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 appreciate that, for procedural reasons, we will not vote on the replacement of clause 12 until the new clauses are put, but I am encouraged that colleagues have offered positive responses and comments to the proposal for a commissioner and a multidisciplinary panel, regardless of how they voted on Second Reading. That tells me that, whatever our views on the Bill, there is a shared commitment to getting protections for terminally ill adults right, which means that we are doing our job. Amendment (c) to new schedule 2 was tabled by my hon. Friend the Member for Lowestoft (Jess Asato). I was pleased to support my hon. Friend’s amendment on additional training on domestic abuse, coercive control and financial abuse for doctors who take part in the assisted dying process.”
“The proposal to have a multidisciplinary panel, appointed by a judge, to examine each request, following earlier assessments by two independent doctors and, where necessary, a psychiatrist, reflects the expert testimony we have heard during our proceedings. It strengthens the Bill by adding more varied expertise to the decision-making process, with judicial oversight, and it includes an important monitoring and reporting function in the commissioner. My amendments show the Committee process working exactly as it should, reflecting on evidence from the UK and around the world, and making a strong Bill even stronger.”
“We have all been told off, and quite rightly. I thank colleagues for another powerful, robust and thorough debate on this important subject. I thank the Minister for providing such an excellent and clear description of the changes to clause 12 that I have proposed this afternoon—I will not repeat that description. The Bill is already the strongest of its kind anywhere in the world. My amendments will make it even more robust. As we have heard, the Bill is much safer than the existing ban on assisted dying, which leaves terminally ill people and their families without any such protections at all.”
“I beg to move amendment 469, in clause 13, page 9, line 11, leave out “subsection (1)” and insert “this section”. This amendment is consequential to Amendment 472.”
“The amendments serve simply to set out clearly what the regulations must include with regard to the second declaration and the subsequent statement from the co-ordinating doctor. They replace the schedules and are consistent with the advice I have received that matters of this nature are not suitable for the face of the Bill. They are simple and straightforward amendments.”
“I might be missing something—it has been a long day—but, presumably, by the time the patient has got to that point, they have been through the eligibility criteria with the two doctors. The hon. Lady said that they would not be terminally ill, but they would have been through all the assessment criteria at this point.”
“I have nothing to add on this group of amendments. I am confident that the Bill as drafted already includes significant periods of reflection. Bearing in mind that we are putting dying people through a very lengthy process already, I remain confident that the periods of reflection are adequate as set out in the Bill.”
“I take on board the Minister’s point on capacity. We need to be aware of that. We will hopefully debate the third layer later today. That layer may be a panel of experts who are there to oversee the full picture of the patient journey. For them to see what has happened with the doctors that they have interacted with is very important. Therefore, I am minded to support amendment 459.”
“I associate myself with the Minister’s comments regarding the other amendments in the group; however, I listened carefully to the debate on amendment 459 and the points made by the hon. Member for Richmond Park, my hon. Friend the Member for Stroud and the Minister. My view on that amendment has changed: I do think independence is really important in the doctor’s opinions during the normal process that the Bill sets out. However, it is a really fair point to make that if the independent doctor refuses the patient, there needs to be transparency about that, and it is important that everybody involved in the process can see how that decision has been made. That is a really valid point. It is a good example of how this Bill Committee is operating, and should be operating, in that we have been listening to different views and opinions.”
“I beg to move amendment 201, in clause 9, page 5, line 36, leave out “and their medical records” and insert “, examine such of their medical records as appear to the assessing doctor to be relevant,”. This amendment provides that the duty on an assessing doctor to examine a person’s medical records is limited to records appearing to the doctor to be relevant.”
“As is the case at all stages in the process, records should be kept of any and all such discussions, and reports should be shared where appropriate. Taken together, the amendments would ensure that the doctors’ assessments are thorough and comprehensive, and have taken into consideration the views and opinions of any wider health and social care team that may be working with a patient.”
