Public Bill Committees

The Committee consisted of the following Members:

Chairs: Peter Dowd, Clive Efford, Sir Roger Gale, Carolyn Harris, † Esther McVey

† Abbott, Jack (Ipswich) (Lab/Co op)

† Atkinson, Lewis (Sunderland Central) (Lab)

† Campbell, Juliet (Broxtowe) (Lab)

† Charalambous, Bambos (Southgate and Wood Green) (Lab)

† Francis, Daniel (Bexleyheath and Crayford) (Lab)

† Gordon, Tom (Harrogate and Knaresborough) (LD)

† Green, Sarah (Chesham and Amersham) (LD)

† Hopkins, Rachel (Luton South and South Bedfordshire) (Lab)

† Joseph, Sojan (Ashford) (Lab)

† Kinnock, Stephen (Minister for Care)

† Kruger, Danny (East Wiltshire) (Con)

† Leadbeater, Kim (Spen Valley) (Lab)

† Malthouse, Kit (North West Hampshire) (Con)

† Olney, Sarah (Richmond Park) (LD)

† Opher, Dr Simon (Stroud) (Lab)

† Paul, Rebecca (Reigate) (Con)

† Richards, Jake (Rother Valley) (Lab)

† Sackman, Sarah (Minister of State, Ministry of Justice)

† Saville Roberts, Liz (Dwyfor Meirionnydd) (PC)

† Shah, Naz (Bradford West) (Lab)

† Shastri Hurst, Dr Neil (Solihull West and Shirley) (Con)

† Tidball, Dr Marie (Penistone and Stocksbridge) (Lab)

† Woodcock, Sean (Banbury) (Lab)

Lynn Gardner, Lucinda Maer, Jonathan Whiffing, Committee Clerks

† attended the Committee

Public Bill Committee

Wednesday 12 February 2025

(Morning)

[Esther McVey in the Chair]

Terminally Ill Adults (End of Life) Bill

Will everyone please ensure that all electronic devices are turned off or switched to silent? I like to maintain the flow of debate, so I remind everybody not to say “you” and “your”, as Members should speak through the Chair, and not to go out of scope. I will stop Members if that happens again today.

Clause 1 Assisted dying

I beg to move amendment 23, in clause 1, page 1, line 19, after “coerced” insert “, unduly influenced”.

This amendment would include the absence of undue influence for the making of a person’s decision. This reflects the changes proposed in Amendments 24 to 33.

With this it will be convenient to discuss the following: Amendment 82, in clause 1, page 1, line 19, after “coerced” insert “, encouraged”.

This would add a lack of encouragement to the list of requirements for a person to make a decision to request assistance. This reflects the changes proposed in Amendments 83 to 92. Amendment 113, in clause 1, page 1, line 19, after “coerced” insert “, manipulated”.

This amendment reflects the changes in Amendments 114 to 115 which require steps to be taken to establish that the person seeking assistance has not been manipulated by any other person. Amendment 24, in clause 7, page 4, line 14, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 83, in clause 7, page 4, line 14, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 114, in clause 7, page 4, line 14, after “coerced” insert “, manipulated”.

This amendment requires the coordinating doctor to ascertain whether, in their opinion, the person has manipulated. Amendment 25, in clause 8, page 4, line 37, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 84, in clause 8, page 4, line 37, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 115, in clause 8, page 4, line 37, after “coerced” insert “, manipulated”.

This amendment requires the independent doctor to ascertain whether, in their opinion, the person has manipulated. Amendment 26, in clause 12, page 8, line 13, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 85, in clause 12, page 8, line 13, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 27, in clause 13, page 9, line 33, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 86, in clause 13, page 9, line 33, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 28, in clause 18, page 12, line 26, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 87, in clause 18, page 12, line 26, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. New clause 5—Encouragement— “(1) For the purposes of this Act, ‘encouraged’ means an act capable of encouraging suicide which would constitute an offence under section 2 (Criminal liability for complicity in another’s suicide) of the Suicide Act 1961.

(2) A person is not rendered ineligible to request assistance to end their own life on the basis of— (a) an act of encouragement that they were unaware of when requesting and going through assisted dying, or (b) an act of encouragement which was not specifically directed at that person.”

This amendment provides a definition of encouragement is consequential on Amendments 82 to 92. Amendment 29, in schedule 1, page 25, line 22, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 88, in schedule 1, page 25, line 22, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 118, in schedule 1, page 25, line 22, after “coerced” insert “, manipulated”.

This amendment adds a requirement to the first declaration for the person to declare they have not been manipulated. It is linked to Amendment 113. Amendment 30, in schedule 2, page 27, line 11, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 89, in schedule 2, page 27, line 11, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 119, in schedule 2, page 27, line 11, after “coerced” insert “, manipulated”.

This amendment requires the coordinating doctor to sign a declaration that to the best of their knowledge they believe that the person has not been manipulated. It is linked to Amendment 113. Amendment 31, in schedule 3, page 28, line 9, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 90, in schedule 3, page 28, line 9, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 120, in schedule 3, page 28, line 9, after “coerced” insert “, manipulated”.

This amendment adds a requirement to the declaration that independent doctor has to sign, that they to the best of their knowledge they believe that the person not been manipulated. It is linked to Amendment 113. Amendment 32, in schedule 4, page 29, line 5, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 91, in schedule 4, page 29, line 5, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 121, in schedule 4, page 29, line 5, after “coerced” insert “, manipulated”.

This amendment adds a requirement to the second declaration for the person to declare they have not been manipulated. It is linked to Amendment 113. Amendment 33, in schedule 5, page 30, line 22, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 92, in schedule 5, page 30, line 22, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 122, in schedule 5, page 30, line 22, after “coerced” insert “manipulated”.

This amendment adds a requirement to the declaration that coordinating doctor has to sign, that they to the best of their knowledge they believe that the person not been manipulated. It is linked to Amendment 113.

One of the major concerns that we have heard from members of the public and MPs relates to the importance of ensuring that appropriate safeguards are in place, so that people make genuine choices and do not request an assisted death because somebody else has pushed them towards it. For that reason, it is vital that subsection (2)(b) is as comprehensive as it can be. It currently refers specifically to a person having been “coerced” or “pressured”, which covers only the more direct kinds of influence, not more subtle ones. It seems clear to me that amendments are required to ensure that more subtle kinds of influence are covered adequately, and that clinicians do not just look for obvious signs of coercion or pressure when considering eligibility.

