Danny Kruger
MP for East Wiltshire · Reform UK · United Kingdom
“There is what might be an important innovation in the text of this year’s sovereign grant annual report and accounts, which the Bill refers to and which the Minister is describing. Usually, the description of the sovereign’s role includes the term “defender of the faith”, but that term does not appear in this year’s report and accounts.”
“Research from the Department for Education confirms that children who move schools frequently often suffer poor outcomes, particularly children with special educational needs. That is why a number of armed forces families—people on average incomes—choose independent education to minimise the disruption that results from their postings.”
“Resilience is obviously the crucial question for the country, and the Government are right to be focusing on the need to strengthen the centre of Government to achieve that. My concern is about the legislation that has been trailed.”
“The Bill contains a lot of useful tightening of electoral law, and we are having a very important debate this afternoon. It is important that we think about how we police donations from abroad and from home. I pay tribute to the remarks made by the hon.”
“No, I am not going to give way. It is their right to support a political cause in their own country, where they are registered to vote and of which they are citizens. It is absolutely wrong to traduce them in that way.”
“That is what the populist revolt is doing, demonstrating the effectiveness and vibrancy of our democracy. Let me turn to the amendments that I support, because we do have a real threat to our democracy, and let me make these points as seriously and soberly as I can.”
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“The Government anticipate that all substances used for assisted dying will have existing licences from the Medicines and Healthcare products Regulatory Agency for other indications, but the amendment would require the approved substances to be licensed by the MHRA specifically for the purpose of assisted dying.” –– [ Official Report, Terminally Ill Adults (End of Life) Bill Public Bill Committee, 18 March 2025; c. 1224.] That was indeed the purpose of that amendment. If there is anxiety that I am somehow straying from the relevant clause and amendments, which I detect from Members who are clearly looking forward to their dinner, I do insist—[ Interruption. ]”
“The regulations are subject to the negative procedure, which means they are highly unlikely to be debated at all or voted upon, for reasons given in my earlier complaints about the use of the negative procedure. Indeed, it is discretionary whether the regulations will be made at all. Last night, the Minister told us that the Government objected to the Medicines and Healthcare products Regulatory Agency approving the drugs or substances in amendment 465, which I had tabled. He said: “The Government’s assessment of amendment 465 is that it would significantly impact the legal and operational delivery of the Bill.”
“Amendment 521, which is in my name, would ensure that the regulations that we arrive at are laid before Parliament, and debated and approved by both Houses of Parliament. Amendment 485 in the name of the hon. Member for York Central would address the same issue. The amendments seek to address the dangerous absence of an adequate regulatory regime in the Bill for the lethal drugs and approved substances. Once again, significant questions are ignored in clause 28. Ministers will be given the power to make regulations for the prescription, dispensing, transportation, storage, handling and disposal of approved substances. The clause is envisaged as sufficient for an entire regulatory regime for approved substances. It is just 87 words. It is as if it is an afterthought—as, it seems, is the role of pharmacists, by the way.”
“It is a pleasure to follow the hon. Members for Ashford and for Banbury. I entirely concur with their points, particularly those that derive from the expertise of the hon. Member for Ashford. This is a very important group of amendments, which concern what is in a sense the heart of the Bill—the management of the lethal drugs. The question of what drugs we are talking about remains open, which is a cause of deep concern to me, but whatever they happen to be, we need to make sure that the management— the regime of dispensing, transporting and prescribing —is safe. I will not reprise the details of all the amendments. Their purpose is to ensure a stricter, more transparent and safer regime for the management of the drugs.”
“As such, any powers that may accrue to Ministers because of a Private Member’s Bill must be acceptable to the Government. It must therefore take a view on the powers and their scrutiny”. Has the sponsor or the Minister consulted with the Royal Pharmaceutical Society on the sufficiency of this power? Has sufficient work been done to look at the workability and operationalisation of this clause? I hope the Committee will join me in supporting these amendments.”
