completely agree with Tim’s assertion.”
“I beg to move amendment 301, in clause 8, page 4, line 39, leave out “7” and insert “14”. This amendment would increase the period of reflection to 14 days.”
“This is such a monumental decision, so that a patient has to be assured that they are making the right decision and have had time to really reflect on it and contemplate all other options available to them. The process appears to be very rushed, and a patient could be caught up in the moment of getting through the stages. It will be intense. There will be lots of information. There may be new things for the patient to consider. Having a proper break clause would enable a patient proper time to reflect and consider in detail everything that has happened in the process to date, and then to contemplate their further options. We know that patients often need to hear information several times before they fully absorb what is being said and what is happening.”
“In line with good practice, extending the reflection period is important. I spoke about that at length when we debated my amendment 277. It is important for the patient to be able to fully explore their options and seek wider counsel before determining to take the route of assisted death. This part of the process is perhaps the most important. The period after a patient has completed their assessment and received court approval or that of the commission and panel—should the Committee choose to change this—will be the main period where they determine whether they want to go through with ending their life. It is right to ensure that the legislation provides time.”
“Therefore, extending the period to two weeks—although that is arguably still too short a timescale—would be good practice. It would be in the interest of the person and of the carers, as we know from other jurisdictions that family often say that the process was too quick for them to be able to absorb. It could also enable a patient to make alternative choices. In medicine, practitioners want patients to make informed decisions and to have time to assure themselves of the choices they make. In the light of the Committee’s vote to block the amendment that would have ensured that a palliative care specialist was involved in the counsel to support someone with decision making as they are dying, it is right that more time is given for patients’ considerations. Amendment 317 would provide 28 days, not 14, for second period of reflection.”
“Issues of intensity, such as someone planning to take their own life, should not be rushed. We know from all the work that has been undertaken on suicide that other interventions, conversations and reflections can help with reflection and reconsideration. It is important that people are given that opportunity. The first time a patient raises the matter with their doctor, the doctor would have provided them with lot of alternative information—for instance, on what treatment options are available. They might also have had a palliative medicine consultation to review their options. There needs to be time for the patient to really reflect on all that new information. We know that when people are presented with information, it takes time for them to absorb and analyse it.”
“This Government are trying to protect the NHS, and the best way of achieving that is to ensure that medical interventions are sought and provided at the earliest opportunity before a patient deteriorates. Giving someone who is dying within the terms of this legislation longer to reflect—just a further week—removes such pressure from GPs or consultants and enables them to properly prioritise their patients. It does not build a false expectation in patients that they have a right to rapidly have a consultation. Likewise, we know that it can currently take weeks, if not months or over a year, for patients to see another consultant, but the clause does not suggest that. It would therefore be helpful and better for the patient to have a more realistic period before moving to the next stage of their assessment.”
“These amendments were tabled by my hon. Friend the Member for York Central. Amendment 301 seeks to provide a time of reflection of 14 days, not seven. As somebody pointed out, the industry standard for returning something bought in a shop far exceeds the cool-off period set out in the Bill. The reality is that the NHS is under such duress, with patients waiting weeks to see their GP for anything other than urgent treatment, that being able to get an appointment with a GP in seven days is something that we are unlikely to see. It is right that doctors are able to triage their patients to ensure that those who require medical interventions to keep them well, prevent hospital admissions, or stop them deteriorating or even dying, are seen as a priority.”
“I appreciate the right hon. Gentleman’s comments. He referred to the same thing twice, yesterday and today, and I just want to clarify it. He said that most people are ill for a while. I have a genuine question. I do not have the research, but my understanding, as a member of the public and a Member of Parliament, is that for many people who get a terminal diagnosis of six months, it will have been very sudden. Does he have any research to suggest that most of these patients will have been on the kind of trajectory he describes?”
“I want to explore that point a bit further. When I talk about a period of reflection, I am referring to the evidence that we have had from psychiatrists, who said that people’s abilities would be impacted in this situation. That is where the amendments are coming from. To come back to the previous point, is there any research or evidence that would back up the claim that many cases are longer-term illnesses, rather than people who have just got the diagnosis?”
“I am trying to understand. My hon. Friend is saying that the oncologist is a specialist, but that they might not be the first doctor to have the first discussion; he said that they might not want to be a part of this process. I would like to understand that a bit more.”