In her oral evidence on 29 January, Dr Mullock said: “In terms of the Bill that we are discussing, one possible weakness here is that it identifies, only very obviously, problematic conduct in terms of coercion or pressure exerted by another person, and actually the kind of undue influence that might occur might be very subtle. More needs to be done to recognise that and the subtle encouragement that might take place, where a relative might frame their support for the person seeking to die in terms of, ‘This will be better for you,’ and, ‘Have you considered this?’ That is not necessarily an example of clear abuse, so when the person seeking to die then consults the doctor, they are not going to characterise what has happened to them as coercion or abuse. More needs to be done to discuss with the person whether or not they have been encouraged by the people around them.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 162, Q204.] Amendment 23 would add the term “unduly influenced” to the clause. It is an important addition, as it is a recognised term in law. It is designed to ensure that relationships of dependence are considered. In some cases, there is no bad intent, but there is a power differential, subtle as it may be, and it is important that we recognise how strong it can be. A child not wanting to disappoint their parent; a wife not wanting to go against her husband’s wishes—there may well be no threats or explicit pressure, and there may be a lot of love shrouding it, but the influence is there and it is strong. That is why the concept is applied in probate cases to test whether someone has faced influence, domination or pressure that prevents them from exercising free and independent volition with regard to the act. It has also been applied in medical decisions, including over a refusal of treatment that can lead to death. For example, there was a case of a Jehovah’s Witness who refused a lifesaving blood transfusion under undue influence from her mother. It is therefore a natural addition to the Bill.

In important judgments, the courts have said that undue influence will have more impact on people who are very tired, in pain or depressed, and that “a patient in a weakened condition may be unduly influenced in circumstances in which if he had been fit, he would have resisted the influence sought to be exercised over him.”

This legal concept could have been designed for the context of assisted dying. That is why it is important that the amendment is made. In her oral evidence on 28 January, Dr Cox said, “I would say that you cannot always identify coercion. You can identify it when it is very obvious and extreme, but when it is very subtle, we cannot always identify it. After the event, there is nobody to tell us about coercion, so it is very difficult to monitor.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 73, Q90.] I would also like to point out that California’s law prohibits coercion or undue influence, so there is established precedent in using this phrase in the safeguards of assisted dying law. If we have the ambition for our law—if it is to pass—to be the safest in the world, we need to add the term “undue influence” as a minimum.

Even with that additional safeguard, however, Dr Spielvogel rather worryingly said in his oral evidence, “I have seen assisted dying laws go into practice across numerous states and have helped many, many people through this process, and I have never seen a case where I even suspected coercion.” ––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 101, Q139.] Richard Robinson of Hourglass, in his oral evidence, said, “I think that coercion is underplayed significantly in cases of abuse of older people…One of the biggest issues we face is the fact that we have no idea of the levels of training that healthcare professionals and the judiciary receive to understand and recognise coercion. That leaves us in a situation where medical professionals say that coercion in these circumstances is minimal, but people need to understand what coercion is and how to recognise the signs of it in the first place, especially bearing in mind that the vast majority of cases that we see take place in the home and by family, rather than by professionals.” ––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 158, Q196.] Additionally, psychiatric and legal experts have said that undue influence is relevant in this context. In written evidence, Professor Allan House refers to undue influence as “coercion in its less overt or threatening forms”.

He also draws attention to the great risk of undue influence in the case of couples seeking assisted suicide at the same time. The probate lawyer Tamasin Perkins, in an article on the Bill, says, “Undue influence or coercion is depressingly common in the arena of contested wills and gifts.”

She suggests that the current law on undue influence could be usefully incorporated into the Bill. To those who worry that adding undue influence could make things more difficult for clinicians when assessing, I would say that it is absolutely right on something of this gravity that rigorous consideration is given to the possibility of undue influence.

I turn to amendment 82, which adds the term “encouraged” to coercion and pressure. This amendment is in line with Dr Mullock’s advice in both her written and oral evidence. It is important to note that encouraging suicide is currently a crime under section 2 of the Suicide Act 1961. It is also important to note that the Bill does not decriminalise encouragement, only assistance. Clause 24 decriminalises only the assistance component, not the encouragement component. Thus, if the Bill were to pass, encouragement of assisted dying would still be a crime. That is absolutely right and something that I fully support.

As encouragement of suicide is clearly recognised as a heinous crime, it surely must follow that when considering whether someone is eligible for such assistance to end their life, consideration is given to whether they have been a victim of such a crime. This feels like a rather basic safeguard that is missing from the Bill and must be rectified. As former Attorney General, Victoria Prentis, has written, “maintaining the prohibition on encouraging suicide is key to protecting vulnerable people”.

She says it is a problem, though, that “doctors and judges under the bill are not required to check whether the person’s decision is their own or whether they have been encouraged by others.”

She goes on to say that she hopes the Committee will support my amendment, and David Hughes—formerly of the Law Commission—says that keeping the offence of “encouragement” would help to prevent “insidious pressure”.

The hon. Lady uses the term “encouragement”. If I were in a situation where a loved one wanted to access assisted dying, and I said I supported their wishes, would that fall under the scope of encouragement? We do not want to end up in a situation where people who support their loved ones end up dragged through a legal process, when it is actually the case that they are there to enable their wishes, rather than pushing them to it. How would she differentiate between those?

That is an important point. Obviously, case law becomes quite important in this. Supporting someone’s decision is very different from encouraging someone who was not in the place of wanting to go through with assisted dying. Again, these things do sometimes end up in the courts, because sometimes it can be a grey line. It is important that we have this protection. Right now, it is an offence to encourage someone to commit suicide, and we need to recognise that. That is the law right now.

The hon. Lady makes an important point. The idea is that the Bill makes an exception to the Suicide Act. I fully support her point about the supportive nature of the conversations that would take place with families. If we use the word “encourage”, we are in danger of lacking clarity. Where is the line between encouragement and support? I would like her to expand on that, if she could.

I do not think that we are trying to exempt something from the Suicide Act through the Bill; we are decriminalising something that is currently a criminal offence. Right now, it is a criminal offence to assist someone to commit suicide, and clause 24 decriminalises that. I totally support what you have done here, but your Bill does not decriminalise encouragement. I imagine that you have done that for very good reasons, which I support; we do not want people to be able to go round encouraging people to commit suicide. It is vital that there is protection for the vulnerable people we have talked about. You are absolutely right that what constitutes encouragement can be subjective and difficult to determine, but encouragement is already in the law, so we have to deal with it. It is already a criminal offence to encourage a suicide, so it does not make sense not to deal with it in this Bill.