“The Bill as drafted provides that the assessing doctor must “make such other enquiries as the assessing doctor considers appropriate” when making the first and second assessments. With the amendments, I have sought to strengthen that language, by being much more explicit and making specific reference to consulting health and social care professionals. I have done so in response to the evidence we have received from professionals such as nurses and social workers, who often spend a significant amount of time with terminally ill adults. It is clearly right that the assessing doctors should have access to all relevant details of a person’s medical records. If the records show that the person has recently been receiving health or social care, that may impact their application, so the doctors have to consult the providers of that care.”
“Amendment 201 provides that the duty on an assessing doctor to examine a person’s medical records is limited to records appearing to the doctor to be relevant, which makes sense. Amendment 422 requires an assessing doctor to make such inquiries of professionals who are providing, or have recently provided, health or social care to the person as the assessing doctor considers appropriate. Amendment 423 requires the assessing doctor to consider whether they should consult health or social care professionals, and to consult them if they consider there is a need to do so. A record of any consultation must be shared with the other assessing doctor. The amendments seek to emphasise the importance of taking a holistic and multidisciplinary approach to the assessments by both doctors.”
“On the hon. Member’s point about recording those consultations, amendment 423 states in its proposed new subsection (2B): “Where an assessing doctor consults a professional…the assessing doctor must give a written record of the consultation to the other assessing doctor.”So the consultation is recorded.”
“That question was indeed put to the experts from Australia, but actually they were quite clear that there is a huge amount of evidence. Indeed, there is a very robust reporting mechanism in Australia—the best in the world, I suggest—so there is a huge amount of evidence from that jurisdiction.”
“My hon. Friend raises a really important point. As clause 9 says, the doctor has an obligation to discuss with the person their wishes in the event of complications, so that conversation would have happened with the patient. To be clear, the doctor cannot intervene to expediate the patient’s death. That is very clear in the Bill.”
“To be clear, it does say “discuss with the person their wishes”. That includes whether they would want the doctor to call an ambulance if things got complicated, or whether they would want to be left—so the doctor would discuss with the patient their wishes in that situation. Fortunately, it does not happen very often.”
“Amendments 142 and 93 both provide helpful clarity for the Bill. There are good intentions behind amendments 305, 306 and 362, but I am confident that they are already covered by clause 9(2)(b)(iv) and clause 9(2)(c). I do, however, take on board the point made by the hon. Member for Solihull West and Shirley about the concept of side effects. Going forward, it might be helpful to look at that use of language. To conclude, I am minded to support amendments 93 and 142.”
“I will start with amendment 93 tabled by the hon. Member for Solihull West and Shirley. He made a really important point about the language in the clause, and I am very happy to support the amendment. It is quite clear that, across the Committee, there is no disagreement that a terminally ill person requesting assistance to shorten their death should be given all the information necessary to help them make the clear, informed and settled decision the Bill requires. That should include an explanation of the drugs that are likely to be used—bearing in mind that there may be more than one option available to the person when the time comes, depending on their medical circumstances—and how they would be administered. As such, I am minded to support amendment 142, tabled by my hon. Friend the Member for Broxtowe.”
“I have nothing to add, other than that I will not be supporting amendments 307 and 308. I associate myself with the comments made by my hon. Friends the Members for Rother Valley, for Stroud and for Sunderland Central.”
“I beg to move amendment 205, in clause 10, page 7, line 11, at end insert “; but this is subject to subsection (4). (4) Where— (a) a referral is made under subsection (1) to a practitioner, (b) the practitioner dies or through illness is unable or unwilling to act as the independent doctor, and (c) no report under section 8 has been made by virtue of the referral, a further referral may be made under subsection (1).”. This amendment provides that a further referral may be made under this clause where a practitioner dies or is unable or unwilling to act as the independent doctor due to illness.”
“I will speak briefly to this small amendment, which provides that a further referral be made under clause 10 when a practitioner dies or is unable or unwilling to act as the independent doctor due to illness. In the very unlikely circumstances that the doctor who has agreed to give a second opinion dies or—because of illness or whatever reason—is unable to continue before making a report into the case, it would be right to seek a second opinion elsewhere. I hope the Committee will support my amendment 205.”