“This not only strikes at the rule of law values I have already outlined, but also at the cardinal principles of accessibility and legal certainty. In my view, the new Government offers an opportunity for a reset in the way that Government thinks about these issues. This means, in particular, a much sharper focus on whether taking delegated powers is justified in a given case, and more careful consideration of appropriate safeguards.” I conclude with this question to the Minister: has she considered the advice of Lord Hermer in coming to a view on the appropriateness of this clause and the way that these powers have been taken? As the Hansard Society notes, “the Government has an overriding duty of care to the statute book.”
“It cannot be argued that the negative procedure is needed because the amendments might need to be made quickly and frequently—that cannot be the case, because we have not yet authorised the regime. The negative procedure would allow the Secretary of State quite unjustified ability to change these processes without any requirement for a parliamentary debate or vote. Lord Hermer, the Attorney General, has said that this new Government will take a new approach, considering the “real need to consider the balance between primary and secondary legislation, which in recent years has weighed too heavily in favour of delegated powers.” He criticised the previous Government’s “excessive reliance on delegated powers, Henry VIII clauses, or skeleton legislation,” which “upsets the proper balance between Parliament and the executive.”
“I will not repeat evidence from the Royal Pharmaceutical Society concerning the legal arrangement, but I will refer to evidence submitted by Máire Stapleton, a pharmacist with more than 30 years’ experience in clinical governance, who made this point: “Based upon a preliminary review of current published data, it is difficult to see how the regulatory and professional standards for prescribing and dispensing unlicensed drugs can be met.” There is further evidence to that effect from the Royal Pharmaceutical Society, pharmacists and barristers. Given that there is so little on the face of the Bill and no guardrails for the use of the power that will be given to the Secretary of State, why is the negative procedure judged appropriate for something of this significance?”
“Absolutely; that is what I am doing. I referenced the debate we had last night, which I hope is within scope, because the suggestion has been either that the Bill insufficiently addresses the need for a regulatory regime for the approval of drugs specifically for the purpose of assisted dying or, as the Government are saying, that the drugs’ existing licences are sufficient for these purposes. Is the Government’s position that there will be no regulator involved and that this will sit entirely with the Minister, as in this clause? If regulators are to be involved, will further legislation be needed?”
“Further to the intervention from the hon. Member for Bradford West, I would like to understand whether the Minister envisages an independent regulator of any sort being responsible for overseeing the regime? We currently do not know what that will be—a future Secretary of State will design it—but does he envisage that there will be some sort of regulatory body with that job, and if not the MHRA, who?”
“We look forward to the amendments that the Government are working on, but, as part of that process, does the Minister envisage that there will be amendments to NHS legislation itself?”
“It might appear a procedural issue, but does the hon. Lady acknowledge that there is a profound difference between the negative and affirmative procedure? Why is she content that the regime for the regulation of these lethal drugs, which are at the absolute core of her Bill, be subject to the discretion of the Secretary of State, without any likelihood or any real possibility of any sort of debate in Parliament? Why should this not be through the affirmative procedure?”
“Nevertheless, the hon. Lady is proposing that this passes through Parliament, just through the negative procedure. If she thinks there is an appropriate rubberstamp by Parliament—that Parliament needs to approve this regime—why should it not have the opportunity to debate it?”
“Since the coroner’s jurisdiction affords a powerful deterrent against misfeasance, the public may wonder why the Bill proposes to abandon such a robust safeguard. The approval of the High Court is no substitute as it would be given in advance of death and could offer no assurance” —we have scrapped the approval of the High Court, but it would have been no substitute, and it will be the same for the panel system— “that the assistance had been provided in strict compliance with the law or that the circumstances of the case had not changed following the court’s declaration. If the Bill becomes law, who will provide the necessary posthumous judicial scrutiny of these unnatural deaths?” That is a powerful suggestion from the former chief coroner.”
“I beg to move amendment 522, in clause 29, page 17, line 14, leave out subsection (1). In a letter to the editor of The Telegraph , the former chief coroner of England and Wales, Thomas Teague KC, wrote that clause 29 “would prohibit a coroner from investigating any death where the duty to do so arises only because the deceased died as a consequence of the provision of assistance in accordance with the Bill. But for that clause, the coroner would be under a statutory duty to investigate such a death and, if satisfied at inquest that the deceased had used an approved lethal substance to end his or her life with the intention of doing so, would be obliged to record a conclusion of suicide.”