Order. I remind everybody that they should not be saying “you” and “yours”.

I will do my best to abide by that, Ms McVey. My recollection of the oral evidence is that the practitioners from California made it very clear that there was not a great deal of coercion, but they had seen families put undue pressure on people to prevent them from pursuing assisted dying. Given human nature, I find it incredible that the pressure would go only in that way and not in the other. I see the proposals as ensuring that and safeguarding people who are at a very vulnerable stage of their lives. Will the hon. Lady speak to that?

I completely agree. It is important to recognise that different people will have different views on levels of coercion. I have already quoted some of the witnesses; I found it quite jarring that certain witnesses who had facilitated assisted dying for hundreds—perhaps thousands—of people said that there were no cases of coercion. I find that difficult to believe, although I do not doubt for a second that they believe it.

The witnesses gave evidence in good faith, and I would be uncomfortable if we started to question the validity or truth behind their testimony.

Just to clarify, I am not questioning that they were not telling their truth. I completely believe that, from their perspective, they honestly believe they have never seen a case of coercion. Maybe I am more of a glass half empty kind of girl than some other people, but I question whether that is really the case. In my 45 years on this planet, I have learned enough about humankind to know that these things do happen, but different people will take different views when it comes to detecting them.

The hon. Lady has made some important points. I repeat something I said yesterday in response to another Member: the word “coercion” and the idea of encouragement were not even in the vocabulary in this place until very recently—only 10 years ago. I do not want to dismiss people’s expertise, but for me it is quite a leap of faith—I wonder whether she shares that idea—to believe that in that jurisdiction, zero people were coerced, when every other jurisdiction records people being coerced and people saying they feel a burden.

I completely agree. The hon. Member has made some powerful points over the course of this Committee. The reality of the matter is, like the hon. Lady said, this has not really been considered fully until recent times. I think we are now all much more aware of the coercion and pressure that goes on. It is only right, when we are making this decision now, to be fully aware of that and have our eyes wide open to the realities.

At the end of the day, we are not legislating for when it works perfectly for that ideal candidate who absolutely wants to do this for all the right reasons and they are in pain, which is exactly what the Bill is designed for. We are legislating for that big group of people who are vulnerable, and who it may not work for. That is a much bigger group. We heard compelling evidence from Dr Jamilla Hussain, which really impacted me, about this big group of vulnerable people who could be detrimentally impacted. We must make legislation for the group that could be negatively impacted. They should be our focus.

I am very struck by that last point. Does my hon. Friend agree that the purposes of these amendments build on the principle of the Bill? The Bill recognises the existence of vulnerable groups and attempts to introduce safeguards. It is not a free for all. The absolute purpose of the Bill is to ensure that vulnerable groups are protected.

My hon. Friend’s amendments support the principle of the Bill, which says that encouraging suicide remains illegal. By implication of the Bill, to encourage people to take an assisted suicide should be illegal too. My hon. Friend is actually building on the principle of the hon. Member for Spen Valley’s Bill, and I hope the Committee will not regard these amendments as in any way harmful to its purpose or as an attempt to make it more impractical in operation. They would make the Bill clearer. To the point made by the hon. Member for Spen Valley about overcomplicating things—I think the complications exist in the current text of the Bill, whereas my hon. Friend the Member for Reigate would be clarifying its purpose.

My hon. Friend makes the point powerfully. I say to everyone in this Committee—we had this discussion yesterday—that I am not opposed in principle to the concept of assisted dying, but I see my role here as to protect the vulnerable. That is what I am trying to do, and I know everyone here wants to do exactly that. I cannot really see any downside to these amendments. Why would the Committee not want them included, if we want to protect the most vulnerable? Yes, it may put a bit more onus on clinicians, because they would need to look for a lower level of coercion. But that is absolutely right—of course they should have to do that. We are talking about assisted death. It is really important that we have a higher level of consideration.

I understand that much of the difference between us on this may founder on our perception of what is actually happening. She speaks of suicide, and to some of us—certainly to me—suicide is a healthy person taking their life, but what we are talking about is somebody who is seeking to take control of their inevitable death in these circumstances. For me, those two are qualitatively different.

I am concerned about my hon. Friend the Member for Reigate injecting an element of jeopardy into what should ordinarily be normal conversations with one’s family. For example, I could see a point at which, if I were in those circumstances and was thinking about seeking assistance to end my life, I would discuss that with my wife: “Darling, am I doing the right thing? Is it the best thing for the kids? I think I’m going to have a horrible death, and I’m trying to decide.” We heard from families—and have done over the last 10 years—who, very often in anguish support their loved one, even to the extent that they are willing to break the law. As my hon. Friend the Member for Harrogate and Knaresborough said, the line between support and encouragement is quite fine. If somebody were to come forward and say, “Well, I’ve spoken to my family. They all think I am doing the right thing”, could that not be interpreted as encouragement? I am conscious that we should not try to police what should be open and natural discussions between families in a way that injects jeopardy for them and the person to the extent that they might start to modify what they say to the doctor to ensure that they get the outcome they want.

I thank my right hon. Friend for that very useful contribution. First, I am saying “suicide” because we are talking about the Suicide Act, and I cannot perform this role without naming the actual bit of legislation that we are talking about. I know people here are a little bit squeamish about the word “suicide”, but it has a clear legal meaning.

Will the hon. Member give way?

Not yet; I am finishing my point. It has a clear legal meaning, and we must not put the blinkers on. I would suggest to Members that if they have an issue with the word “suicide”, they remember that this will actually result in the end of someone’s life. We must not be squeamish about using correct and accurate terminology in what we describe.

The second point made by my right hon. Friend the Member for North West Hampshire is a really good point: it is a fine line and it is really difficult. I have proposed this amendment not because I want “encouragement” specifically to be in the Bill, but because the encouragement of suicide is already a crime. I am being logical and taking what is already a criminal offence under the Suicide Act. If we do not include it in the Bill, it means that someone can commit a criminal offence against a victim, and that does not preclude the victim from being eligible for assisted dying, so I am suggesting a very logical amendment. My right hon. Friend makes a great point, but if we have an issue with the word “encouragement”, we need to take that up with the drafters of the Suicide Act, which was long before my time in 1961.

