Kim Leadbeater
MP for Spen Valley · Labour · United Kingdom
“The right hon. Lady is making a very important point, which I have considered at length during the last two years. Many amendments relating to coercive control were made to the Bill to ensure that all professionals involved have training, and there are multiple checks for coercion throughout the process, which do not currently exist.”
“Q9. Thank you, Mr Speaker, and welcome back. I also welcome the Prime Minister to his role. We have many shared passions—sport, music, and a deep sense of community.”
“The answer must be courage—the courage to listen, the courage to speak responsibly, the courage to reject extremism in all its forms, the courage to defend democratic values even when emotions run high and, most importantly, the courage to remember that we belong to one another.”
“The Brexit referendum was one of the most divisive periods in modern British history. People were encouraged to see each other not as neighbours with differing opinions but as enemies.”
“They are very like Jo in so many ways and they are annoyingly good at everything. They are musical, they are sporty, they are academic and they are really nice human beings. When they come up to Yorkshire, we try to find something that we can beat them at—and we fail every time. They are very much in my thoughts today and every day.”
“Every disagreement becomes moral warfare. We see a growing blame culture in Britain. When the economy struggles, when public services let us down, when communities feel left behind, someone must be blamed— migrants, politicians, the poor, the rich.”
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“I have been desperately trying to find the amendment number—I think it is amendment 500 that looks at what will be recorded, and it covers such data as the hon. Member for Richmond Park is requesting.”
“As has been alluded to by various Committee members, I fully support the intention behind amendment 273, but I think it will be covered already. I have mentioned my amendment 500, but amendment 455 is probably more pertinent. It looks at the annual report that the assisted dying commissioner would produce, which makes reference to protected characteristics, and sets out that any other such data can and should be collected under regulations. I am therefore confident that that report would encompass the points made by amendment 273, and that reference is made to the analysis that is covered by amendment 274. I feel confident that the intention will be met by the introduction of the voluntary assisted dying commissioner, but I wholeheartedly agree that data collection is a fundamentally important part of the process.”
“I thought we were going to get a full house with this group, but let us have a look. I am minded to support amendment 447, as I have previously said. I will wait to hear from the Minister the impact that that will have on amendment 523.”
“Amendment made: 430, in clause 30, page 18, line 30, at end insert— “(da) responding to unexpected complications that arise in relation to the administration of the approved substance under section 18, including when the procedure fails;”.— (Daniel Francis.)”
“As such, I cannot support that amendment this evening, but I think we could look at coming up with something on Report that would achieve the objective that my hon. Friend the Member for York Central intended. Amendment 447 agreed to. Amendment made: 394, in clause 30, page 18, line 24, at end insert— “(ba) the provision of information and support to persons with learning disabilities who are eligible to request assistance to end their own life under this Act, including the role of advocates for such persons;”— (Daniel Francis .) Amendment made: 416, in clause 30, page 18, line 25, leave out paragraph (c).— (Jack Abbott.) This amendment is linked to Amendment 417.”
“That is very helpful indeed. In that case I am very pleased to support amendment 523 in the name of the hon. Member for East Wiltshire as well. I am also minded to support amendment 394 in the name of my hon. Friend the Member for Bexleyheath and Crayford, which I think is very sensible, like his other amendments that I have supported. I am not sure that amendment 534 in the name of my hon. Friend the Member for Ipswich is entirely necessary, but I fully understand the sentiment and therefore I am minded to support that amendment as well. That brings me on to the final amendment, 448. I wanted to support this amendment, but I have taken on board the Minister’s comments on the lack of clarity about what it means to be registered and qualified.”
“Actually, this group presents very clear evidence that it is and must be about both, and I hope he can support the amendments. I take on board the Minister’s comments. I heard an element of caution from him, and I am happy to work with the Government and my hon. Friend the Member for Penistone and Stocksbridge if there are any further requirements prior to Report stage, but I am very happy to support the amendment and the new clause.”
