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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“We need the Bill to show that this has been considered, and the logical place for that would be clause 30, on codes of practice. I am happy to support that amendment when the time comes to vote on it.”
“I thank colleagues for a thorough discussion of a group of interesting and important amendments. Amendment 429, tabled by my hon. Friend the Member for Bexleyheath and Crayford, would require the doctor to remain in the same room as the person. I respectfully disagree with my hon. Friend on that point. If a person is literally in the last few minutes and moments of their life, it should be up to them to decide who is in the room with them. In some cases, that might be the doctor, but I suspect that in many cases it would be loved ones and close family members. We have had a thorough discussion of the range of amendments that look at how we deal with complications. My view is that amendment 430 would do what needs to be done.”
“I believe that amendment 447, tabled by my hon. Friend the Member for York Central, would change the “may” to a “must”. I am minded to support it for that very reason. Amendment 532, tabled by my hon. Friend the Member for Ipswich, comes from a good place as is meant to be a way of trying to help the doctor, but I worry, as medical colleagues have commented during our deliberations, that it could create more of a problem for the doctor in that it would remove flexibility and the use of their clinical judgment and expertise. It always worries me when we are considering putting that level of detail in the Bill.”
“Friend the Member for Ipswich to new clause 8—the duty to consult—bearing in mind that there will be a long period of consultation before the Bill, if it passes, is enacted. The Minister referred to amendment 255, which I think will fall as it refers to a schedule that has been removed from the Bill.”
“The challenge would be in whether the co-ordinating doctor would be able to take actions that were not listed. I worry that a list would be quite restrictive. Amendment 430, which would look at the code of practice, would achieve something in a less restrictive way, which is why I am minded to support it. We have had a really interesting discussion about amendment 533, and we will probably come further down the line to discuss where patients should have the choice to have an assisted death. I am not entirely sure how the amendment would work, which is why I am not minded to support it. I am slightly concerned about the terminology and am not sure what the definition of “disadvantaged and marginalised communities” would be for the purposes of the amendment. I refer my hon.”
“However, I also take on board the fact that the word “consultation” does some heavy lifting, and I think that is an important point, so I am happy to support amendment 408. I have mentioned already in response to my hon. Friend the Member for Bradford West that I am happy to support amendment 22, for the reasons I have given previously in relation to similar amendments.”
“Clause 19 applies when the co-ordinating doctor may not be available to provide assistance. They may be out of the country or unavailable due to other personal circumstances, as the hon. Member for Richmond Park articulated beautifully—I associate myself with her comments. Of course the doctor who steps in has to be trained appropriately, and if they are not satisfied of all the matters mentioned in clause 18(4), they must immediately notify the co-ordinating doctor. That is what my amendments 210 and 499 cover. On amendment 408 in the name of my hon. Friend the Member for Broxtowe, who sadly is not with us today, it could be argued—and I take on board the comments by the hon. Member for Solihull West and Shirley—that it is unnecessary because it would be common practice by practitioners to consult.”
“My view is that this is very clearly a matter for the Secretary of State, but with expert clinical and medical guidance. These are the people who should be making the decisions about such drugs. The evidence about this type of medication exists. As part of the commencement period and the consultation period, I anticipate there will be wide consultation about the drugs that are available. I think it is best left with the Secretary of State, so I would leave the clause unamended.”
“I beg to move amendment 379, in clause 21, page 14, line 10, at end insert— “(3A) The coordinating doctor must, as soon as practicable, give a copy of the final statement to the Commissioner.” This amendment requires the coordinating doctor to give the Commissioner a copy of a final statement.”
“Amendment 379 would ensure that the co-ordinating doctor provides the commissioner with a copy of their final statement in cases in which the person has successfully been provided with assistance to end their life in accordance with the Bill. That is an important part of the reporting procedures and of the role of the commissioner. If agreed to, the amendment will ensure a robust recording and monitoring process for assisted dying. Amendment 500 provides that regulations about the form of the final statement must make the provision mentioned in paragraphs (a) to (i) of proposed new subsection (3A). It builds on my amendment 214, which would amend subsection (3)(a) to require that the form of the final statement must be set out in “regulations made by the Secretary of State”. This is another way of ensuring robust and thorough reporting.”