“From what I hear, my hon. Friend is supportive of the amendment. Does he agree that it just sets out what he says is best practice? I am trying to understand the objection to setting out good practice on the face of the Bill.”
“Clause 4(4) would require a generalist to work alongside a specialist to secure the understanding of a patient’s diagnosis and prognosis. Once again, I recognise that my hon. Friend the Member for Stroud suggested that that already happens and does not need to be tied up in law. However, I feel the amendment gives us more protections if we are to make the Bill safe. It would then enable specialist clinical advice to be provided in the conversation about treatment options.”
“I rise to speak to amendments 285 and 286, tabled by my hon. Friend the Member for York Central. On amendment 285, we have to understand that, in medicine, clinicians only retain the areas of expertise in which they have clear confidence. I am grateful to my hon. Friend the Member for Stroud, who made very powerful points that, if anything, actually support this amendment. This is why we have developed a health system with so many specialities. Although generalists have incredible knowledge, they cannot confess to the depth of understanding that someone who dedicates their career to a speciality has. Therefore, the amendment seeks to draw on such knowledge rather than assume that a GP, for example, specialises in all fields of medicine.”
“This measure would therefore be in line with normal medical practice. I hope that hon. Members will support the amendments.”
“Amendment 286 would set out the requirements for the co-ordinating doctor and ensure that the standards are upheld throughout the process of assessment, so that the patient and clinician have the highest levels of advice available. Even though the co-ordinating doctor might already have sought the advice of specialists as part of their assessment, the purpose of having an independent doctor is to assess the patient without preconceptions influenced by the co-ordinating doctor’s decision-making process. It is therefore important for the clinician to have access to the same level of advice to inform their clinical decision making. In medical practice, should a second opinion be sought, the person providing that second opinion might consult a range of sources to establish an opinion.”
“The hon. Member makes a valid point. That brings us to a very important question: do we wait for something to have happened? In this instance, people will have died. If we were considering kidneys, for example, and the issue of consent, it would require somebody independent. It needs a specialist. We come back to the point about specialisms: whether they relate to diagnosis, coercion, the care pathway, palliative care or the drugs that bring a person’s life to an end, which we will discuss later, these are specialisms. I know that later my hon. Friend the Member for Spen Valley will speak to her amendment about the panel, which is intended to require expertise. That is what amendment 285 speaks to, and I hope hon. Members will support it.”
“The Minister’s point speaks to what my hon. Friend the Member for Stroud and I have spoken about in relation to the amendment, so I wonder which bit he supports. The Minister says that there will be extra time, but my hon. Friend pointed out that doctors do this routinely, so the objection is only that it will be on the face of the Bill. I just want to understand the Minister’s position on that.”
“I have mentioned this point a few times and have raised it with the Minister, and I appreciate that the Minister has responded, but this is where my frustration—for want of a better word—comes from about not having an impact assessment in the first place. If we had had an impact assessment, the Government would have looked at these things. Even with small Bills, we go out to consultation for weeks and weeks. With this Bill, we have not spoken to anybody during Committee stage about the nuances of the provisions on languages and what they will mean for patients. Although I support the essence of what the amendments are attempting to achieve, they fall short of providing the necessary protections. I do not know how the Government will address that.”
“I would really value a response from the Minister and from my hon. Friend the Member for Spen Valley to these questions about the nuances of having such a difficult conversation. These are really brave conversations, both on the doctor’s side and on the patient’s. Take a woman from an ethnic minority background whose first language is not English and whose doctor is unable to translate their conversation with her. Would that conversation be disempowering? Would it be empowering? Would we be doing a disservice to that person, with the best will in the world from the doctor? I really would like to understand what consideration is being given to making this accessible, if it is to be a service and a piece of legislation that is open equally to all.”
“In a previous life I chaired the largest mental health charity outside London for ethnic minority communities, and I am a former NHS commissioner, so when we talk about health inequalities and patient intervention, I understand acutely the nuances involved in translating from one language to another. In the first instance, there is a language that someone does not understand. In the second instance, particularly for minority communities who speak languages from the south Asian subcontinent such as Punjabi, Urdu or Hindi, the words do not exist to translate the Bill literally or to talk about assisted death. That speaks to the point that the hon. Member for Reigate made about understanding what it means. I have the same stats that she cited, which show that people do not understand what assisted death is.”
