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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“I am not convinced that clause 9(2)(c) actually covers this point, and I think the amendment would make the Bill much stronger. Ultimately, these drugs have not been tested—and for a very good reason, because they lead to death. We are in unchartered territory. When we are doing things that we have not done before, we cannot just pick and choose what we apply an analogy to. We need to be careful. We really need to consider the options to make this clause in particular much stronger.”
“Yes, fortunately not. I am not convinced that the clause covers it. I will go back to that, but I have just read it because the hon. Member for Solihull West and Shirley raised it and I support his amendment, and somebody else raised it earlier. I am not convinced that the complications are covered, because the clause does not set it out. In the usual sense, complications are side effects from medications. We have research and literature given to us and we understand the potential side effects. In this instance, we do not have a yardstick. I do not know whether the Minister can speak about the Government’s intentions—it would be helpful to have an impact assessment—and whether any research has been done in this area.”
“I thank my hon. Friend for his intervention. As drafted, the Bill does not include effects. All it says is “complications”. It does not include the potential effects of the drugs that will be used. That is how the amendment would strengthen the Bill.”
“I completely agree with the hon. Member. He said it much better than I did in response to my hon. Friend the Member for Ipswich, so I thank him for that.”
“I am genuinely trying to understand and would like my hon. Friend to clarify. He says that doctors generally do this anyway, but the difference is that, in this instance, somebody has chosen to die. Generally, when doctors do anything they are trying to save patients, are they not? The general rule of thumb is that a doctor saves lives. In this instance, they are not doing that because the patient wants death.”
“That is the very point I am struggling with. Generally speaking, the GMC guidelines are absolutely right, and doctors are saving lives and making the person better. In this instance, somebody might have complications and they might vomit, for example—that happens a lot because people are unconscious. What does the clinician then do? Do they proceed with an assisted death, or do they get the person into A&E? I am trying to understand the answer to that question, and I hope the Minister can respond.”
“Having this measure in law would hopefully dissuade doctors from transferring their patients unless absolutely necessary for the continuity of care. It would also dissuade the clinician from taking on a new case if they were aware that continuity of care would be disrupted, due to, for example, a move.”
“In the light of the significant impact of the decision, it is important that the doctor can be satisfied as they will need to consent to a patient having capacity and not being coerced. They cannot just take the word of another clinician who has managed the case before them. They themselves need to be satisfied. If a doctor does not do that and something goes wrong, and it comes to light that the patient did not have capacity, the clinician who is the new co-ordinating doctor would carry liability. It does not stand up if they say, “But someone else assessed that the patient had capacity” or, “Someone else said that the patient had not been coerced” if it comes to light later that they have. This measure would therefore protect the clinician and ensure that the patient understood that a further assessment would need to take place.”
“I rise to speak to amendment 309 tabled by my hon. Friend the Member for York Central. The amendment proposes that if a doctor changes, there should be a reassessment of the patient. My understanding is that that is in line with current practice: if a doctor is changed, the new doctor has to assess a patient to their own satisfaction because they cannot rely on just looking at notes. It is a sensitive issue where a doctor is required to make objective and subjective assessments, as has been agreed by the Committee to date, in clinical decision making. A clinician does not inherit the risk of another clinician without being satisfied themselves that the conclusion of another clinician aligns with their own. For instance, the clinician has a responsibility to fulfil their own professional standards and their own duty of care.”
“The matters the panels will be dealing with are far more important than that. It is baffling to me why we should hear evidence on these matters without making witnesses swear oaths to tell the whole truth and nothing but the truth. Anyone speaking to one of these panels should do so with the same commitment to telling the truth as they would in a court of law.”
“He wrote that the new clauses did address some of the problems of the original Bill, but he went on: “These changes are to be welcomed, so far as they go. It is important to recognise, however, that they do not, in my opinion, go anything like far enough.” As I have said, some elements of new clause 21 do indeed address some of the problems that Sir James identified but, again, the new clause unfortunately still leaves many of the biggest problems untouched. The Bill does not set out that evidence must be heard under oath. That is an extraordinary omission. Sir James Munby asks, in his most recent essay: “is the panel to hear evidence on oath? Indeed, will the panel have power to administer an oath?” We rightly expect our courts to hear evidence under oath if they deal with cases concerning property or contract.”