“I do not think that anyone has ruled out discussing complications. Clause 9 makes it clear that the doctor has a very clear discussion with the patient about what will happen if they proceed with an assisted death.”
“Amendment made: 500, in clause 21, page 14, line 10, at end insert— “(3A) Regulations under subsection (3)(a) must provide that a final statement contains the following information— (a) the person’s full name and last permanent address; (b) the person’s NHS number; (c) the name and address of the person’s GP practice (at the time of death); (d) the coordinating doctor’s full name and work address; (e) the date of each of the following— (i) the first declaration; (ii) the report about the first assessment of the person; (iii) the report about the second assessment of the person; (iv) the certificate of eligibility; (v) the second declaration; (vi) the statement under section 13(5); (f) details of the illness or disease which caused the person to be terminally ill (within the meaning of this Act); (g) the approved substance provided; (h) the date and time of death; (i) the time between use of the approved substance and death.”— (Kim Leadbeater.) This amendment provides that regulations about the form of a final statement must make the provision mentioned in paragraphs (a) to (i).”
“I have nothing to add other than to respond to the fair point made by the hon. Member for East Wiltshire about complications. The doctor does have to record the final statement in the medical records, and I am confident that they would also record any complications in the medical records. Similarly, we have talked about the code of practice with regard to complications, so there is scope to include what would happen in those instances there. It is, however, a fair point, and it could be something to look at amending on Report, if the hon. Gentleman wants it to be in the Bill. Amendment 379 agreed to.”
“I beg to move amendment 380, in clause 22, page 14, line 25, at end insert— “(1A) The coordinating doctor must, as soon as practicable, notify the Commissioner that this has happened.” This amendment requires the coordinating doctor to notify the Commissioner of a matter mentioned in subsection (1).”
“The amendment would require that if a person has decided not to take the substance or the procedure has failed, the co-ordinating doctor must, as soon as is practicable, notify the commissioner of that. It is fairly straightforward.”
“I have nothing to add, other than to say that the complications that have been referred to many times today would be covered by the code of practice that we will introduce by agreeing to amendment 430. Amendment 380 agreed to. Amendment proposed : 440, in clause 22, page 14, line 34, at end insert— “(4) For the purposes of subsections (2) and (3)(b), the information recorded must include— (a) any interventions made by a medical practitioner in response to the procedure failing, and (b) the timing of those interventions.” — (Sean Woodcock.) This amendment would specify certain information to be recorded under section 22 when the procedure fails. Question put, That the amendment be made.”
“The hon. Member is making an important point. I would like to get it on the record that I agree with him: there should be no duty on any person to take part in the Bill’s provisions if they choose not to, for whatever reason. I will struggle to support his amendment because there are other issues with it, but on that principle I wholeheartedly agree, and I would be happy to work with him in sorting it out, before Report, to that effect.”
“I am just trying to imagine what this would look like in reality. My own grandparents, for example, ended their days in a care home, and that was their home—that was where they lived, that was their address, and they paid to live there. If they had had a terminal diagnosis and had wanted to end their days in their home, having lived there for however long it was—four or five years—it would have felt incredibly cruel to expect them to go somewhere else to do something that was legal.”
“If my hon. Friend will give way, in response to the point made by the hon. Gentleman, the drafting of “directly or indirectly” does worry me—”
“I am speaking to my hon. Friend. The point she raised about “directly” and “indirectly” is a very good one, and subsection (1A) says “In particular”, which is not exclusive. That lack of clarity and certainty concerns me; does she agree?”
“This is a very interesting point. I am slightly concerned about the equality and human rights issues in terms of the patients and terminally ill people, as well as the staff—that relates to the point that the right hon. Member for North West Hampshire just made. I do not know whether the hon. Member has done any research into gay marriage and whether there were similar issues there, because I imagine that when that was brought into law, there may have been similar issues. Does the hon. Member know how that was addressed?”