“Like the right hon. Member for Dwyfor Meirionnydd and the hon. Member for Reigate, I will not press the amendments to a vote, but I certainly want to speak to them. I do not think that they go far enough. Let us put ourselves in the position of people of colour: if the English language is seen as superior to or more powerful than Welsh, that means an extra layer of intervention that I do not think the amendments quite capture. We have not even talked about British Sign Language in our discussion of languages, but it is also really important. I am a qualified interpreter from Urdu to English—in health, funnily enough—and I can tell the Committee that in Urdu there is not even a word for depression. The word for depression does not exist.”
“Assisted dying is much too important to be allowed to operate without strong scrutiny by the press, the public and ourselves in Parliament. I therefore urge hon. Members to vote for both these amendments.”
“There is no doubt that these services will continuously need improving. If we keep these records and understand that these conversations have been had then, ultimately, should this Bill become law, these records would form part of the data collection that we could rely on as parliamentarians and for those service improvements. The amendment speaks not just to the Bill itself, but to ensuring that it continues to do what it is intended to do going forward. These amendments improve equality in assisted dying. That, in turn, will make it far easier for us in Parliament, for our constituents and for the media to find out what is happening with any assisted dying system. In this country, we believe in open justice and open Government.”
“It is also vital for the reporting mechanisms to be deployed for the process by which the chief medical officer compiles their report. That is ultimately what Parliament will be able to scrutinise. Both these amendments would greatly improve the quality of records kept on assisted dying. If I recall correctly, the role of the medical examiner was brought into legislation following Shipman, to tidy up and tighten the records we keep—because clearly we had lessons to learn from them. Also, we have heard in evidence that some other jurisdictions keep good medical records, especially when that speaks to people who are potentially coerced. In one jurisdiction, we had somebody who said that they had never felt a burden, but there were many more who said that they had felt a burden.”
“In light of the magnitude of the decision being made, it is important for records to reflect that. It is equally important that those who will depend on the evidence can access the same evidence on which the co-ordinating doctor made their determinations. Therefore, it is essential that the basis of the decision making is accurately recorded, along with the evidence from other practitioners. For instance, if a palliative care specialist, a clinical consultant and a psychiatrist or psychologist have been consulted, evidence of what they did and said must be readily available, and it is essential that that sits with the record of the co-ordinating doctor. The information must be gathered for the medical examiner to be able to come to their determination with all the evidence before them.”
“We would lessen the impact of the Bill on wider suicide prevention strategies and provide evidence for meaningful review at a later date. Amendment 295, also tabled by my hon. Friend the Member for York Central, is about enabling public and parliamentary scrutiny of the assisted dying system. It will ensure that, if the Bill passes, there are good records of all applications for assisted dying and that they are readily available to the medical examiner. Some Members will know exactly what the medical examiner does, but I note for the record that it is a newly created public office, in operation since 2024. The task of the medical examiner is to examine any deaths within the context of healthcare, whether NHS or private, that are not being examined by a coroner.”
“We have had disabled people who have actually had it suggested to them or their families that their lives are expendable, when actually those people have got a lot of years to give.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 180, Q234.] Providing records of a doctor’s efforts to dissuade the person from ending their life will address some of these concerns. It will ensure that there can be a more meaningful review of the impact of the Bill on different groups, so that the right to die does not become a duty to die. In conclusion, amendment 288 would strengthen the safeguards in the Bill by ensuring transparency and accountability in doctor-patient discussions by requiring the documentation of efforts to dissuade individuals from ending their lives.”
“The amendment would record instances where the medical practitioner may try to dissuade the person from ending their life. Some doctors may take the view of Professor Allan House, who said in his written evidence, “a statement about wanting to end one's life cannot be simply taken as the result of a straightforward rational decision to choose one type of end of life care over others.” Furthermore, this amendment would also address some of the concerns about unconscious bias. Recording efforts to dissuade the person from ending their life would show when doctors assume a person should have an assisted death where others should not. Fazilet Hadi of Disability Rights UK spoke about this in her oral evidence: “We often find that doctors, because they cannot treat or cure us, do devalue our lives.”
“Dr Annabel Price, a member of the faculty of liaison psychiatry at the Royal College of Psychiatrists, gave oral evidence that among people who need palliative care at the end of their life, “20% will have diagnosable depression, around 10% will have a wish to hasten death, and around 4% will have a more persistent wish to hasten death.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 270, Q351.] She went on to say: “Those who had a wish to hasten death were 18 times more likely to also feel suicidal”. –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 275-276, Q359.] Terminally ill people are therefore at particular risk, and it is vital that the Bill does not diminish wider suicide prevention strategies.”