Does the hon. Lady agree on the value of her amendment, and the value of introducing the word “encouraged” into the Bill? Reflecting on what has been said about the “fine line” argument by the right hon. Member for North West Hampshire and the hon. Member for Harrogate and Knaresborough, the value of inserting this amendment is that, where it can be proven beyond doubt that someone has encouraged or actively sought to influence someone else to choose assisted death, that is a crime encoded in the law.

To the point made by the right hon. Member for North West Hampshire, in discussions among families about this possibility, and where spouses are supporting each other in this decision, it will never be demonstrated beyond reasonable doubt that a crime of encouragement has taken place. By putting it in law, where encouragement can be proven—and it must be proven—it can be prosecuted as the criminal offence that it would be.

As ever, the hon. Lady so eloquently makes her point and I completely agree. I am not a lawyer but, given that the Suicide Act made the encouragement of suicide a criminal offence back in 1961, I imagine there is quite a lot of case law that would help define where that line is drawn on encouragement, but I would refer to better qualified people than myself.

I reassure the hon. Lady that her sweeping statement about us all being squeamish when talking about suicide may not be accurate. I would put it back to her: how squeamish is she when talking about assisted death, because we are actually talking about two separate things here? I reiterate the point made by the right hon. Member for North West Hampshire: a healthy person taking their own life by suicide is different from a terminally ill person, who is facing their death, ending their life by shortening their death. Would she accept that point?

I am talking in legal terms, because we must use the right language. Under the law, I think what the hon. Lady said is not correct. I stand to be corrected by someone who is a lawyer, but given that we are amending the Suicide Act, I think technically an assisted death is the assistance of a suicide. I understand that the hon. Lady would like to reframe that and use different words to describe it. Maybe that could be done, but right now, under the law, it would be suicide.

If the Bill becomes law it would be a different situation, which is exactly what we are scrutinising.

My interpretation is that it would not.

What the hon. Member for Luton South and South Bedfordshire said is not the case at all. What the Bill would do is to exempt people who go under this new procedure from the operation of the Suicide Act. It would not create some new category of person; the law would just operate in a different way. I recognise that she is saying that, in her mind, there is a difference between somebody who is dying who has an assisted death and somebody who is healthy who commits suicide, but that is a completely arbitrary distinction in reality. Many people who have terrible diagnoses kill themselves, even though one might say that they are not actually dying and they could be treated. Should that person qualify?

Entering into the mind of someone who wants to take their own life is an absolute impossibility, and that is the whole problem with this Bill: we are trying to create distinctions that are impossible to police properly. It goes to the point of my right hon. Friend the Member for North West Hampshire about trying to police private conversations. That is what this Bill entails. We are inviting the state to intrude, in an absolutely impossible way, on what is going on in people’s minds. To go back to the point made by the hon. Member for Luton South and South Bedfordshire, there is no clear distinction between somebody who would choose assisted dying through a doctor’s prescription and one who would choose to take their own life without assistance. It is not possible to draw that distinction. In fact, we have seen so many times that people who might want to kill themselves one month change their mind a month later. I am afraid that this is the challenge with the whole Bill.

I support my hon. Friend’s comments. Outside of this place, I speak about this topic in a manner that is as sensitive as possible. When we are talking about the legislative changes that are needed to this Bill and how it interacts with other legislation, I will use the correct legal terminology, because I think it is really important that we do that.

I appreciate the hon. Lady raising the need to use accurate legal language. Does she agree, therefore, that introducing “undue influence”, which is used regularly in the law of equity but not in the criminal law, would unhelpfully complicate matters, considering that coercive behaviour is defined in section 76 of the Serious Crime Act 2015 where it provides for an offence of controlling or coercive behaviour in that context? We have 10 years of case law. The hon. Lady rightly pointed to the importance of looking at case law and at how courts have dealt with this; the understanding of coercion in the criminal law offences is well known and well rehearsed, whereas the use of undue influence in the context of criminal law offences, which is what we are dealing with in clause 26, is not.

I thank the hon. Lady for that point, but I do not think we are talking about criminal law here. This debate is not relevant to clause 24—it is relevant to eligibility. We are simply saying, through this amendment, that if a clinician thinks someone has been unduly influenced, they would not be eligible. I think the hon. Lady is crossing over to the encouragement point, but these are separate points.

Will the hon. Lady give way?

I am sorry, but I am going to give way to the hon. Member for Bexleyheath and Crayford, if he still wishes to intervene, as I am aware that he has been waiting.

I want to bring us back to the points raised by the right hon. Member for North West Hampshire. I may have misread this, but I understand that, under the current law and under the law as it would stand if this legislation were introduced, it would remain an offence to encourage somebody to commit suicide with a 12-month diagnosis—perhaps someone with motor neurone disease or Parkinson’s disease, who may still be a loved one. I do not understand the counter argument about not using the word “encouraged”: it would remain a criminal offence, unless I am mistaken, to encourage someone to take that decision if they had a diagnosis of longer than six months left to live.

That is exactly right. As I have mentioned, I am not bringing in the concept of encouragement; it is already in the law and currently an offence. I am putting forward this logical amendment in order for the Bill to deal with that. If we do not do that, we have not circled the wagons.

I have no doubt that my hon. Friend speaks to the amendment with very good intentions due to genuine concerns about the safeguards. We have talked a lot about coercion. Clause 1(2)(b) sets out a requirement that the person, “has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it.”

“Pressured” is an important word. If we look at the case law, there are the comments of Lord Nicholls in the case of Royal Bank of Scotland plc v. Etridge (No. 2) in 2002. He looked at two components of the concept of undue influence. There are acts of improper pressure or coercion, such as unlawful threats, which fit with the coercion element of the Bill as drafted. There are also relationships where one has acquired over another a measure of influence or ascendency, of which the ascendent person takes unfair advantage without any specific acts of coercion. Could my hon. Friend set out why she thinks “unduly influence” would add something beyond what “pressured” already does in the Bill?

My hon. Friend is very knowledgeable about these things and is well qualified on the legal side. I value his contributions on this matter. The reason I want to include “unduly influence” is because it deals with those more subtle forms of coercion. Arguably, it could be included in “coerced or pressured”, but by including “unduly influence” in the Bill it becomes more explicit that a clinician has to be looking for it. In the absence of the language, clinicians will not be required to look for those more subtle forms of influence.

The provision is something that is included in the assisted dying laws of other jurisdictions. We have the opportunity here to learn and benefit from jurisdictions that have already implemented it. We heard various witnesses give us very useful evidence during the sessions. For example, California includes “undue influence” in the law. We should recognise that there is value in including it here. It is a well established legal term that is used in myriad situations, so it is relevant that we include it.