“My hon. Friend the hon. Member for Penistone and Stocksbridge has made a powerful and passionate case for the provision of independent advocates, and, as always, has done an outstanding job of advocating for people with disabilities, including learning disabilities, mental disorders and autism, as she has done throughout this entire process. It is essential that anybody considering the choice at the end of life made possible by this Bill should fully understand the nature and consequences of any decision they may make. These amendments have made me reflect on comments—I think made by the hon. Member for East Wiltshire a few weeks ago—about the purpose of the Bill. He proposed that the Bill is either about choice and autonomy or it is about safeguards.”
“I understand the sentiment behind the amendment, but as the Minister said, codes of practice serve a particular purpose. Everyone has to comply with and abide by the law, but codes of practice are there to assist in the exercise of a person’s professional judgment. I worry about losing the ability for professionally trained and regulated people to use their professional discretion and have the flexibility they need to do their jobs well, if we accepted this amendment. I think the hon. Member for East Wiltshire answered his own question in his description of what a code of practice does. Although the amendment comes from a good place, I cannot support it. We need to have flexibility, and trust in our professionals to do their job.”
“I briefly show my support for these amendments that have been tabled by my hon. Friend the Member for Bexleyheath and Crayford. Amendment 395 agreed to. Amendment made: 396, in clause 31, page 19, line 14, at end insert— “(ba) persons with learning disabilities;”— (Daniel Francis.) Clause 31, as amended, ordered to stand part of the Bill. Ordered, That further consideration be now adjourned. — (Bambos Charalambous.)”
“The shorter period of reflection is a recognition that a person’s death is expected within a month, so they literally have a few weeks left of life.”
“It is a pleasure to serve under you this morning, Ms McVey. My amendments 374 and 471 serve to clarify that the second declaration must be made before it is witnessed—it is a drafting amendment—and to bring clause 13 in line with the reporting requirements elsewhere in the Bill. For the functions of the commissioner to be carried out effectively, including supervising the assisted dying panels and making annual reports on the legislation’s operation, it is essential that all relevant details and reports are made available. I am unable to support amendment 457, in the name of the hon. Member for Richmond Park. As I said when we started discussing the amendment, I do not fully understand why it has been positioned at this stage in the process.”
“Surely that is even more important than ever as they face their final weeks. As the right hon. Member for North West Hampshire said, palliative care will have been discussed at length throughout the assisted dying process. It is also worth noting, as the hon. Member for East Wiltshire said, that evidence from other jurisdictions with similar laws—Australia and America—shows that between 80% and 90% of people who have gone through the assisted dying process are already receiving palliative care, so I am not minded to support the amendment.”
“I appreciate that; that is helpful and I thank the hon. Member. As the Minister said, a person whose death is approaching may have stopped eating and drinking for a number of reasons. They may simply be too ill. They may be unable to digest food. It may be that they have lost their appetite, or that they will be even more ill if they eat and drink, so it would seem particularly cruel to intervene on that basis at that point, but I appreciate her comments. Amendment 316 in the name of my hon. Friend the Member for York Central seeks to mandate the action a doctor must take if a patient is likely to die within one month. Like other amendments, it goes against the basic principles that underlie the Bill—that the wishes of the person seeking assistance should be respected.”
“I beg to move amendment 375, in clause 14, page 10, line 9, at end insert— “(1A) Where notice or an indication is given to the coordinating doctor under subsection (1)(a), the doctor must as soon as practicable notify the Commissioner of the cancellation.” This amendment requires the coordinating doctor to notify the Commissioner of a cancellation of a first or second declaration.”
“I hope that these are a couple of nice, simple amendments. The right of the patient to cancel at any time is obviously really important. It is also important that, for the purpose of monitoring and reporting the process, the commissioner, as proposed, is kept informed at every stage. I hope that the whole Committee can see the necessity of these amendments.”
“To allay those fears, perhaps the fundamental answer to the question is that those people do not stop being patients—sadly, they do not stop being terminally ill patients. They have just chosen to cancel the declaration, and they will already have wraparound care. To some degree, the hon. Gentleman answered his own question when he said that doctors have a duty of care. That duty of care does not stop because the person has chosen to take this course of action. They will still be cared for by the professionals looking after them.”
