YouSaid · the spoken record
Kim Leadbeater
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On the record 2021–2026
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“It is a privilege to open the debate on this next important stage of the Terminally Ill Adults (End of Life) Bill. It seems a long time ago that we held the Second Reading debate in November on what many of us felt was a very proud day for Parliament, when we saw an emotional and passionate but largely respectful debate on a hugely important subject that means so much to so many people. I know that there are a range of views on the subject of choice at the end of life, and today is not about revisiting the fundamental principle of assisted dying. Before I address the amendments in my name, as the sponsor of the Bill, I will make some brief introductory comments on why we are here. Put simply, if we do not vote to change the law, we are essentially saying that the status quo is acceptable.”
House of Commons16 May 2025Contains Parliamentary information licensed under the Open Parliament Licence v3.0Source ↗
“I thank my hon. Friend for that intervention. That was a very powerful point, if slightly long. There are people who face these really traumatic and difficult decisions every day, including Louise Shackleton, who I believe is also with us today.”
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“I thank the hon. Gentleman for that intervention and he is absolutely right that there are a range of views on this issue, and I am deeply respectful of that. I take all those points into consideration as we embark on this debate again today. Perhaps most importantly, Mr Speaker, I have spoken to terminally ill people themselves over recent months. It is impossible to know what it must feel like to receive a terminal diagnosis and I have nothing but admiration for people who have bravely spoken about their personal situations, some publicly—including, of course, Dame Esther Rantzen—and others who have done so privately, many by emailing their MP. I know mine is not the only inbox full of such emails.”
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“It is right that we consider this change with great care, as we are doing today. But we should also remember, as with other big social changes such as giving women bodily autonomy on their reproductive rights or allowing gay—”
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“I thank my hon. Friend for that intervention. I have not seen those comments, but it is absolutely right that whatever our views are on this issue, we must remain respectful. I also want to thank colleagues here in Parliament—MPs and indeed staff—who have shared their personal stories of loss with me over recent months. This is a really important point: these are real people with real stories, and they must always be at the heart of the debate. Public support for assisted dying in this country has been consistently high for a long time now, and we have seen movement in jurisdictions around the world, including just this week in Scotland. I congratulate colleagues in Holyrood, particularly Liam McArthur MSP, for holding such a compassionate and respectful debate, which I hope we can emulate today.”
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“Thank you, Mr Speaker. I will move on to the amendments. If I may, I want to acknowledge the work of the Bill Committee in relation to the amendments, because a huge amount of work was done by Members from all parties, with a range of views—”
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“I do indeed, Mr Speaker; you are absolutely right. The amendments that we are discussing today build on some of the work of the Committee, and I think that is important. We took a lot of steps to strengthen the Bill in Committee, and I was pleased to work collaboratively with colleagues in that way. As I come on to the amendments, which have been tabled in my name, let me say that the Government are, of course, neutral on the issue of assisted dying, but have always been clear that workability is essential if the Bill is to pass. I have worked closely with an outstanding team of civil servants from the Department of Health and Social Care and the Ministry of Justice, and it is with their technical advice on making the Bill workable and giving coherence to the statute book that I propose these amendments today.”
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“It broadens the people to whom it applies and the functions to which it relates. New schedule 1 makes provision for enforcement of this right “not to be subjected to any detriment” in connection with the Bill.”
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“I thank the right hon. Gentleman for that intervention. The civil servants are clearly neutral on the issue. They certainly have not expressed any opinions on the content of the Bill. They have merely provided the technical advice and expertise, and they have done so brilliantly in that regard. New clause 10, amendment 52 and new schedule 1 are tabled in my name. As well as correcting the injustices in the legal situation, one key tenet of this Bill is choice for dying people, but it is also important that there is choice for doctors and other healthcare professionals and, indeed, anyone else. The Bill was always clear that: “No registered medical practitioner or other health professional is under any duty…to participate in the provision of assistance in accordance with this Act”, but new clause 10 expands that protection.”
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“I refer my hon. Friend to my previous comments that the Bill and these clauses and schedules have been drafted with the highest level of legal expertise. It is not something I anticipate being a problem.”
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“I reject the assertion that patients will shop around. Bearing in mind that we are talking about dying people, they are not in a position to start shopping around for services, but I also agree that the Bill is strict in that regard. There are very strict protocols that doctors will have to follow.”
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“I will just make some progress, if I may. It is about not just patient choice but choice for professional people, too. We know there are a range of views on assisted dying across a range of professions. I have always been clear that no one who is uncomfortable taking part should have to, and nor should there be any detriment to anyone, whatever choice they make in whatever role they have.”