“The new clause states that the panel must hear from, and may then question, the doctors who made the certification, the applicant for assisted death, and any other person who may have relevant information. These moves are very welcome steps towards a tighter set of safeguards, but they are inadequate because of what they leave out. Sir James Munby, the former president of the family division of the High Court of England and Wales, has written several times about the problems with the Bill. It is a matter of great regret to me that we did not hear from Sir James; I appreciate that my hon. Friend the Member for Spen Valley set out that he was invited to give evidence to the Committee. Sir James has expressed profound concern about the series of new clauses— new clauses 14, 15, 16 and 17—that my hon. Friend has tabled.”
“I rise to speak to new clause 21, new clause 14, new clause 16, new schedule 2 and amendment (b) to new schedule 2. I will start with new clause 21—and have a break in between. I oppose new clause 21, tabled by my hon. Friend the Member for Spen Valley. I also wish to oppose new clauses 14, 15, 16 and 17, which between them set out the panel procedure to replace the use of a High Court judge, but I will focus my remarks on new clause 21. That is because, first, it is the most recently tabled of my hon. Friend’s new clauses on the panel. Secondly, and perhaps more importantly, it seems to be an attempt to solve some of the problems of the earlier new clauses. I welcome what I think my hon. Friend’s intentions are with the new clauses. The Bill as drafted did not provide anything like adequate safeguards.”
“What is going to happen? Are we just hoping that they will successfully make it up as they go along? Is there not a danger that in some cases the non-legal members of the panel end up deferring to the wishes of the lawyer, who has more experience in these matters?”
“He goes on to say that “it says nothing about who should exercise that function; nor about the nature of any independent evidential investigation and nothing about who is to undertake this and who is to pay for it.” Finally on this point, he says that new clause 16 “says nothing about what, if any, public funding arrangements there will be for the applicant, the two doctors, and any other parties or expert or lay witnesses.” The first point raised by Sir James is an extraordinary one. The panels will bring together three people: a lawyer, a consultant psychiatrist and a social worker. They will sit on what is a quasi-judicial body. The latter two will not necessarily have any experience of questioning witnesses and assessing evidence as part of a quasi-judicial process. The first person—the lawyer—will have such experience.”
“As I make progress, I will speak to that point, but I share the hon. Gentleman’s concern. I will return to my speech and expand on the point when I arrive at that juncture. Sir James goes on to say that there are even graver problems with the panel procedure. I appreciate that his paper was published before new clause 21 was tabled, but it does not address all the concerns he raised. He referred particularly to new clause 16, but it is relevant to note that the problem he identified is left untouched by new clause 21. Sir James says of new clause 16: “It says very little about the procedures to be adopted for testing and, if need be, challenging the evidence”.”
“As I make progress I will address some my hon. Friend’s points—I have a fairly long speech—but I will say now that when the Bill passed on Second Reading, one of the safeguards was that it included judicial oversight. That is very different to what we are talking about now.”
“Yes, in some cases there will be no hidden circumstances that a panel would hear of from a witness only if they were called, but in other cases there will be, and those circumstances are much more likely to occur in the cases of people who are coerced or who feel like a burden to their families. They will be more likely to occur for those who have poor mental health, who are isolated, or who lack the social care they need. The panels are not likely to find witnesses with relevant information if what they have to go on is the statement of witness evidence of a person who has, for example, been successfully and skilfully coerced.”
“That would be one step towards being able to detect whether people were choosing assisted death because of a lack of palliative care or social care. But how will the panels know which witnesses are most likely to have or be aware of the significant evidence they seek? The panel members will have the statements by the applicant and the doctors, and they will have the answers to any questions they have of the applicant and the doctors. I ask Members to think through how certain it is that those sources alone will be enough to find all the people who might have significant knowledge of a person’s circumstances. I would argue that it will not be certain.”
“New clause 21(4) says that the panel “may hear from and may question any other person” and “may ask any person appearing to it to have relevant knowledge or experience to report to it on such matters relating to the person to whom the referral relates as it considers appropriate.” I welcome that as a start, because it acknowledges that there will be cases in which people other than the applicant and the doctors have vital information. But that really should not be where we finish—not if we want a genuinely robust assisted dying Bill with strong safeguards for vulnerable people. The ability of the panel to hear evidence from other parties would indeed be one step towards detecting whether people are, for example, being coerced towards an assisted death.”