May I take the hon. Member back to the point of clause 24, and the issue of suicide and the terminology there? Perhaps the Minister could respond as well, although I am not sure how that would work in this Committee. What I think we are doing in clause 24 is to decriminalise encouraging suicide. That is my understanding. So can we have some clarity? Are we trying to decriminalise encouraging suicide? That is what clause 24 says, so in that case it would be absolutely right to talk about the word “encouragement”.

Clause 24 decriminalises assistance to commit suicide, in order that assisted dying becomes lawful. It does not specifically decriminalise encouragement, which means that the Suicide Act 1961 still applies if someone were to encourage someone to commit suicide. It would therefore be a crime and have a sentence associated with it. However, the hon. Lady makes a really good point: it would be of great value at the relevant time to hear from the Minister on the legal point I am making. I hope everything I am saying is coherent and sound, but it would be useful to hear from the Minister.

The hon. Lady is doing an amazing job—and taking lots of interventions. As I have always said, I am very open minded to whatever we need to do to make the Bill more robust. I am not a lawyer, like the hon. Lady—we have lawyers in the room, fortunately, who can provide guidance and assistance in that regard—but what has been made clear to me is that the law needs clarity.

The hon. Lady has already mentioned a couple of times that this change could be described as a lower level of coercion, or it could be argued that there is a lack of clarity there. I think the sentiment is absolutely right, and I really support that, but we need the law to be clear. And if legal colleagues are assuring us that the concept of undue influence would be covered under “coercion”—and I am kind of hearing that—then I think it would be covered. I think that point about the law being clear is really important. Does the hon. Lady agree with that?

I thank the hon. Lady for that intervention. I know that she is wholeheartedly seeking to make sure that the safeguards in the Bill are as good as they can be, so I very much appreciate her recognising the positive intent behind my amendments.

It would be useful to understand whether those who are legally qualified believe that undue influence is already covered by “coercion”. I am not qualified to give a view on that, but if that were the case, that would provide some reassurance, and that could then maybe be included in guidance. However, I would want to see a legal opinion on that.

In the absence of such a legal opinion, putting that on the face of the Bill is the safest—and the right—thing to do at this point in time. I suspect that we will be voting on this shortly, before we can get a legal opinion, and given that we are talking about safety here, I would rather go for belt and braces and include “undue influence” on the face of the Bill.

Can I just clarify something? As my hon. Friend the Member for Penistone and Stocksbridge said, I understand that “undue influence” has an existing meaning, but only in equity law. The hon. Lady herself mentioned wills, for example, being challenged in probate. There, as I understand it, the burden of proof rests fully on the person challenging the will; there is not an active test that someone has not been unduly influenced. If the hon. Lady is to use undue influence as an existing legal concept, would she favour reversing the presumption on the burden of evidence? In addition, I think there is a distinction between actual undue influence and presumed undue influence in the case law. I wonder which of those she thinks we should be using when considering this amendment.

I thank the hon. Member for that intervention. I think the point on probate is right; it is commonly used there, but it is not just used in that situation. My understanding is that, when it comes to decisions by clinicians with regard to withdrawing life sustaining treatment, undue influence is one of the considerations.

Just to amplify that point, my hon. Friend is absolutely right. In the “Re T” case, the Court of Appeal judged that undue influence should be taken into account in medical decisions, so that is an existing principle in law. It feels totally appropriate to bring that in here, seeing as, as we have discussed, the principle already exists that it is wrong to encourage suicide, and that it is possible to have undue influence without coercion or pressure being present. To address the point made by the hon. Member for Spen Valley, I do not think those terms are adequate to include undue influence; undue influence can exist even when there is no evidence of coercion.

I thank my hon. Friend for that intervention. The point that I would make is about an example that we talked about a lot yesterday, so I know that it resonates for many on the Committee. If someone is making a decision and a treatment is being withdrawn, or life support is being turned off, undue influence is already one of the things they consider, so when we are considering assisted death, surely, in order to be consistent, we would apply undue influence to that as well, rather than having a lower level. Why would we have a lower threshold for assisted dying compared with withdrawal of treatment?

The hon. Members for Sunderland Central and for Penistone and Stocksbridge said of existing concepts in law, “This is how they have always been used.” It was reminiscent of the conversation we had yesterday about the Mental Capacity Act 2005, and mental capacity being an established concept in law, and “This is the way that it is always applied.” Does the hon. Lady agree that although precedent and established usage are extremely important, the Bill is quite a novel piece of legislation, and it is really incumbent on us as a Committee to ask ourselves whether we need to approach this piece of legislation in a different way, compared with other pieces of legislation that have gone before; and whether, just because something has always been used in a particular way, it is still appropriate for it to be used in that way for this legislation, as a general principle?

I completely agree. If we do not incorporate undue influence, we are at a lower threshold compared with withdrawal of life sustaining treatment. That does not feel to me like the right position, but equally, this is a novel bit of legislation and we need to increase the safeguards further. Obviously, we shall be debating numerous amendments whose purpose is to raise that threshold. It is always very hard—how long is a piece of string?—to know exactly where to set a threshold. Different people have different views. My personal view is that in this Bill the threshold is too low, so we need to raise it by agreeing some of these amendments. So far, none of the amendments that have been suggested has been accepted. I really hope that during this Committee stage we will increase the safeguards.

Hopefully this will be my final point on this subject. I believe there is consensus in the room; no one is saying that undue influence is acceptable. The question is, where does it sit within the Bill in terms of definitions? That is where I would appreciate, along with the hon. Lady, advice from legal experts—and indeed the Minister—around whether we are confident that with the concept of coercion we are including undue influence. Does she agree that that clarity would be helpful?

I absolutely agree that such clarity would be very useful. The hon. Member and I both want to ensure that undue influence is captured somewhere; I am less picky about where. As long as it gets covered somewhere in the Bill, that would be an improvement to the Bill, and I hope that everyone would really welcome that. I think everyone recognises the issue. I am not hearing that people are opposed to this; they recognise that there can be more subtle forms of coercion. If we can work together to find the best place for that to go in the Bill, I am very open to that.

It might help if I offer—with the usual caveat that of course the Government are neutral—the Government’s position with respect to what the hon. Lady has been discussing. It is important to point out that the terms “coercion” and “coercive behaviour” and “pressure” that are used on the face of the Bill appear in existing legislation without statutory definition. In other words, they are given their ordinary meaning and they operate effectively in that manner in the criminal law. The hon. Lady is absolutely right that clause 26, which we shall come to in due course, is a separate matter, but of course it will be important to review the Bill as a whole and to understand the interaction between the different provisions in clause 1, as we trace it through to the criminal offences.