“Amendment made: 376, in clause 14, page 10, line 12, after “doctor” insert “and the Commissioner”.— (Kim Leadbeater.) This amendment requires a practitioner other than the coordinating doctor to notify the Commissioner (as well as the coordinating doctor) of a cancellation of a first or second declaration . Clause 14, as amended, ordered to stand part of the Bill . Clause 15 Signing by proxy”
“I repeat what I said earlier about what will happen to the patient if they choose to cancel: their care will continue. From a medical practitioner perspective, it is inconceivable that those patients would be abandoned, as the hon. Member for East Wiltshire is suggesting. That would not happen. I understand that cancellation of the second declaration does not need to be included in clause 14(4) because of when in the process it would happen. The first declaration comes much earlier, so clauses 7 to 9 would be applicable; the second declaration comes further down the process, so does not need to be included. However, I am happy to look at that in further detail and come back to the hon. Member on that, if necessary. Amendment 375 agreed to .”
“Does the Minister agree that it will be on the record that we have had this conversation, and that many of us—including myself—have expressed our concerns about the concept of good standing in the community? I would like to think that that will be taken into consideration.”
“I will speak first to my amendment 473. It is important to be clear that the role of the proxy is very specific and would be used only in a very limited number of cases, where the patient is not able to sign their own name. That is, however, important when we are talking about terminally ill people who may be physically impaired, as my hon. Friend the Member for Bexleyheath and Crayford alluded to.”
“That is why amendment 321 in the name of my hon. Friend the Member for Bexleyheath and Crayford is really important. We have to put the reason down for why there is a proxy. It depends on personal circumstances and what that patient is going through, so we have to have a bit of flexibility, but they have to be unable to sign their name and they have to explain why they are unable to sign their name.”
“Clause 16 Recording of declarations and statements etc Amendments made: 209, in clause 16, page 11, line 8, leave out paragraphs (b) and (c) and insert— “(b) a report about the first assessment of a person is made under section 7; (c) a report about the second assessment of a person is made under section 8;”. This amendment is consequential on Amendments 420 and 421. Amendment 377, in clause 16, page 11, line 12, leave out paragraph (d) and insert— “(d) a certificate of eligibility has been granted in respect of a person; (da) a panel has refused to grant such a certificate;”.— (Kim Leadbeater.) This amendment is consequential on NC21.”
“As the Minister said, a cancellation need not be in writing; it can be made orally or through any other form of communication. Amendment 321 agreed to. Amendment made: 473, in clause 15, page 11, line 3, leave out from “person” to end of line and insert “of a description specified in regulations made by the Secretary of State.”— (Kim Leadbeater.) This amendment provides that persons of a description specified in regulations (rather than persons “of good standing in the community”) may be proxies. Amendment made: 253, in clause 15, page 11, line 3, at end insert— “(6) For the purposes of this section “declaration” includes the cancellation of a declaration.”— (Sean Woodcock.) This would allow a cancellation of the first or second declaration to be signed by a proxy. Clause 15, as amended, ordered to stand part of the Bill.”
“Looking at different lists, there is the list of people who can sign the back of someone’s passport. I do not think that would be appropriate, so I moved away from that. I have also looked at much shorter lists. I do think that this question would be part of a consultation; it is really important to get it right, which is why we must have it as part of a consultation. I am content that having the Secretary of State put it in regulations is the right thing to do. As I said, I am happy to support amendment 321 in the name of my hon. Friend the Member for Bexleyheath and Crayford. It is a sensible amendment that makes the reasons for the use of the proxy more transparent. If amendment 253 in the name of my hon. Friend the Member for Filton and Bradley Stoke (Claire Hazelgrove) is moved, I am happy to support that too.”
“As we know, no two people are the same, nor are their circumstances. The hon. Member for East Wiltshire said that surely it should be done by someone the patient knows. The clause defines a proxy as someone the patient has known for two years, which is an important inclusion, but not everyone might have known for two years a person who they are comfortable asking to undertake that role. I also appreciate the challenges with the wording “of good standing in the community”. I will let the hon. Member for East Wiltshire and the right hon. Member for North West Hampshire fight that out among themselves. I am sure we all have our own version of what that means. I have explored various options and, contrary to the suggestion of the hon. Member for East Wiltshire, I have spent a huge amount of time on this question, because it is very important.”