“I agree: there is not a judicial process, so to speak. There most definitely is not. As I make progress, I will outline my concerns about that very clearly. Let us take the second point raised by Sir James. He asked who will go about “testing and, if need be, challenging the evidence”? New clause 21 finally gives the panel the power to call people to give evidence who are neither the applicant nor the doctor.”
“There are two reasons why this is essential in every case…Without this, it will not be proper for a judge to be involved in the process as a member of the panel.” He goes on to make it plain that by “judge” he means the legal member of the panel.”
“As I have stated before—I will make reference to that very point later—I would argue the safeguards are just not robust enough. There should be a mechanism for trained and experienced people to find witnesses who might have relevant information. This could relate to another criticism that Members have made of the panel system: there is no provision for the Official Solicitor to act on behalf of the applicant. Sir James Munby argues that we should strongly consider this, saying that “there must be a rigorous procedure in every case for testing and if need be challenging the evidence, including an independent evidential investigation, perhaps by the Official Solicitor, of the kind discussed in Conway.”
“That is the very distinction I am trying to highlight further, because the panel takes away the judicial oversight. Yes, they have expertise—there is no question about people’s expertise—but Sir James Munby says clearly that these people will not be sitting in their capacity as judges, as my hon. Friend just outlined, but just as experts. That does not provide judicial oversight. That is not what the panel does.”
“I will go into this in even greater detail in later speeches, but I will say now that although the process was not fit for purpose, Sir James Munby also says that this one is not fit for purpose. Neither process gives us the legal aspect—if anything, the Bill has been watered down. As I make progress, I will outline how I think Sir James Munby’s evidence is clear that the safeguard has been watered down. I appreciate the mood in the room while I insist on talking about this, but it is very, very important, because when we voted in the House to send the Bill to Committee, one of the biggest reasons why we did so was judicial oversight. Many Members have said that they let the Bill get to this stage because of that.”
“I will make some progress. As it is, we have removed the judicial oversight. I appreciate what my hon. Friend says about the panels having expertise, but that is not judicial oversight.”
“If she did not, that seems an extraordinary omission. Ministers keep saying that the Government will release an impact assessment only when the Committee has finished amending the Bill. I say again: that seems to me a most unsatisfactory approach to a Bill that would lead to such a huge change. Surely the Minister could ask civil servants to prepare a preliminary estimate of how many applicants there might be in England and Wales. It should probably be phrased as a likely minimum and likely maximum number. That would be extremely helpful. Surely the Government could do the preliminary work on whether the psychiatric profession in England and Wales is capable of meeting that demand. I say this in the light of my understanding that the present state of the country’s judiciary contributed to the removal of the judge in the first instance.”
“Another question about the resourcing of the panels is just as important: can we make good on the commitment in the Bill to provide a consultant psychiatrist for every panel? I think the answer may well be no. We spoke to the Royal College of Psychiatrists during our evidence sessions, but at that stage my hon. Friend the Member for Spen Valley had not tabled the amendments that would create a panel including a consultant psychiatrist, so we did not ask the professional body whether it would be able to do so. I have had private conversations with my team of senior psychiatrists. We asked whether England and Wales had enough consultant psychiatrists to serve on each panel. They said it was extremely unlikely. I would like to understand whether my hon. Friend consulted the Royal College of Psychiatrists before she tabled those amendments.”
“I think that by making some progress I will answer that question. Turning to Sir James Munby’s question about what, if any, public funding arrangements there will be for the applicant, the two doctors and any other parties, experts or lay witnesses, each time a panel meets we will be asking three senior professionals to give up many hours of their time to scrutinise applications, listen to and perhaps question witnesses, and then decide whether to call further witnesses. I could ask many questions about funding, but I will ask just one at the moment. Both Ministers will be well aware that courts and tribunals in England and Wales face lengthy delays—in some cases, delays of years. Will the Government commit to adequately funding the panel so that applicants do not face lengthy delays?”