It is the Government’s view that manipulative behaviour or undue influence—the terms that the hon. Lady is using—would come within the normal meaning as understood in case law by the judiciary of the terms “pressure” and “coercion”. In terms of the integrity of the statute book, there is a concern that by adding additional terms, we run the risk of creating confusion, because when it comes to the interpretation of those provisions, judges will be looking to understand and ascertain what Parliament meant by “undue influence” that was not currently covered by coercion. Given that those terms are commonly broadly interpreted, it is the Government’s view that the sorts of behaviours that the hon. Lady is describing—“undue influence”—would be covered by the terms used on the face of the Bill. For simplicity, given that our existing body of law interprets those provisions widely, and to ensure consistent application of the law in this context and other contexts where coercion arises, it is important from the Government’s point of view to retain the Bill’s current wording.

It is helpful to understand the Government’s position. If the amendment is not made, I hope that the Minister is right, but one thing that I have learned in my time is that different judges will have different views on these things. Personally, I would prefer to see this provision in the Bill, as it would absolutely ensure that the protection is in place. We all know that decisions in the courts can sometimes go a different way from what we expect.

I have a concern about what the Minister says. As one psychiatrist put it, the Bill is very novel and untested. The MCA has not been tested. Now the Government say that this will work, without consultation or any impact assessment. I struggle to understand that. Does the hon. Lady share my concern that this does not feel right?

It is reassuring to hear that I am not the only one worried about this, so I thank the hon. Lady for that.

I understood the Minister to say that the judge needs clarity when they come to adjudicate on a case. We have heard through the media, although an amendment has not yet been tabled, that a judge will not oversee the process. Does my hon. Friend share my concern that we are setting up a legal system that will not provide proper legal oversight of the proposed measures?

My hon. Friend’s point goes to the heart of the case, and to the point that I made earlier: it is extremely difficult when the Bill is a moving feast. We are tabling amendments to the Bill as drafted, but if substantial changes are made, that will impact some of what we did earlier.

We are looking at different amendments as the Bill progresses, but a judge would always be involved in criminal offences, which is what we are talking about now.

I thank the hon. Member for sharing her view on that.

This is a very helpful conversation, and I am grateful to my hon. Friend for allowing all these interventions. It is right that there would be a judge in the event of a criminal offence. We are trying to ensure that we do not get to that point by insisting that in the early stages of the process, when a doctor makes their assessment—indeed, when a judge makes their assessment, if there is still that judicial stage, as we hope there will be—they are required to ensure that there has not been undue influence. It is important that, at that early stage, they are asked to check not just whether there has been coercion. I hear what the Minister says about the concept of undue influence hopefully somehow being incorporated in the definition of coercion or pressure, but we need to ensure that that test is applied at a very early stage. The first people who discuss the matter with the patient should ensure that there has been no undue influence, which by the way is about much more than outright coercion; it is about an imbalance of power in the relational dynamics within families, which as we all know can be very complicated. That is what necessitates the amendment.

I completely agree with my hon. Friend. As always, he makes the point powerfully.

Does the hon. Lady share my concern? My understanding is that, in normal parliamentary business, if the Government announce any changes to the law in the press first, they are usually rebuked by Mr Speaker in the Chamber. I appreciate that this is a private Member’s Bill, but a Guardian piece yesterday outlined how we will now scrap the involvement of a High Court judge and have a panel instead, with an amendment to be tabled to that effect. I am happy for my hon. Friend the Member for Spen Valley to clarify how the system is going to change.

Once we have debated the amendments on undue influence and coercion, we have debated them. We cannot then come back to them, because of the nature of private Members’ Bills. Does the hon. Lady share my concern that, as we said yesterday, the horse has bolted? We are having to go over things and we might not be able to revisit this issue, which is why it is even more important to have probing conversations on the record so that, if nothing else, we can refer to them on Third Reading, for which we have only five hours.

I completely agree with the hon. Lady. We should not make the mistake of assuming that certain amendments will be accepted. Until there is a Division, we do not know what the Bill is going to look like. It is incredibly difficult to table amendments early on when we do not know whether other fundamental things are going to change. That is why it is important that we are really thorough and improve the safeguards as much as we can, clause by clause. I do not want to get to the end of this process without our having accepted any of the improved safeguards, only for the Bill to be turned on its head at the end when there is a Division on something fundamental. As the hon. Lady rightly says, we do not get the opportunity to come back and review the decisions we have made on the back of that.

Further to the point made by the hon. Member for Bradford West, is it not a further complication that if a question is put in Committee and considered settled, it cannot be revisited on Report by any other Member outside the Committee? It may well be the case that amendments that are accepted further down the line fundamentally change the nature of the Bill, and Members who are not on this Committee will be prevented from revisiting questions in respect of the early clauses because the matter has been discussed in Committee, is considered settled and cannot be revisited on Report.

As a new MP—there are many in the room today—I am still very much learning the process; we have to contend with not quite understanding how the full process works. In two years’ time, I think that I and many other new colleagues would be in a different position and would fully understand all the interactions and the subtleties of the legislative process. But it is a challenge I have, which is why, right now, I will always table the most robust amendments that I think will safeguard the most vulnerable in our society.

I would like to bring the Committee back to a certain amount of reality. What we are talking about is how we can assist clinicians to assess coercion and pressure. I like the way we have discussed this in a very good way, trying to make the Bill safe, but would the hon. Lady’s amendment make that any easier for the clinician? I do not think it would. The Bill is very clear as it is. I do not think there will be any implications if there are further amendments, because the Bill provides a statement of what we do; as a clinician, I would understand and be able to apply that.

The hon. Member is absolutely right that the amendment would not make it easier for the clinician. My job is not to make it easier for the clinician to determine that someone is eligible for assisted death. It should be a robust, rigorous and well considered process.

I find the hon. Lady’s point about the mechanism by which we are making this legislation to be very pertinent. I have been here for almost 10 years. As somebody from a small party, I suspect we are all experiencing how Bill Committees work from the outside, if you like. We need a note of humility. On the one hand, we are all here trying to make this Bill a piece of legislation that is as watertight as possible. That very much then comes over to the Government; I know we are here on a private Member’s Bill because of the nature of the ethical question with this Bill, and I am very comfortable with that, but none the less there is an immense responsibility in the next stages with the questions we raise. Perhaps it might be an idea not to push this question to a vote—although I leave that entirely to the hon. Lady—because that keeps the matter alive. There is an immense responsibility on the Government to listen to the issues that we can only touch upon here and to ensure they are all sewn together.