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“There is absolutely nothing in the Bill that has any suggestion that any funding would be impacted by whatever decisions organisations make around assisted dying. I will make some progress. New clause 10(1) states clearly: “No person is under any duty to participate in the provision of assistance in accordance with this Act.” That is something I feel strongly on a personal level. If people do not want to be involved, they should not have to be involved, and those who do, should. Subsection (5) covers pharmacists and pharmacy technicians and new schedule 1 provides comprehensive employment protections, so I hope that whatever colleagues’ views are on assisted dying, they will see the value of these changes and support them.”
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“Just as it would be wrong for anyone to be compelled to be involved in the process, it would be wrong for anyone to be prevented from doing so, particularly if there was an impact on patient safety.”
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“It is not clear how it would work with regard to the requirement in subsection (7) for professionals to provide information to an assessing doctor about a patient—someone whom they may have previously treated—or in relation to information about a specific condition that they may specialise in. That information would need to be provided in the interests of patient care. An employee will always be bound by their contract of employment, but flexibility is needed, as many health and care professionals work for multiple employers. It is not uncommon for clinical staff to have more than one employer—for example, a doctor may be employed by the NHS but also work for a hospice—so it is not a straightforward scenario.”
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“If an employer can stop their whole workforce participating in any sort of assisted dying services, it could prevent the sharing of information or the recording of information in a patient’s records. That could relate to safeguarding, and it could put patients at risk as a result of the employer’s decision. Terminally ill patients may be receiving different treatment at different places and from different healthcare professionals, and it would potentially be harmful if they were not able to transfer information or records. There are also workability issues with amendment (a) to new clause 10.”
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“I thank my hon. Friend for that intervention, and I agree that we must be respectful, but we must also be honest with each other. Amendment (a) to new clause 10 was tabled by the hon. Member for Reigate (Rebecca Paul), who I thank for her work on the Bill Committee. I understand the thinking behind the amendment, but I worry about unintended consequences for patient care and protection. I have been advised that that is the case, and I think the Minister will speak to that. I think there is consensus across the House that, in the interests of patient safety, it is vital that there is clear and open communication, and sharing of information, between healthcare professionals in the assisted dying process.”
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“My hon. Friend is absolutely right. We keep coming back to the word “choice”. It is about choice for patients and terminally ill people, but it is also about choice for medical professionals and others. Because of the unintended consequences, I cannot support amendment (a), but I am confident that new clause 10 and new schedule 1 provide robust protections for employees, regardless of their choices about participating in the provision of assisted dying services.”
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“The patient could request information, but so could doctors and other healthcare professionals. It would be wrong if people were not allowed to share that information if it was requested, even if their employer did not want them to do it. I turn now to new clause 11 and consequential amendments 64 and 65, which will ensure that the Bill is workable by making provision about the replacement of the co-ordinating doctor or the independent doctor where they are unable or unwilling to continue to carry out their functions in the Bill. The doctor may be ill or on holiday, retire, or have a change of personal circumstances.”
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“This is not about eligibility; it is about the doctor’s change of circumstances, rather than the patient’s. If the doctor decides that the person is not eligible, they will reject the application. They would record that in the patient’s records, so it would be transparent.”
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“I will make some progress, if I may. This is essentially about providing flexibility for doctors while ensuring continuity of care for patients, and I hope colleagues can support new clause 11.”
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“I will make a little more progress, if I may, because a lot of people want to speak. New clause 12 ensures that there is thorough reporting of instances where the co-ordinating doctor concludes that the patient does not meet the strict eligibility criteria set out in the Bill. It is very important that this data is recorded, but at present there is no requirement for the co-ordinating doctor to produce a report when they are not satisfied about all matters set out in clause 23(5) and will not provide the person with the approved substance. That lack of a reporting obligation does not align with the rest of the Bill—hence new clause 12, which I am sure colleagues will feel it is important to support.”
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“That would not be an issue, because copies of the report would be given to the patent, the co-ordinating doctor if they are not in the patient’s GP’s practice, and the commissioner, so that information would be recorded, and it is very important that it is. The report must set out the reasons—”
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“I will make some progress, if I may. I am trying to be very open to interventions, but I do need to crack on. The report must set out why the co-ordinating doctor is not satisfied and must contain an explanation of why the patient cannot proceed with the assisted dying process. The co-ordinating doctor must give a copy of the report to the person, to the person’s GP practice if they are not a practitioner within that practice, and to the voluntary assisted dying commissioner. That reflects the thorough and robust reporting and monitoring mechanisms throughout the Bill. I turn to the other amendments in my name. I will try to keep my comments succinct, as many colleagues wish to speak. Amendment 56 ensures that the co-ordinating doctor gives the commissioner a copy of the patient’s first declaration.”