“He said: “I appreciate that some may point to the multidisciplinary membership of the panel and to an assumption that the function and process of the panel may (it is said) be inquisitorial rather than adversarial. Plainly, it might be thought, it is an advantage that the panel has a multidisciplinary membership, and it is often said that three heads are better than one. Yet it would be a mistake to think that either of these features of what is now proposed are sufficient to overcome the very real problems I have identified. They are not. What remains crucial is the substance, not mere appearances. If the panel is to perform its function effectively and do more than just ‘check the paperwork’—if it is to be the real safeguard intended by its proponents—then its processes must be much more thorough than is currently proposed.””
“That was not my understanding; I will come back to that point, because I am sure I have references to where that has been talked about. There is also the question of whether panels should be heard in public. Under new clause 16, the legal member of a panel would decide whether it should sit in public. Finally, I return to Sir James Munby’s paper on this question. As I have gone through in some detail, he raised significant concerns about panel procedures set out in new clauses 14 to 17. Unfortunately, it seems to me that most of those concerns have not been addressed by new clause 21. Sir James was a very senior judge, who headed the family division of the High Court, and is someone we should listen to with the utmost attention on these matters.”
“My hon. Friend’s intervention takes us back to the concerns I already have. I understand that mental health tribunals relate to the Mental Capacity Act 2005, which would inform people on that panel in making their judgments. I have spoken extensively against the use of the Mental Capacity Act in this particular field.”
“I either misheard my hon. Friend or did not understand his earlier point, so let me speak to the point he makes now. My understanding is that sectioning someone under the Mental Health Act is a very extreme measure. Someone is sectioned in circumstances in which lots and lots of evidence has been taken from people who know the person, and there is a history. That was certainly the case when I chaired a mental health charity. Whether it is carers or other people who contribute to that, there is a long-standing relationship; from my understanding, it is very rare for something to happen otherwise. That is my understanding and experience of it, but I am happy to have a chat with my hon. Friend to talk more about it and understand it more.”
“I thank the hon. Member for reminding me of that; I talked about that earlier. I agree with him that this is about the legalities. Ultimately, it comes back to judicial oversight, which is what was promised originally. That is why judges were part of the original proposals for the Bill. The words we must listen to are Sir James Munby’s. If we want an assisted dying Bill with real safeguards for the vulnerable, then we should reject new clauses 14 to 17 and new clause 21. They are not thorough enough to do the job.”
“Given my hon. Friend’s expertise, does he anticipate JR being allowed in the panel setting? If so, would it be before the death or after? Can the decision by the panel be judicially reviewed?”
“No, we do not do that, because we do not wish to put too much power into the hands of any one person. However, under the new clause, we would do exactly that.”
“The commissioner would also decide if particular panel members had made any mistakes or shown any misconduct in their work. In this country, we do not give one person the job of selecting judges, overseeing their work and then functioning as a court of appeal, even if that one person is extremely well qualified. That is for good reason. But the new clause suggests giving all those powers to one person. Hon. Members might object and say that the comparison is not exact, and that there will be fewer assisted dying cases heard by the proposed new panels than there are cases heard before the courts, but that misses the point. We do not put all the powers over the judiciary into the hands of one man or woman because it would be a lot of work for them.”
“Part 2 of five, I might add, Mrs Harris. I rise to oppose new clause 14 from my hon. Friend the Member for Spen Valley. The clause would create the post of a voluntary assisted dying commissioner. It is quite an extraordinary clause, and I am not sure we have seen anything like it in recent legislation. What I am sure of is that we have not seen a law as far-reaching as this introduced without any of the detailed work that should have been done on it by the civil service. The voluntary assisted dying commissioner—I will call them the VAD commissioner—created by the new clause would have unusual powers. The commissioner would select the members of the panel, who would in turn decide on people’s assisted dying applications. The commissioner would be the authority to whom people could appeal if their application was refused.”
“Members might object that the voluntary assisted dying commissioner will be a very senior judge. According to the new clause, the commissioner “must hold or have held office as a judge of— the Supreme Court the Court of Appeal, or the High Court.” I agree that only people of high intelligence and good standing become judges in those courts, but that does not mean that the very highest judges in the land do not sometimes make mistakes—sometimes very bad ones.”
“I absolutely agree that we have not thought this through enough, because that process has not been laid out. We really need to think about these potential eventualities. When such cases happen, the public, including family members of the person who has died, will rightly demand answers, and so will the media. They will want to know who the panel members were and why they made the judgment they did. In such cases, who would investigate whether panel members had got it wrong? The commissioner who had appointed them? The commissioner, or any person, no matter how honest and how learned, would come back to that question with a very strong bias. The commissioner will mark their own homework. That is not a system that anyone can argue will provide proper safeguards. Hon.”