“It is remarkable—and worth pointing out in response to the suggestion that terminal diagnoses are always accurate—that one study found, after autopsy, that one in four cases had been misdiagnosed. Doctors might say somebody is dying of a certain condition, but it turns out they were not. I take the point that a coroner would not be prohibited by clause 29(1) from launching an investigation in appropriate cases, but given that we do not know what we do not know, it might be hard to decide when that is required. With a new scheme like this, it would be best to start with an investigation in every case. If, in a few years’ time, it appears that the safeguard is not needed, a future Parliament could change the law to reduce it, but I implore the Committee to consider the idea that we should start with the safest Bill we can.”
“Some coroner’s inquests can be dealt with in as little as 20 minutes if matters are simple and not in dispute, which they would be in the great majority of the cases we are talking about. The presence of this jurisdiction—the ability of the coroner to investigate—would be a most valuable safeguard. It would help to identify whether matters have gone wrong in the act of self-administration and the process of dying, which could significantly assist whatever regulatory regime—we are yet to discover that—oversees the process. It could assist the continuous improvement of the regime. It would also help to identify issues relating to misdiagnosis, which we know happens often.”
“The concern is that it should be automatic. I just cite Professor Ahmedzai’s recognition of the frequent necessity, or the distinct possibility, of a referral to the coroner being appropriate. I suggest that it should happen as a matter of course. I would be grateful to understand from the hon. Lady or the Minister under what circumstances they feel it would be appropriate for a coroner to be involved. The difficulty is that we are putting a lot of emphasis on the role of the local medical examiner to decide whether it should be appropriate for the coroner to consider a case; I suggest that they should consider all cases. The obligation on coroners need not be over-burdensome.”
“The purpose behind the amendment is to ensure that there is a statutory duty for the coroner to review the death. It is also a point of principle that it is appropriate to record the death as suicide, because that is what has happened—assisted suicide. Nevertheless, given the state of the debate, and that I suspect I am not in the majority in supporting the amendment, I will not press it to a vote. I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn.”
“I will respond quickly. My concern is that, as Thomas Teague said, without clause 29 the coroner would be under a statutory duty to investigate. I recognise that there is an opportunity for an investigation if a family member or the medical practitioner decides to refer it to the coroner. It is unlikely—although they might—that the medical practitioner who has overseen the death would suggest that they themselves had somehow failed in their duty or that there had been a complication they could not have dealt with. The fact is that the only way a coroner would get involved under the Bill as it stands is if they conclude that there is something wrong on the basis of not knowing what has happened, because they have not performed any investigation.”
“I think the hon. Member for Penistone and Stocksbridge meant the previous Conservative and Liberal Democrat Government—just to be strictly accurate.”
“I beg to move amendment 446, in clause 29, page 18, line 9, at end insert— “(4) The Secretary of State must, by regulation, specify the data sets which must be made available by the Registrar General for England and Wales. (5) Any regulations made under subsection (4) are subject to the affirmative procedure.” This amendment requires the Secretary of State to specify in regulations the data sets which are to be made available by the Registrar General for England and Wales.”
“I hope that that would be specified in the data that the Registrar General will provide, but that is not clear at the moment. It is also vital that any complications are properly reported—not just recorded, but reported. I do not propose to push these amendments to a vote; I think that the argument has been sufficiently made. I am grateful to the Committee for supporting the previous amendment. However, I wish that things were otherwise and that we were specifying more clearly what data will be collected. I hope that perhaps this debate will encourage the Registrar General to ensure that the most comprehensive data is presented to Parliament.”