“I think it is fair to say that the evidence from New Zealand is mixed. One family said that the final few precious hours of their mum’s life were mostly filled with stress and distress, as they had to scurry around to move her out of her so-called home. Does the hon. Lady agree that there are different views and opinions about the New Zealand model?”
“The hon. Member is absolutely right that we are here to ask questions, and I appreciate those questions being asked. On what happens earlier in the process, I hope she is reassured by the fact that we will now have compulsory referral to a psychiatrist if there is a doubt about capacity, and we have specified in the Bill doctors consulting other health and social care professionals, to provide for a holistic approach earlier in the process.”
“The other point I would reiterate is that none of that stops happening. We have heard from professionals and experts that that happens. Someone who has cancer will have a multidisciplinary team around them as part of their natural treatment process. Nothing in the Bill stops that happening.”
“Is the hon. Lady reassured by the fact that, under the Bill, coercion becomes a criminal offence with a serious prison sentence? If any family members are in any doubt as to whether coercion is taking place, it is straightforward: they go to the police.”
“The hon. Lady mentioned a few moments ago that the family would make such an appeal only if there was new information, but her amendment does not say that, and it has no explanatory statement. Could she clarify what she meant?”
“I might have misheard, but I believe the hon. Member asked what happens when a patient asks for assisted death not as a result of illness. If that was the case, then they would not fall under the criteria of the Bill.”
“I am interested in exploring the characterisation of the two sides referred to, because this is not about two sides. This is about an individual patient with a terminal illness. I am just interested in how we can explore that a little further.”
“The quick answer is that there would be an injunction. I hope my hon. Friend will also be reassured that the panel is coming towards the end of this very long process. In the situation he describes, the patient would have gone through all the other stages with the doctor. I imagine in that situation, in a psychiatric referral, the doctor would have said, “Would you consider speaking to your next of kin?” There are a lot of other stages prior to getting to this point, which I hope provides some reassurance.”
“I will stand corrected if this is not true, but my understanding is that Hansard will show a very different story. I do not think that 60 people got up and said on record that this element was why they were voting for the Bill.”
“I understand the hon. Member’s framing of this and it might very well be his perspective, but there were 650 MPs who voted on Second Reading that day, so I think it is unfair to represent colleagues who did not have the view that this is the central component of the Bill. There are lots of other components to the Bill that colleagues have certainly spoken to me about, and it is important to acknowledge that.”
“The hon. Gentleman is making a point that we hopefully all agree with. The job of the Committee is to take evidence and look at ways of improving the Bill on that basis. This is a really good example of where we have actually done our job and done it very, very well.”
“I thank the hon. Gentleman for giving way again; I will sit down after this. I will not take it too personally that he thinks I have done a very poor job, but the point is that we heard a broad range of evidence from professionals including legal experts, medical experts, psychiatrists and social workers—lots of different people. We have also had evidence come in over recent weeks and months that has added to that and has talked about these changes. It is important to acknowledge that.”
“The hon. Gentleman is been very generous with his time. I am interested in how he can conclude that the eligibility criteria have somehow been expanded by adding an expert panel with a psychiatrist and a social worker.”
“I am not entirely sure who the hon. Gentleman is referring to, but it is fair to say that there is a range of views across a range of professions. It is important to acknowledge that.”
“To clarify, the point that I am making is that there is a range of views across a range of organisations—many of which are neutral on the issue of assisted dying, full stop—and a range of views within each profession. We heard evidence from people working in palliative care with different views, and from medical people with different views. It is important to acknowledge that.”
“It is really important to be clear about this. I do not think anyone is suggesting that what is in the Bill will replace existing good practice. That is really important. We probably all have family and friends who are being treated for cancer now, and they are looked after and cared for by a multidisciplinary team. That team does not suddenly disappear, to be replaced by what is in the Bill; it can continue. The assisted dying option involves the two doctors, and I struggle to envisage any situation in which they would not work with the multidisciplinary team and add on, where appropriate and necessary, psychiatric intervention, social care and healthcare professionals. I always come back to the point that I do not think the two things will operate independently.”