I thank the right hon. Lady for that really helpful intervention. That is exactly the kind of advice that is extremely useful to us new MPs undertaking this process. I will have to make the decision on that question in a matter of minutes, and it is very difficult, but I will do my best to make the right decision.

New clause 5 seeks to define encouragement for the purposes of the Bill and includes some exclusions. We have already talked about some of the challenges with exactly what encouragement means, and clearly there are certain acts that we do not want to be captured by it. The aim of the clause is just to ensure that it is only intentional, targeted and effective encouragement that is covered. I am very open to working with the Government to ensure that the drafting reflects the intent; it may well be that some other things go in there to address some of the concerns raised by my right hon. Friend the Member for North West Hampshire around support being given by families. No one wants to see that included in this definition—I think we all agree on that.

In summary, I hope hon. Members will view these amendments, incorporating undue influence and encouragement into clause 1, favourably, in order to bolster the safeguards in this Bill. It is vital that subtler forms of influence are addressed, to protect patients and to ensure that it is not just the obvious signs of coercion that are looked for. I also welcome amendment 113, tabled by the hon. Member for Broxtowe, which is very much in the same spirit as amendments 23 and 82 and would insert the word “manipulated”. I hope we will debate it because, if accepted, it would certainly improve the safeguards in the Bill.

It is a pleasure to follow the hon. Lady. Just to put it out there, to begin with on amendment 23, the Court of Appeal, in the case of “Re T (Adult: Refusal of Medical Treatment)”, held that undue influence was relevant to medical decisions and said that doctors must check for it. Undue influence is about power imbalance, rather than outright coercion.

That brings me nicely on to the points we discussed in some detail yesterday. The right hon. Member for North West Hampshire talked about having a conversation with his family, with his wife and children and so on. I will give another example. Say there is a woman who has been the victim of domestic violence—we know this happens; we know two women a week are killed in this country, to this day—and she is subtly encouraged: “Sweetheart, you’ve got a diagnosis and the option is to have this.” There is a fine line, and the fine line conversation has been mentioned quite often as well, but I would rather stay on the side of caution with that fine line conversation when it comes to domestic abuse, coercion and the power imbalance in a relationship.

Let me come back to that woman or elderly person whose loved ones have the conversation—and they indeed have the conversation; it happens every day. Ask any victim of domestic violence. On average, it takes a woman 40 attempts to leave an abusive partner—that is the fact—because we do not even recognise it.

I know somebody who recently left an abusive partner—that took three years of encouragement because she did not recognise that what was happening to her was about power and control. It is when power is juxtaposed with vulnerability that there is the potential for abuse. That happens—it happens every single day. Victims of domestic abuse are not just younger people; according to Age Concern, over 375,000 older people are at risk of domestic abuse.

The abuse of people is a cancer in our society, and that very subtle power imbalance is where the fine line is crossed. Given that the Court of Appeal has ruled and is already saying that medics have to look out for undue influence, I would argue that amendment 23 actually strengthens the Bill. My hon. Friend the Member for Spen Valley has repeatedly insisted that this Bill needs to be the tightest in the world. How does the amendment not complement her view? How does it not strengthen the Bill, to protect victims?

My hon. Friend mentioned domestic violence and vulnerable people. Do we not also need to think about the many people in hospital beds and nursing homes who may not have any relatives? They might get influenced or encouraged to choose this route by professionals because of the pressure on the NHS and hospices. Amendment 23 would strengthen the Bill in that respect as well.

I would like to hope that that would never happen; I have a huge love of the NHS and of the people I know in it who make decisions every day, particularly given all the cuts—even more so, post covid. But there is that risk; I would like to hope that it is very small.

When it comes to mental health, the debate is similar to the one about capacity: it is the same conversation about whether something is fit for purpose. Just because something already exists does not mean that it will necessarily suit what we are doing here.

On International Women’s Day, the Minister for Safeguarding and Violence against Women and Girls, my hon. Friend the Member for Birmingham Yardley (Jess Phillips), eloquently reads out a list of victims of domestic violence who have been murdered. There are two a week—I make no apologies for keeping coming back to this. Only yesterday, there was an article about women’s charities that support victims of domestic abuse citing their concerns. The amendment speaks to those concerns. How could it not be supportive?

I am not convinced by the idea that the amendment would introduce an element of jeopardy. People make decisions with their families every day. We sit and have conversations. I speak from a position of privilege—as we all do in this place, frankly. We speak from positions of privilege about how we could have these conversations with our families. But we know that inequalities exist and that some people do not have those privileges. We know that society is unequal. We know that domestic abuse, elder abuse and mental health issues exist.

In my constituency, it takes 14 months just to get a child and adolescent mental health services referral for a young person; I appreciate that we are not talking about young people. My point is that there is a real backlog in the NHS—in terms of waiting times and pain medication, for example. Palliative care is not equal, as I said yesterday. I am genuinely asking Committee members: which bit of the amendment can we not support?

The hon. Lady is making a powerful speech. She referred to an article she read yesterday about domestic violence in relation to the Bill; it may have been the article by Sarah Ditum in the New Statesman, which I also read yesterday. It cited two cases in which people had been on trial for murder and had pleaded mercy killing, or said that they had carried out the killing of their spouse or partner on the basis that that person was suffering greatly at the end of their life. In both cases, when the evidence was examined, the men were found guilty of murder, because it was very clear that that was what had actually happened.

The article had a profound impact on me, because it demonstrated the risk that we are running: that people will be able to use the Bill in instances of domestic violence. We have to take that very seriously and consider the implications.

I thank the hon. Member for her powerful intervention. She is right: that was the article I mentioned. Reading about such stories does have a profound impact.

My hon. Friend is making some powerful and important points about, sadly, a lot of the ills in society, which we all deal with.

Let us take the example of a woman who has a terminal illness and is coerced and pressured by a loved one to end her own life. At the moment, we have no idea whether that has happened, because there is no legal framework around that dreadful situation. The Bill would create a legal framework, so that conversations would be had with that woman prior to that point and, hopefully, that point would never come. She would speak to two doctors, potentially a psychiatrist, and other experts to ensure that that did not happen. At the moment, there is no legal framework around that. The Bill also includes a criminal offence of coercion, for which someone could go to prison for 14 years. At the moment, that just is not there.