“Amendment 446 would give the Secretary of State the power to specify the datasets that must be made available, and those must be approved by Parliament. MPs would then be able to interrogate what data we are collecting and what questions that enables us to answer. Ensuring that that is determined by regulation places it in law, and ensures ministerial responsibility and parliamentary oversight. Amendment 486 sets out the data that must be included. That includes demographic information, including breakdowns by protected characteristics—and I acknowledge the conversation that has just been had on that topic—and the length of time between the taking of the approved substances and the time of death. It strikes me that that is a very important consideration.”
“These amendments were tabled by the hon. Member for York Central. As discussed, clause 29 requires the Registrar General to “prepare and lay before Parliament a report providing a statistical analysis of deaths” arising. We have spoken before about the paucity of data from other jurisdictions and the problems arising when data is not collected from the start; when data is collected only in relation to one thing, such as disability in Canada; when data collection is suddenly discontinued, as in Washington state as I understand it; or when data is insufficiently granular, so that we get only the headlines. I therefore think that this approach is valuable, and I welcome the Committee’s decision to support amendment 273 tabled by the hon. Member for Richmond Park. Amendments 446 and 486 would ensure that we fix those problems from the start.”
“I beg to ask leave to withdraw the amendment. Amendment, by leave, withdrawn. Clause 29, as amended, ordered to stand part of the Bill. Clause 30 Codes of practice”
“I want to quickly explain that my amendment 523 is consequential on amendment 447, but there is drafting issue. I will not go into the details but, if amendment 447 is made, as I understand it will be, my amendment 523 is not necessary. I would be grateful for the Minister’s guidance: if he has been advised by parliamentary counsel that the clause as amended by amendment 447 is okay and there is no need for amendment 523, I do not propose to press it to a vote.”
“It does not specify that the advocate should be obliged, equipped or experienced in supporting the patient to engage with other options.”
“Given that we have retained the right of medical professionals to raise the possibility of assisted dying unprompted with patients, I am concerned about whether, as I think the hon. Member for Bexleyheath and Crayford implied, the medical professional initiates the conversation, or the advocate themselves is supportive of assisted dying and they deliberately or inadvertently have the effect of encouraging the patient to consider that option. As I think the hon. Member for Penistone and Stocksbridge said in her intervention on the hon. Member for Bexleyheath and Crayford, new clause 25 creates the role of independent advocate to provide support to a patient, to help them to effectively understand and engage with all the provisions in the Bill.”
“I am pleased to hear that he is satisfied and will support the amendments, although I echo some of the suggestions of concern that he just made. New clause 25 makes it clear that the advocate is there to provide support if the person “is seeking to understand options around end of life care, including the possibility of requesting assistance to end their own life”. Amendment 517 addresses the need for a code of practice when a qualifying person is requesting assistance to end their own life. My question is whether the new clause and the amendment fully cater for a situation in which that individual is not requesting assistance to end their own life—when they are not seeking to explore that particular option.”
“But if the amendments are accepted, we will be introducing the role of the independent advocate with the sombre recognition that it is necessary, in consequence of a Bill that will allow doctors to discuss ending the patient’s life as an option with anybody, no matter how well-equipped or ill-equipped that person may be to handle such a conversation on their own, and no matter how old they are—they could even be 18 years old. I support the amendments, but I do so in recognition of the very significant dangers that I think the Bill represents to all potential applicants. I want to ask the hon. Member for Penistone and Stocksbridge, or perhaps the Minister or the Bill’s promoter, whether they feel that the amendments go to the heart of the concerns raised by the hon. Member for Bexleyheath and Crayford.”
“I pay tribute to the hon. Member for Penistone and Stocksbridge for the amendments that she tabled and to the work that she has been doing on our Committee. I regret her victory over my friend, the former MP for Penistone and Stocksbridge, but the hon. Lady is bringing a lot to Parliament and to this Committee. I am happy to follow the hon. Member for Bexleyheath and Crayford in supporting the amendments. I do not know whether the hon. Lady is in a position to respond with a further speech or by intervening, but I have some concerns about their operation. I recognise that the role of the independent advocate exists in our system already, very usefully and importantly: I see its value and appropriateness for an assisted dying regime.”
“I am grateful to the hon. Lady. That is very helpful. That is my concern: we need to ensure all necessary support for the patient at the earliest stage possible.”