“There is a judge—it may be a retired judge—who is the commissioner, who heads up the entire assisted dying commission, and there is a legal expert on the panel as well, as the hon. Gentleman said. That could be a retired judge, so there is legal expertise there. I think the hon. Gentleman also made the point that there is not a doctor on the panel. My understanding is that psychiatrists are doctors, but I will stand corrected if that is not true.”
“Does the hon. Gentleman agree that that is exactly the point? This is a unique situation, and therefore we need a unique system. That is the perfect opportunity to use the skills that a judge or retired judge has.”
“Many of us have quoted Sir James Munby, for whom I have a huge amount of respect, but there are a number of other views from ex-judges and very highly-regarded legal professionals that conflict with what Sir James says.”
“We have already talked about this, and I think the hon. Gentleman mentioned it himself: there is a similar situation with public inquiries, on which a judge sits because of their skillset and who they are, but not necessarily in a traditional judicial capacity.”
“A strong argument has been made to me that the professionals on the panel would have the skills and training to fulfil their role, but it is important, particularly given the time we have spent discussing this issue, that they do have it, so I am happy to support that amendment.”
“It absolutely is the policy intent that there should be a unanimous decision of the panel. If there is any lack of clarity, I am very happy to look into working with official draftspeople to tighten that up.”
“It is important to acknowledge that it will be a number of years before this law will be implemented. Hopefully, the Government will continue the fantastic job that they are doing to improve capacity in our courts, so that even if capacity is an issue now, a few years down the line it will not be.”
“That is another important argument for having the panel. Where a terminally ill person with an eating disorder has been deemed to have capacity by two doctors and—I surmise, as we now have the compulsory referral—a psychiatrist, we will have on the panel another psychiatrist and a social worker. The panel does help to address concerns about capacity. Does the Minister agree?”
“It is a pleasure to serve under your chairmanship, Sir Roger. It was a delight to see the mum of the hon. Member for East Wiltshire. Sadly, I think she is no longer in the Public Gallery, but I hope they had a really good chat.”
“I would welcome the clarity from the Minister regarding some of the legal language and terminology around other amendments, and as such, I will not be supporting them this afternoon. We have had another thorough debate, and I welcome the contributions from colleagues across the Committee.”
“My reading of amendment (a) is that it is not the right hon. Lady’s intention that this will be required in every case. However, it will ensure a very patient-centred approach, in which I believe passionately. I take on board the Minister’s concerns, which I appreciate may need to be considered further down the line, but I am minded to support amendment (a) to new schedule 2. Finally, amendment (e) to new clause 21, tabled by my hon. Friend the Member for Filton and Bradley Stoke (Claire Hazelgrove), in on audio and video material. I think this comes from a really personal, sensitive and important place, and demonstrates a very patient-centred approach, so I am also minded to support it this afternoon.”
“Under the Welsh Language Act 1993, as the Minister said, all public bodies operating in Wales must create a Welsh language scheme with the aim of ensuring that Welsh and English are treated equally in all aspects of public service delivery. The Ministry of Justice’s Welsh language scheme, for example, sets out where services can be provided in Welsh, typically through translation services. I take on board the right hon. Lady’s comments about the limitations of using translators. Given the sensitivity of the conversations and deliberations we are discussing, we need to be sensitive to that. It is, of course, the patient’s prerogative to request a fully Welsh-speaking panel, if that is what they want at such a difficult time—as long as they are made aware of the potential delays this may or may not create. That is my concern.”
“As members appointed to the panel will already be very well qualified in the fields of law, psychiatry and social work, I am confident that they will have the necessary expertise to determine referrals, but I appreciate the challenges in detecting the subtleties of coercion, as the Committee has discussed at length. As such, I support amendment (c). Amendment (a) to new schedule 2 was tabled by the right hon. Member for Dwyfor Meirionnydd. I am fully supportive of her position on ensuring accessibility and equality for Welsh speakers, but in this instance I have some concerns about the barrier her amendment may create for patients in accessing the assisted dying process in a timely manner, and therefore about the workability of the amendment.”