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“Amendment 60 makes provision, corresponding to the provision in clause 12 about the death or illness of a doctor from whom a second opinion is sought, for a further referral to be made where, before reporting, the independent doctor dies through illness, or is unwilling or unable to act. The amendment once again ensures continuity of care and is an important detail to add to the Bill. Amendments 67 and 68 clarify the provision of clause 23 in cases where an approved substance requires administration via a medical device. The current drafting of the clause is not clear about whether it is allowable to administer the approved substance via a device, which it is. The amendment provides clarity for clinicians.”
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“Amendment 74 ensures that the term “domestic abuse” in the Bill has the same meaning as in the Domestic Abuse Act 2021. It clarifies the definition of “domestic abuse” and ensures that the term is consistent with existing legislation. It provides for a very broad definition to capture the full range of behaviours, including physical or sexual abuse, violent or threatening behaviour, controlling or coercive behaviour, economic abuse, and psychological, emotional or other abuse. It does not matter whether the behaviour consists of a single incident or a course of conduct. These really important amendments address concerns about coercion and provide additional layers of safeguarding within the Bill. As such, I hope colleagues support them.”
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“Due to amendments made in Committee, with very good intention, the current wording suggests that the regulations themselves must include details about training. That obviously does not make sense and would be unworkable, as it would have to be done separately. Similarly, amendment 58 removes unclear drafting as a result of changes made in Committee that could have the effect that the regulations have to contain training about training, which obviously does not make sense. Amendments 59, 52, 74 and 62 are also tidying-up amendments that are necessary as a result of the introduction of compulsory training for all doctors and panel members in domestic abuse and coercive control, following amendments tabled by my hon. Friend the Member for Lowestoft (Jess Asato), which the Bill Committee voted unanimously to accept.”
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“I thank the hon. Lady for her intervention. Given her background, she knows what she is talking about. Regulations will set out the level of expertise required by the doctor, but there will also be training for every single doctor taking part in the assisted dying process. That is done well around the world, so there is work we can build on in that regard. Amendments 57 and 61 are essentially tidying-up amendments that modify the wording of the Secretary of State’s duty to set out training requirements in clauses 7 and 10. That fits with the intervention from the hon. Member for Sleaford and North Hykeham (Dr Johnson). Training is of paramount importance within the assisted dying process, and there will be a period of years in which anyone who opts in to be part of this process will have thorough and robust training.”
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“I thank my hon. Friend for that intervention. The Royal College of Psychiatrists has a neutral position on the issue of assisted dying. If we refer to the impact— [ Interruption. ] Yes, it does.”
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“I will just finish this point. If we refer to the impact assessment, the number of people who will access assisted dying in the first few years will be very small. I think there are around 4,500 psychiatrists in the country, but there is also a period of time of a number of years to do the training required for psychiatrists taking part in the process, so I would not anticipate any problems there.”
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“Amendment 79 ensures that those reasons—the reasons for the panel’s decision—are communicated in writing in a document to the person to whom the referral in question relates, the co-ordinating doctor and the commissioner. This creates clear channels of communication and will enable those people to fully understand the expert panel’s decisions.”
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“I will keep going, if I may, because I think I have been fairly fair. Amendment 78 ensures that all three members of the panel must agree before a certificate of eligibility is issued, so abstentions cannot result in approval. The amendment came about as a result of discussions in Committee. It is really important to clarify that when the panel of experts is doing its work, its decision must be unanimous for a certificate of eligibility to be granted and for the patient to proceed. If a panel member abstains, no certificate of eligibility can be granted to the person. Schedule 2 also sets out that the panel must give reasons for its decision in each case. This is really important.”
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“I also know that this is a personal issue for a number of colleagues across the House, as a result of their own experiences. Eating disorders cause huge distress for individuals, their families and loved ones, but with care and the right treatment, it is possible for people to recover and to go back to leading a full and fulfilling life.”
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“I am going to finish, if I may, because other people want to speak. Amendment 14, which was tabled by my hon. Friend the Member for Bradford West (Naz Shah)—another outstanding member of the Committee—states: “A person who would not otherwise meet the requirements of subsection (1) shall not be considered to meet those requirements solely as a result of voluntarily stopping eating or drinking.” I suspect the amendment has been put forward as a result of the lengthy discussions in Committee regarding whether people with anorexia would be eligible for an assisted death under the Bill. In my previous career before becoming an MP, I worked with a number of people with eating disorders. I am very aware of the hugely sensitive and complex issues surrounding disordered eating, particularly anorexia.”