“I thank the hon. Lady. I worry a little about the magic powers of the training fairy, whom we frequently invoke to resolve all the anxieties. We are putting the resolution of difficult tensions on to future professionals and imagining that through training we can resolve all the difficult challenges. However, given the absolute and obvious value of an independent advocate for the people who need that role in the process and given that the hon. Member for Penistone and Stocksbridge has asserted that it is important for the role to be fulfilled at the earliest stage possible, which I entirely agree with, I am happy to support the amendments.”
“On a point of order, Mrs Harris. Before I move the next amendment, I wish to correct the record. I do not know if this is the moment to do so, but I wish to correct a mistake I made earlier today.”
“I am grateful, Mrs Harris. Earlier, I cited evidence about an exodus of care workers from the Australian care system. Members challenged me on that—fairly. I have been looking since, and I could not find the evidence that was in my mind. I think I was confusing it with evidence about the number of palliative care professionals who said that they would not want to work in the sector if assisted dying were performed by their organisations. The only evidence I have got on Australia was from Robert Clark, the Attorney General, who, rather than referring to statistics, gave his own evidence on how many professionals are leaving the Victorian hospital system in consequence of the introduction of voluntary assisted dying. I thought I had statistical evidence to show an exodus, but I did not.”
“I beg to move amendment 524, in clause 30, page 18, line 40, leave out from “have regard to” and insert “comply with”. This amendment would require individuals to comply with the Codes of Practice issued by the Secretary of State.”
“I find this perplexing. Not to make a party-political point, but we know how much Labour MPs distrust Conservatives, and yet they are seemingly willing—as indeed, Conservative colleagues in support of this are—”
“It typically differs from legislation in that it offers guidance rather than imposing requirements: its prescriptions are not hard and fast rules but guidelines which may allow considerable latitude in their practical application and may be departed from in appropriate circumstances. The provisions of a code are not directly enforceable by legal proceedings… Codes of practice are not to be used to define specific legal obligations. Where specific legal obligations are to be imposed, breach of which leads directly to civil or criminal liability, their content should be spelled out in primary or secondary legislation. A code of practice is not appropriate for this purpose, either to delineate the main obligation or to provide for exceptions or defences.” I do not think it appropriate that so much is being left to ministerial discretion.”
“It is perplexing that the Bill does not clearly specify that practitioners should “follow” or “act in accordance with” the guidance. These words matter. The Office of the Parliamentary Counsel explores the choice of these different phrases in its guidance on common legislative problems. That guidance was produced by the drafter of this Bill, the former First Parliamentary Counsel, Elizabeth Gardiner. It is quite a deliberate policy choice to leave compliance with these codes of practice to the discretion of the individuals rather than to require it. The guide to making the legislation—the Cabinet Office manual, which the drafter would have been very familiar with—states: “A ‘code of practice’ is an authoritative statement of practice to be followed in some field.”
“We have been told repeatedly by the Minister that the Government’s preference is to leave things until later and not to address issues on the face of the Bill, because additional words, phrases and amendments would increase risk and be counterproductive. That is an argument that we have heard from the Government Front Bench repeatedly. Other Members have dismissed as embroidery suggested amendments to strengthen safeguards; it has been suggested that the more we write, the less safe the Bill will be. I do not think those arguments will survive the other place, if the Bill arrives there. There is a vast difference between something in the Bill that must be “complied with” because it is in legislation, and something that those providing assistance under the Bill must only “have regard to”.”
“The amendment would specify that individuals should comply with the codes of practice issued by the Secretary of State. I am glad that the hon. Member for Spen Valley agreed to accept an earlier amendment requiring the Secretary of State to issue codes of practice. That was a helpful step, but it is not quite sufficient, because it does not address the critical weakness in the Bill. Time and again, we have been told that amendments tabled are not suitable for the face of the Bill and that we should rely on codes of practice and guidance that will be issued subsequently. Now we are at this point, though, and it is clear that under clause 30(6) the code of practice is something that those “performing any function under this Act must”, simply, “have regard to”.”