“That is the sort of thing that the doctor would explore with the patient. It would happen in a very limited set of circumstances. We have to accommodate people who are physically impaired as a result of their terminal illness, and we have to include that there are a range of circumstances where this might apply. The proxy is being asked not to make any kind of judgment or assessment, but merely to act as an intermediary for the patient if they are unable to sign for themselves. They would have to explain why they are unable to sign for themselves, and the proxy has to be satisfied that the person understands the nature and effect of the making of the declaration. I thought long and hard about who should and should not be accepted as a proxy. As always, I try to imagine how it would be seen by someone with a terminal illness.”
“I beg to move amendment 474, in clause 16, page 11, line 17, at end insert— “(1A) In this section ‘recordable event’ means an event mentioned in a paragraph of subsection (1).” This amendment is consequential on amendments 209 and 377.”
“The amendments are designed to streamline the drafting of the Bill. Taken together, they create a new definition of a recordable event, namely those events set out in clause 16(1), where declarations and statements are required at any stage of the process. We can all agree that record keeping is essential, so it is necessary to define the events that should be recorded. I commend the amendments to the Committee.”
“I do not know the details of the individual cases that the hon. Member speaks about, but he makes a powerful point and we absolutely agree on the importance of recording and monitoring. I know that he voted against the changes at clause 12, but I hope he gets some reassurance from the changes that the commission would bring in. Having the commission and the panels would ensure robust monitoring and reporting. I hope he agrees that that is a positive step.”
“Amendment 478, in clause 16, page 11, line 30, leave out from second “a” to end of line 32 and insert “declaration, report or statement within subsection (1) must include the original declaration, report or statement.” —(Kim Leadbeater.) This amendment is consequential on amendments 209 and 377. Clause 16, as amended, ordered to stand part of the Bill. Clause 17 Recording of cancellations”
“I have nothing further to add. Amendment 474 agreed to. Amendments made: 475, clause 16, page 11, line 19, leave out from second “the” to “in” in line 21 and insert “occurrence of the recordable event”. This amendment is consequential on amendments 209 and 377. Amendment 476, in clause 16, page 11, line 24, leave out from “the” to “, and” in line 26 and insert “occurrence of the recordable event”. This amendment is consequential on amendments 209 and 377. Amendment 477, in clause 16, page 11, line 27, leave out from “the” to “in” in line 29 and insert “occurrence of the recordable event”. This amendment is consequential on amendments 209 and 377.”
“I beg to move amendment 479, in clause 17, page 11, line 37, leave out “at” and insert “with”. This amendment clarifies that a cancellation may be given to a practitioner with the person’s GP practice.”
“The amendment, which would clarify the drafting, speaks for itself. The important point is that the record of cancellation be with the GP practice as soon as is practicable. It is not necessary for that to take place physically at the practice, as that could potentially delay its delivery.”
“I commend the amendment to the Committee. Amendment 479 agreed to. Clause 17, as amended, ordered to stand part of the Bill. Clause 18 Provision of assistance Amendment made: 378, in clause 18, page 12, line 9, leave out paragraph (a) and insert— “(a) a certificate of eligibility has been granted in respect of a person,”. —(Kim Leadbeater.) This amendment is consequential on NC21.”
“We need to be really sensitive to that, having heard so many examples of families who have been through these really difficult situations. But the hon. Gentleman makes a very good point, and I am minded to support his amendment because I think it comes from a good place.”
“The hon. Gentleman is making a powerful speech, and I thank him for the respectful way in which he is doing so. He has given an example of a very personal story; it is also important to remember the other personal stories we have all heard. We have with us today in the Public Gallery family members who have lost loved ones. Catie’s mum went to Dignitas in Switzerland for an assisted death, and her daughter could not go with her. As a family they have suffered to this day as a result of that experience. We need to be really careful about the language we use around suicide. We have spoken about this before. The cases we have heard of are not people who want to die. They are people who want to live, but they are terminally ill.”
“The hon. Member is making an interesting philosophical point with his biblical references. I think the point he may be making is that there might not be any difference for the individual, as the result is sadly the same, but I put it to him that there is quite a significant difference for the other person. If we think about the autonomy of the medical professionals we ask to be involved in the process, there is a strong argument that it would be very different for them to be more involved in the process. Does that makes sense?”