“Additionally, I associate myself with the Minister’s comments about amendments 309 and 310. It feels as though those amendments do not necessarily do what was intended.”
“I will speak briefly about amendment 461. A co-ordinating doctor is central to the whole process set out in the Bill, from start to finish. If a co-ordinating doctor becomes unavailable, a replacement would need to be found. There may be a number of reasons, not restricted to the doctor’s own death or illness, why that could happen. We have already heard a few examples—it could be retirement, maternity leave or anything going on in that doctor’s personal life. A close family member might fall ill or die, or something else might happen in the doctor’s life that forces them to withdraw. We have talked a lot about patient autonomy, quite rightly, but we need to think about the autonomy of the doctors involved in the process as well. It is therefore important that they have the ability to step away, as set out in clause 11.”
“I hope I can provide some reassurance. This issue is covered by my new clause 21. The amendment, I think, asks why the High Court would not have heard from the patient. My new clause would ensure that the panel—as it potentially would be—will hear from the patient.”
“I think I have responded to the hon. Member for Broxtowe on amendment 407 by saying that the concern will potentially be covered by my new clause 21. On amendment 410, it is also my view that, whether it is the High Court or the panel or whoever we end up having over the course of this Committee, that third layer of scrutiny and safeguarding should be able to hear from other people, not just the patient and the doctor, so I would not support that amendment.”
“I will be brief, because we will come on to this debate when we get to clause 15. To be clear, the circumstances where a proxy would be involved in this process are literally when somebody is so ill that they are unable to sign their own name, so it is a very limited set of circumstances.”
“Where else in our judicial system does one find a judge, sitting judicially as a judge, whose function is not to decide some disputed issue or…to resolve some controversy but only to certify, as it were, that some decision taken by a private individual complies with the law? That, it might be said, is not what judges do and not what judges are for.” He also expresses his concerns around conscientious objection and the challenges of ensuring “an open and transparent process that may deter those for whom the scheme is designed, and a secret process destructive of the integrity of the scheme and corrosive of the judicial function.” I absolutely agree that this is a very tricky balance.”
“172-173, Q222.] Lord Sumption has been critical of the complexity of the process set out in the Bill as drafted, describing it as “over-engineered, bureaucratic, and coldly inhumane”. He told us in evidence that he disagreed with the inclusion of the need for High Court approval of a person’s application for an assisted death. Former High Court judge Sir James Munby has written various articles in this regard. In his piece “Assisted dying: what role for the judge?” he asks: “Should the judges be involved at all in this process? Is what is proposed a proper judicial function?” He continues: “Is this, indeed, truly a judicial function at all? Many would say that it is not.”
“It is important that we as a Committee acknowledge that. Barrister and former Supreme Court judge Lord Sumption said that “clause 12 is unnecessary and in some respects undesirable.” He went on: “The concern that I have about clause 12 in its current form is that it is not entirely clear what the judge is supposed to do…is he there in order to ensure that the two doctors have done their job and that the ducks are all in a row, or is he there to form his own view on all of those matters, completely independently of those who have already given their certificates?...It seems to me that this is a protection that no other country, so far as I am aware, among those that have authorised one or other form of assisted dying has included.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c.”
“That is, of course, extremely sad. I also know that, certainly in this country, people feel strongly that oversight and scrutiny of what we might call the initial medical stages of the assisted dying process are important. The challenge is achieving an appropriate balance between compassion and patient autonomy, and robust safeguarding—plus, of course, medical autonomy. If there is to be a third layer, what should it look like? As the Bill stands, the third layer of scrutiny is a High Court judge, who would make the final decision regarding a patient’s choice to have an assisted death. I was, and remain, very confident in the ability of High Court judges to have that role, but it is fair to say that there is a range of views on the suitability of the judiciary to fulfil this function—not least from ex-judges themselves.”