“As Professor Allan House noted in his written evidence, the National Institute for Health and Care Excellence guidelines apply “in other areas where it is important to explore thoughts about life not being worth living”. After an episode of self-harm or instances of suicidal thoughts, the medical professionals will explore “current and recent personal and social circumstances, recent adversities, psychological state beyond merely assessing mental capacity and the presence of severe mental illness.” In line with this suicide prevention strategy, a doctor may feel the need to explore those psychosocial factors and seek to dissuade the person from ending their life. We know that suicidal thoughts and depression are particularly common among terminally ill people.”
“I rise to speak to amendments 288 and 295 tabled by my hon. Friend the Member for York Central (Rachael Maskell), both of which would improve the quality of records kept about people applying for assisted dying. Their aim is to make parliamentary and public scrutiny of the system easier and better. Amendment 288 would insert a new subsection at the end of clause 4, on page 2, line 36, reading: “All efforts to dissuade the person from ending their own life must be recorded in the clinical records and subsequently made available to the medical examiner.” That recognises that a doctor may follow existing guidelines and seek to dissuade the person from ending their life. It would ensure that such efforts are recorded to improve understanding of the Bill and its interaction with suicide prevention.”
“The Minister referred to a patient not wanting to keep a written record. How does that fare if there is a potential issue of negligence later on? Is that not a requirement of every NHS service that we provide? For example, in the case of a kidney donation where an independent assessor was needed, the details would have to be kept. I am just a bit confused. I wonder if the Minister might comment on that.”
“If that is an issue, then it is my understanding, being new to Bill Committees, that it is not because the provision is poorly drafted, but because the outcome is not clear. Can the Government not clarify that on Report or Third Reading? I have heard nothing from the Government, even where they are supportive of amendments, about going away and looking at them. There is none of that conversation coming from the Government. Perhaps the Minister will comment on that.”
“The Minister is being very generous with his time. I want to understand the idea that someone might say that they do not want a written transcript, when everybody in our country who uses the NHS has a written medical record. Why, in this instance, are the Government of the view that we should stray from normal practice?”
“The Minister is being generous with his time. I am even more confused now. Originally, the Minister suggested that a patient might not want a transcript, but in response to the question from my hon. Friend the Member for Spen Valley, he mentioned that under new clause 19 people will have access to their written records. That appears to be a contradiction. I just want to nail this down. What will it be? If a patient does not want a written record, we would not have a written record to access, so that contradicts the Minister’s response. I want to understand exactly what the Minister is suggesting.”
“I would like to add that there is nothing about female genital mutilation in anybody’s religion. It is not a religious belief; it is cultural, and it is actually child abuse. That is what it is—there are no ifs or buts about it.”
“It would in no way block the ability of adults who meet the conditions set out by this Bill to explore assisted dying, nor would it place any burden at all upon doctors. It would simply place upon them a duty to follow what we can all surely agree is best practice, and it would greatly improve the early access to palliative care advice for patients with a diagnosis of serious illness. That would improve those patients’ chances of receiving good palliative care. I therefore urge hon. Members to support the amendment.”
“I would be astonished if we could find a doctor who said they had always got everything right. As lawmakers, we have to guard against the fact that even some of our most admired professionals can and sometimes will make mistakes. One way that we will guard against that is to set out duties that they have to follow. This amendment does just that. I hope that we will not hear the objection that we have heard to a great many good amendments: that it will somehow make the Bill more dangerous by adding complications. The amendment simply adds a small step, by placing a duty on a doctor to give palliative care advice to a patient with a diagnosis of serious illness. Surely the Bill cannot be so lacking in robustness that such a small change would make it dangerous. In summary, the amendment is a sensible change.”
“Given the conversations we had this morning, I can foretell one objection to this amendment: that since good doctors will do this anyway, it is unnecessary to have a provision on the face of the Bill to ensure it. This seems to me a very weak objection. Let us be honest, the doctors that we have in this country are of extremely high quality. They are dedicated, skilled and compassionate men and women. We are lucky to have them, but we cannot say that every doctor participating in all the processes that they currently undertake always follow best practice. Similarly, we simply cannot say that in any assisted dying process doctors will always automatically follow best practice. People make mistakes. That includes people who are highly trained and extremely compassionate.”