“The point I am making is that we are suggesting that some future Secretary of State, in a different Government of which we know nothing, might decide to issue codes of practice that will determine how this process is delivered, but I will leave that point. We must address the weak status of these codes of practice. I regret that they are being left in this weak form. At a minimum level, we should require that they are properly complied with. This cannot be remedied after the Bill has passed. No matter how strong the language in the codes of practice, that language cannot override or change the nature of a statutory duty. Any enhanced duty has to come from a source external to the document being considered itself—namely, the statute. I ask the hon.”
“Q9. Having had 14 years to get ready, Labour came into power with no plan to reform welfare. Now, in a panic because of their economic mismanagement, the Government are cutting benefits for disabled people without consulting them at all. It probably says in the Prime Minister’s folder that the High Court ruled that the Conservatives’ consultation was too short, but at least we consulted. The Government are not consulting at all. Will the Prime Minister explain why he is doing things to disabled people and not with them?”
“We have seen evidence from the former Attorney-General of Victoria, Australia, of all sorts of irregularities, with doctors falsely certifying that patients had signed statements and so on.”
“I very much recognise that the intention of the Bill is not to have those sorts of mistake. Indeed, the intention is to ensure that some of them should be impossible, because a doctor should be present and so on. Nevertheless, there is evidence that in other countries that have inspired the Bill, the data is inadequate. I will give a few more examples. British Columbia has poor documentation, incomplete assessments, recurrent and excessive delays in reporting. In the debate on the last group of amendments, we spoke about the necessity that a doctor be informed if a declaration is cancelled; I am very concerned that that will not happen quickly and that people could fall through the gaps. That is what happens abroad.”
“The fact is that no other country does adequate record keeping. One ambition of the hon. Member for Spen Valley that I really do share is to have a better system of keeping data than in other countries. In Oregon, the most recent annual report demonstrates a whole series of failures in record keeping. Ingestion status was unknown for 25% of the patients prescribed the drugs, so we do not know whether they took the drugs or what the process was. In 72% of cases, it was unknown whether there were complications; we have been talking about how exaggerated my concerns and those of other Members are about complications, but in 72% of cases in Oregon we do not know. In 30% of cases, it was unknown whether a healthcare provider was present. In 44% of cases, the duration between ingestion and death was unknown.”
“My more general point is about the importance of effective record keeping and declaration. I thank the hon. Member for Spen Valley, who throughout the whole Bill process has stressed the importance of good data collection and record keeping, which will be vital so that in later years, if the Bill passes, we can judge whether it is working as intended. I am concerned about going on the evidence of other countries, which is frequently adduced in support of the Bill, particularly in respect of the absence of evidence of coercion, questions around capacity, proper administration of drugs or the support that patients receive. It is often said that concerns are exaggerated or inappropriate, “because look at what happens in other countries”, but let me briefly run through some evidence from abroad.”
“I very much respect the hon. Lady’s intention, and I support the amendments. On clause 16, however, I must take the opportunity to express a certain concern. The clause applies if, under subsection (1)(b), the co-ordinating doctor “refuses to make…a statement” to be entered into the person’s medical records. That is good but, as I understand it, a statement could be made that complies with the Bill but does not put on record, in relation to subsection (2), which requirements the co-ordinating doctor did not believe were satisfied. We have missed an opportunity to have more clarity about which exact requirements have not been met. There is also the eternal question about the co-ordinating doctor’s reasons for reaching that conclusion. I just note the missed opportunity to be a little safer with the drafting.”
“We have no publicly accessible evidence that the eligibility criteria and safeguards prescribed by law were respected and that the Criminal Code has not been transgressed.” It is fine for us, in this Committee and in Parliament, to specify that all doctors should do their job properly and that all data should be appropriately collected, transmitted and recorded. Nevertheless, as we all know from our casework, the reality is often one of bureaucratic mistakes being made, albeit not with any ill will. Given the volumes that we may well be dealing with, I think it is appropriate to raise significant concerns about the operation of the Bill and the data collection that we seek.”