“That poses the danger that some of the people who sit most on these panels will be advocates of assisted dying and will approve applications that other members may not have.”
“We also do not know how many social workers, psychiatrists and lawyers would be unwilling to approve any assisted death applications at all—I do not want to repeat myself, but I will be referring back to psychiatrists in another amendment. However, the number of psychiatrists who are strongly opposed to assisted death is very high, according the Royal College of Psychiatrists. We have also heard strong reservations expressed by the Association of Palliative Care Social Workers. Therefore, many professionals will choose not to sit on these panels, because they will not want to approve any cases. That means that some panel members are likely to end up dealing with dozens of cases per year.”
“There were problems with that proposal, which is why she abandoned it. But there was one strength in making a High Court judge the arbiter: the Crown does not appoint High Court judges on the basis of whether they agree with assisted dying. We could all reasonably expect High Court judges to have a range of views on assisted dying; there is no reason I can think of that would mean that High Court judges, as a body, were biased in favour of assisted dying. Something different will happen if a commissioner selects people to serve on these panels. Anyone serving on a panel will know that they will have to approve some applications for assisted death. We do not know how many applications for assisted death the Government expect to have.”
“The truth is—I said this in my previous speech, which I will not repeat, as instructed by you, Mrs Harris—that neither of the safeguards is strong enough. As it was, the Bill was not strong enough—that has been recognised and changes have been proposed—but neither is the idea of a commissioner. There is another great problem raised by this set of changes to the Bill: they seem likely to increase the prospect of group-think when it comes to members of the panel. I would argue that that danger has been greatly increased by the move away from the High Court judge model that was originally in the Bill. When my hon. Friend the Member for Spen Valley introduced the Bill on Second Reading, she reassured the House that all assisted dying applications would have to be examined by a High Court judge.”
“I am not questioning people’s integrity; I am putting it to the Committee that people have biases. We all have subconscious biases. We have things that we like; we know that that exists, whether it is a subconscious bias or a conscious bias. As human beings, we all have that. In this instance, I am suggesting that if we have members of a panel who choose to be there because they have a fundamental belief, which is different from that of those who oppose assisted dying, there is a risk of subconscious bias and group-think.”
“I am happy to take an intervention from my hon. Friend the Member for Luton South and South Bedfordshire, and then I will come to my hon. Friend the Member for Rother Valley.”
“I disagree with my hon. Friend. Subconscious bias operates in society; this is not about being held to account. People are not doing these things deliberately, but because they have a subconscious bias.”
“Friend the Member for Spen Valley said earlier that decisions would be unanimous, but that is not entirely correct, and I am happy to point to the relevant bit in the Bill. If two people decide they agree, and the other decides to stay quiet, that would be seen as a unanimous decision, and the panel would proceed. I am happy to point that bit of the Bill out to my hon. Friend, as I would love to see an amendment if one were needed.”
“My hon. Friend the Member for Banbury asked her: “Does it concern you that a large proportion of people who opted for assisted dying cited being a burden as their reason?” She replied: “That is not the evidence that we have got.” My hon. Friend responded: “Let me just clarify. The state’s own report in 2023-24 had 35%.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 220, Q284.] I do not recall having a satisfactory answer from Professor Blake to that question, but please feel free to check Hansard . If we see a series of questionable decisions by one or more panel member, the only official scrutiny will come from the person who appointed them to do their jobs, and that is not a robust safeguard. Furthermore, my hon.”
“I would say that nine out of 10 of patients I have conversations with have no idea that that is even legal. If they do not know it is an option, they are never going to ask for it.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 105, Q143.] I wonder whether I would be comfortable—this is just a personal thing, but I want to put it out there for people to think about—about a doctor such as that, who really supports assisted dying, being on the panel. I am not casting aspersions on him, but I genuinely am unsure. Of course, the panel will be chaired by lawyers. I would like to remind hon. Members of the evidence of Professor Meredith Blake, who is a senior legal adviser to the Western Australian government on their assisted dying law. Professor Blake’s evidence was quite extraordinary.”