“My hon. Friend makes a powerful point. I certainly have not heard anyone try to diminish the experience of suicidal people. We probably all have our own stories of loved ones who we have either lost to suicide—I know that I do—or who had very severe mental health issues. The point I would make is that the families I have met who have lost loved ones through assisted dying or a harrowing terminal-illness death have said that they desperately wanted to live. That is the distinction I would make, but I appreciate that my hon. Friend is absolutely right that people with suicidal tendencies and ideation also want to live—they just do not feel they have a choice. It is a very delicate debate to have, but please be assured of my sensitivities to it.”
“Clause 18(7) states that “the final act” of self-administering the substance “must be taken by the person to whom the substance has been provided.” That is very clear. The hon. Member for Solihull West and Shirley, with his medical background and expertise, has been clear and helpful on this point: it is a question of passive versus active. We have to be clear that the patient must have an active role in self-administration.”
“The Minister has covered my amendments 497 and 498 very clearly, so I will not speak to them. I am happy to support amendment 462, tabled by the hon. Member for East Wiltshire, about which we had a conversation this morning. I only make the observation that there is already a requirement in clause 18(4)(b) that, at the time the approved substance is provided, the co-ordinating doctor must be satisfied that the person has “a clear, settled and informed wish to end their own life”. Nevertheless, I am happy to support the amendment, because the hon. Member made a very valuable point this morning. I cannot support amendment 463, however. The Bill states that the patient must self-administer the drugs.”
“Member for Reigate about medical profession levels, which we discussed this morning. I also agree with the Minister’s comments about the concept of an independent witness, and with the comments from the hon. Member for Solihull West and Shirley about the concept of additional assistance. On that basis, I will not be supporting the amendments.”
“I completely understand where these amendments are coming from. In many jurisdictions where assisted dying laws are in place, this would be an accepted part of the process. However, as I have said repeatedly, our Bill stands in its own right, and its safeguards are stronger than those anywhere else in the world. One of those safeguards is that the line cannot be crossed between a person shortening their own death by administering the drugs themselves and by having another person—in this case the doctor—do it for them. While I am hugely sympathetic to the argument, that is a line that I do not believe the Bill should cross. I concur with the comments of my hon. Friend the Member for Bradford West about Second Reading and what the House voted for, and with those of the hon.”
“I am not aware of the situation in America, but is the hon. Gentleman not reassured that the evidence from Dignitas, which we all now have access to, says that there have been “no cases of failure at Dignitas using this medication”?”
“In response to the intervention of my hon. Friend the Member for Bradford West, the evidence from Dignitas is really clear: there have been no cases of failure when using this medication.”
“My hon. Friend is referring to Oregon. Obviously every jurisdiction has its own methodology when it comes to assisted dying. Is he reassured somewhat by the evidence from Dignitas that for not one person did the procedure fail? A survey from Victoria in Australia showed that 1,076 deaths from the self-administration process took place, and 86% of patients died within one hour. There are different models, and it is important to look more broadly at this if we can.”
“On the hon. Member for Richmond Park’s point, which a couple of people have made, I do not think anyone is saying that this is not a new situation—of course it is, as we are all aware. My hon. Friend the Member for Stroud’s point was that a doctor being with a patient who is dying is not a new situation. That is the important distinction.”
“I can help my hon. Friend out on this point. There is an expectation in the jurisdictions where assisted dying happens that it happens in different locations, very much centred around the patient’s wishes, which is the approach we should take.”
“To try to tie this together, I should say that there seems to be consensus that something has to be recorded in the event of complications. It feels to me as though what the Government are saying is that this is not the best crafted way of doing that—that is the worst sentence ever; I apologise. We have to look at the best way of achieving the intention of a number of amendments. I am looking at amendment 430, which I think achieves the objective. This feels as though it is a drafting issue, rather than necessarily a policy issue. I might be wrong.”
“As a matter of clarity, although I appreciate the power that the Minister has just given me, which amendments we vote for is actually the job of the Bill Committee—rather than just my job, I would hope.”