“Most jurisdictions have a process that involves two doctors, as the Bill does, but there is no additional stage. There are different views as to whether a third layer is necessary; many other jurisdictions have processes that provide a very compassionate, patient-centred and well-safeguarded approach to assisted dying without it. Indeed, some of the most difficult emails I receive are from terminally ill people who are very concerned about the complexity of the process laid out in the Bill. They feel that it is overcomplicated and too bureaucratic to navigate for people who are in their dying days and weeks. I am very sensitive to that. I am also aware that the thorough process set out in the Bill will take time, and there will be people who embark upon it who will die before they can complete it, as happens in other jurisdictions.”
“I hope you are sitting comfortably, Mrs Harris; it is a pleasure to see you this evening. I rise to speak to new schedules 1 and 2, new clauses 14, 15, 17 and 21, and their consequential amendments. These provisions relate to the introduction of the assisted dying commission, which would oversee the assisted dying process in England and Wales, and the multi-disciplinary panels of experts, which will operate as part of the commission, should the Bill be passed. It has always been my view, and I have always been clear, that there should be a third layer of scrutiny and safeguarding in the assisted dying process, particularly given the significance of the change in the law. However, I appreciate that, if we compare the Bill with the many other models of assisted dying around the world, this is very unusual.”
“The hon. Gentleman makes a good point. It is fair to say that there is a range of views on this subject from the judiciary. Ex-judges have commented, and I will come to those comments shortly. In his evidence, the chief medical officer, Professor Sir Chris Whitty, said that the best safeguards were the simple ones and warned that patients could find themselves in “a bureaucratic thicket” at the end of life if there is too much to navigate. I am very sensitive to that. Responding to his comments, Lord Sumption said: “I do agree with that…one suggestion that I think would make a significant difference…is the removal of the clause 12 stage.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 182, Q236.] That shows the difference of opinion among former judges.”
“The introduction of a multidisciplinary panel of experts to consider all applications for an assisted death, overseen by a commissioner in the form of a High Court judge, sitting or retired, really does achieve that, and embeds a truly robust, multidisciplinary approach, which I am confident will put patients at the centre of the assisted dying process and provide additional scrutiny, safeguards and protections.”
“That would include data on demographics; statistics on the populations and characteristics of the patients who have chosen an assisted death; their age and gender; geographical analysis; data regarding the illnesses and diseases; how many cases were rejected; and how many patients did not complete the process and so on. When completing the annual report, the commissioner must consult the chief medical officers for England and for Wales, and anyone who represents the interests of people with protected characteristics. The Law Society, which is neutral on assisted dying, says that if the law were to change, the system must have “robust, accessible and independent safeguards” as well as “strong independent monitoring and review mechanisms”. I agree.”
“Indeed, Professor Michael Dooley, who is the director of pharmacy at Alfred Health and the head of Victorian voluntary assisted dying pharmacy services, and who some of us met yesterday, told us that in that state in Australia some 90% of assisted dying patients also still access palliative care. That shows the holistic approach that can be taken. There is of course another very important role for the commission, which is in relation to the monitoring and reporting of cases—something I feel very strongly about. The details are set out in my amendment 455 to clause 34. The commission must produce an annual report, which must include details about the application of the Act. That report must include details in relation to persons who have protected characteristics, and details of any other description of people specified.”
“Only if all three members of the panel are satisfied that all the criteria have been met will it issue a certificate of eligibility. It must refuse to do so if it is not satisfied. The decision of the panel has to be unanimous. If there is any doubt from any of the panel members that the criteria have been met, the patient cannot proceed. The patient then enters a 14-day period of reflection, before making their second declaration. It is worth reiterating that, as has been said previously, a significant number of patients get to that stage and never actually continue with an assisted death, but the comfort it provides enables them to live out their final weeks and days with a sense of reassurance. As families have described, a weight is lifted.”
“That is the decision I have taken, addressing the concerns of colleagues who have tabled amendments to the same effect. Indeed, Lord Munby said of the Bill as it stands that “the absence of any requirement that the judge ‘must’ hear from and question the patient is a quite extraordinary lacuna.” I appreciate, though, that there will be exceptional circumstances, which we know may be the case if the patient is very ill and in their last few weeks of life. The panel may also ask any person who appears to have relevant knowledge or experience to report to it on such matters relating to the person as it considers appropriate. It can basically ask to hear from anybody it wishes. That would obviously vary from case to case. Every case will be different, as we have discussed, and flexibility is really important.”