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“Stopping eating and drinking also leads to a range of symptoms that would make meaningful conversations, as required by the Bill, impossible. Having said that, I know that some people have expressed concerns that the severe physical consequences of a decision to stop eating or drinking could still enable someone to claim eligibility for assisted dying when they would not otherwise be able to do so, and I believe that is the motivation behind amendment 14.”
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“Of course, at every stage of the assisted dying process the patient must be found to have capacity to make the decision, and this is checked repeatedly throughout the process. Someone with severe anorexia would be highly unlikely to be assessed to have capacity to make a decision on assisted dying. The other tragic reality is that if a patient was so ill as a result of not eating and drinking for whatever reason, they would die before the process of assisted dying was able to take place, as it could take up to two months to complete all the stages of the process as set out in the Bill, and the latest clinical guidance states that the general range of survival once voluntary stopping of eating and drinking has begun is between seven and 21 days.”
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“The hon. Gentleman makes an important point. The amendment is not specifically about eating disorders; there is a broader context. I will come to that later. It is with that experience in mind—my own personal experience and having spoken to many colleagues on this issue—that I say now, as I said in Committee, that under the Bill as it stands, having anorexia would not qualify a person to be eligible for an assisted death. The Bill is clear that a person cannot be considered terminally ill on the basis only of a mental disorder. Clause 2 makes it clear that a person must have an inevitably progressive illness or disease that cannot be reversed by treatment. Anorexia is a serious mental health condition that is not inevitably progressive and can, thankfully, be reversed by treatment.”
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“I thank the hon. Gentleman for that point. The eligibility criteria in this Bill are very different from those in the jurisdictions he mentions—people with mental health conditions are not eligible for assisted dying under the provisions of this Bill.”
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“I will just finish this point, because it is very important. I acknowledge the concerns that colleagues have expressed around this issue, and I believe they are the motivation behind amendment 14. As I have set out, I think that risk is negligible. I have taken advice, and there is some concern that clinicians might have difficulty assessing with certainty that the decision to stop eating and eating was the only reason for a person’s terminal prognosis; as such, some further drafting changes may be required in the other place if this amendment should pass. With that in mind, however, and to ensure there is no sort of loophole, no matter how small the reality is of there being one, I am happy to support this amendment today.”
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“I am going to leave it there for now, if I may. I am conscious that many colleagues wish to speak in this important debate, and I am keen to hear their contributions, so I will conclude my remarks there. I thank colleagues for listening, and I hope they are able to support the amendments in my name today in the interests of strengthening the workability of the Bill and providing greater flexibility and safeguards for patients and professionals.”
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“Is my right hon. Friend reassured by the fact that the Bill creates a criminal offence of coercion and pressure, which does not exist at the moment? No one is checking for coercion when victims of domestic abuse or others take their own lives under desperate circumstances.”
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“I thank my hon. Friend for her passionate contribution, but this is exactly how we make law. We take evidence and have discussions— [ Interruption. ]”
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“Q6. Will the Prime Minister join me in thanking colleagues from across the House and the excellent Clerks and staff who have spent the last few months working on the Terminally Ill Adults (End of Life) Bill Committee? Does he agree that if the law is to change on assisted dying, it is extremely important to implement that change as soon as it is safe and practicable to do so?”
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“I hope that the Committee can support the amendments.”
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“Brought up, and read the First time. Question put, That the schedule be read a Second time.”
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“The hon. Lady said that she is not questioning the ethical judgment and practice of doctors, but the comments she is making suggest otherwise.”
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“Clause 40(4) is very clear that medical practitioners can receive only “reasonable remuneration” for the provision of services, so it is clear that they cannot make money from the provision of assisted dying. Is the hon. Lady saying that where there is a private provider or one commissioned by the NHS—the model that I have set out in the Bill—there is a financial incentive for doctors to do more hip or knee operations, or other things? That is a question about the model of public and private healthcare as it stands, not about assisted dying.”
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“If the hon. Lady is saying that she would not want to see assisted dying services within the NHS, then where does she think they would sit? Would she support my hon. Friend the Member for Shipley’s suggestion that this should be done by the voluntary sector and charities, or would she suggest the private sector?”
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“There is a clause that I have laid before the hon. Lady—that is what we are discussing. I will come on to that in my comments. Since she is clear that she does not think this sits within the NHS, she must have given consideration to where she thinks it should sit, if it were to come into effect.”
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“I thank the right hon. Lady for her constructive and collegiate approach to the Committee, particularly on devolution. I have contacted the Welsh Government and am keen to speak to them when Committee proceedings have finished. They have said that they are happy to do that. I am keen to continue to work with the right hon. Lady and other colleagues on devolution to ensure that we get the Bill right for the people of England and Wales.”
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