“I mentioned that in relation to the amendment from my hon. Friend the Member for Broxtowe earlier. It is the default. This was a difficult decision. I appreciate that to make the patient undergo another level of personal scrutiny could be viewed as cruel. Indeed, a number of people have said to me that they feel it will be too burdensome on the patient during what is already a deeply emotional, highly personal and stressful time, when they are likely to be in pain and having treatment. I acknowledge that. Again, this is about finding the very difficult balance between avoiding an unduly stressful bureaucratic process and ensuring that the patient is making, as the Bill says, a “clear, settled and informed” decision. There is a very strong argument that in order to do so, the panel should hear from the person themselves.”
“Gentleman’s opposition to assisted dying, I hope that, in the interests of strengthening the Bill, he will be able to support the amendments today, because that is the job of this Committee—to strengthen the Bill, not to try to stop it, however strongly people may feel about the issue. A significant part of the strengthening is through additional patient-centred safeguards. I firmly believe that the introduction of the assisted dying commission and the addition of the multidisciplinary expertise and oversight provided by the panels are a crucial part of that. The panel will look at the detail of every individual case and scrutinise the doctors’ reports. It must hear from and may question the co-ordinating doctor or the independent doctor; it may hear from and question both; and it must hear from and may question the patient themselves.”
“I disagree: they are involved earlier. I have talked about the amendments we have already made around health and social care professionals. We have tabled those amendments, changed the Bill and added that provision on the basis of the evidence we heard. Remember that either doctor can speak to any other health or social care professional they wish. I would say that, actually, a multidisciplinary approach is taken throughout the Bill and, by ending the process with the panel, that is reinforced. The hon. Member for East Wiltshire said in his radio interview on 12 February, “I do welcome”—as he has confirmed today—“the additional role of more experts in the process”. Hopefully, irrespective of our different views, that is something that the idea of the panel can coalesce around. Despite the hon.”
“I appreciate the point my hon. Friend is making, and it is a shame that we did not hear from James Munby in evidence. I understand why he says that: he is looking at it through a judicial lens, because he is a judge. But this is not a judicial entity. It is a panel—it is not a court—and the range of expertise on it is actually a strength, not a weakness.”
“I appreciate that this is slightly difficult to get our heads around, but we have legal expertise—we potentially have a judge, a sitting judge, a retired judge or an eminent KC—but they are not there in their capacity as a judge. I understand that that is tricky for people to understand, but they are there because of their skillset. That is the important distinction.”
“Just to be clear, that was not the reason for the change. We need to be very clear about that. The reason for the change was that it strengthens the Bill.”
“To be clear, the point I have tried to make with regard to the evidence that we received was just that there is a need for a multidisciplinary approach, wherever it happens.”
“The point is that it has to happen at every stage, and I think the evidence that we heard was that it does happen. I know from the experiences of family and friends of mine who have had cancer that it does happen. There is a multidisciplinary approach; there is an oncologist, a nursing team and a doctor. That does happen, and nothing in the Bill will take away from that.”
“Does the hon. Member not agree that by accepting amendment 6, tabled by the hon. Member for St Albans, we have early intervention with psychiatric analysis at a very early stage, when either of the doctors feels it is necessary?”
“My hon. Friend is making an excellent and powerful speech. I thank him for putting the human being back at the centre of the process; sadly, in this Committee we can forget to do that. Early on, we had Nathaniel Dye here, who is a terminal cancer patient. He has just had a 12-month prognosis. The thought of making that man jump through hoops and over hurdles breaks my heart. I understand that we have to do it, but these are the people that we are actually talking about when we discuss the Bill.”
“I just want to provide some reassurance to my hon. Friend the Member for Bradford West. I have met my hon. Friend the Member for Lowestoft and today I will support amendment 20, which she has tabled. I hope that provides some reassurance to my hon. Friend the Member for Bradford West.”