I thank my hon. Friend, but I feel that the point is being missed. It is true that there is no framework, but for somebody to get to this point in the first instance they need to have a terminal illness. There is a framework around domestic violence, and domestic violence laws exist for everybody. Frameworks already exist for women fleeing domestic violence, and there is no shortage of attempts to try to get those legal frameworks right across society. That is why we had the Domestic Abuse Act 2021, why we have committed to halving violence against women and girls, and why the Prime Minister made a personal commitment in that regard—and rightly so.

There has already been a test case in which a judge said that medics have an obligation in this context. An hon. Member referred yesterday to assisted dying being a treatment, although I disagree, and we had that conversation later.

That was a misunderstanding; I was talking about “treatment” as a legal term.

No, I was talking about another hon. Member, not the Minister. We already have laws to protect people from domestic violence, but that does not mean that they necessarily access them.

From what I understand from the promoter of the Bill, the argument is that we should put these measures in place to protect from coercion people who have less than six months to live, but we would not put those protections in place for people who have nine or 12 months to live. If we are putting the measures in place for someone with six months to live, why are we not doing so for someone with nine or 12 months to live?

My hon. Friend makes a valid point. There has already been a test case, and the Court of Appeal has ruled that undue influence is relevant to medical decisions and that doctors must look at it. If that is already a ruling, I struggle to understand the resistance to adding the words “undue influence” to a Bill that, in the promoter’s own words, should be the safest in the world. A judge has already ruled on it. We already know that we are not going to get to a judge. I struggle to understand this.

As the Minister pointed out, the concepts that the hon. Lady is trying to embed in the Bill are already covered by what is a settled legal interpretation and a framework that, over the last 10 years, has become used to dealing with those issues. Do not forget that families who are going through such situations will be advised and will examine the legislation quite carefully. I am nervous about injecting yet another level of consideration for them that might mean that conversations are interpreted—by them, but not necessarily in a legal sense—in a way that is not beneficial to the patient.

I understand the group that the hon. Lady is seeking to protect—that is what we are all trying to do. But what about the majority of people in such circumstances, who might say, for example, “Darling, I am thinking about taking an assisted death because of my horrible disease. If you were me, what would you do?” If I then say, “Well, painful though it is for me, I would do exactly the same thing,” how would families interpret that?

I also want to respond to the hon. Member for Bexleyheath and Crayford. He made a strong point, but I am not sure he is exactly right. I think that if at nine months I have a disease that is progressing, and somebody in my family says to me, “When it comes to it, Kit, you have absolutely got to take an assisted death. We really want you to,” and then when I get into the six month period I do, and I tell the doctor, my interpretation is that would be covered under the Bill.

I think what the Minister was eloquently trying to establish was that we have to be careful about the clarity of the legal language, and not make it embroidered in a way that makes interpretation by laypeople as well as by lawyers more difficult and complicated. I will come on to this in the next grouping, but we must not use language in a way that skews behaviour, or that makes what should be healthy and fulsome discussions within families guarded and nervous.

I have to respectfully disagree with the right hon. Member that this is a settled position. I also challenge, on the record, what the Minister said. I struggle to understand how the Minister and the Government can say that this is a settled position without having gone to consultation on the Bill and without having an impact assessment. That does not satisfy me. My role when I agreed to be on the Committee was to come in to scrutinise and help strengthen the legislation. In doing so, these are the things that I am pointing out, because the safeguards are not strong enough for me.

I come back to the Court of Appeal. This would be a medical intervention, albeit to end somebody’s life. It would be administering a lethal drug to end somebody’s life, and it would be done by medics. Medics are involved in every stage. If there is case law that has already established that doctors have to look at undue influence in medical decisions, then I say to every single person on the Committee: what are we resisting? When the Court of Appeal has already said so, why is the Committee debating keeping this language out because it makes things complicated?

Let us go back to the words of Dr Jamilla Hussain, who gave evidence to the Committee. She is a clinician, and she absolutely accepts that there are some people who would really benefit from this law. As a clinician, she wants to get there. Indeed, I spoke to Professor John Wright, and he said, “Naz, absolutely—this is where we need to be.”

My hon. Friend is making a very powerful argument. She is absolutely right to focus on protecting the vulnerable people who this law might apply to. She has touched on medics. I also want to mention the state and its role in what we are talking about. For example, I am opposed to capital punishment, and I link this discussion to that because we are talking about the state providing an individual with a method by which they can end their own life, such as by handing them a pill. I am concerned that, if we are not taking these safeguards seriously, we are abandoning vulnerable people by allowing the state to aid and abet the misuse of the Bill against them. Does my hon. Friend share my concerns?

I share my hon. Friend’s concerns about the Bill not being tightened and fit for purpose. We cannot afford for those people to slip through the net. One woman’s death is one too many. One older person’s death is one too many. That is the bar we have to set.

I come back to the words of Dr Jamilla: she said, “Yes, absolutely.” Every single Committee member, and anyone familiar with this debate, found it heartbreaking to listen to those who came in to give testimony about how members of their families died. Those stories will stay with us forever, and rightly so. That is why, in principle, I am supportive of where we need to get to with the Bill. However, as Dr Jamilla said, we cannot get there by ignoring this big lot of people with vulnerabilities and inequalities, who would absolutely need this legislation. We need to fix the inequalities first.

Let us be honest: as legislators, we know that we will not fix every ill in society, otherwise we would not need a police force. We would not need laws if everybody behaved as they should and supported each other. However, it is incumbent upon us, as legislators in this place, to try our best.

Nobody came to this Bill Committee thinking it was going to be a walk in the park. We certainly did not know that we were going to get evidence throughout it, and plenty of challenges are popping up. We came to this Committee—I came new to the subject—because it is of such importance. I sat in the Chamber for five hours on Second Reading, bobbing, but I did not get the chance to speak—and that happened to another 100 colleagues, who also did not get to speak. However, those who made contributions—whether they were for the Bill, concerned about the Bill or were clearly not going to support the Bill—did so because they feel very strongly about it. That is our responsibility.

I come back to amendment 23, which was tabled by the hon. Member for Reigate: we should really consider adding it to the Bill, because that would strengthen it. The amendment does not dilute the Bill, and it does not add another hurdle given that the Court of Appeal has already said that there is a responsibility to look for undue influence. I do not understand the resistance to the amendment, which I will support.

This debate has been very interesting and has reminded me of my life before being elected. When I was a barrister in court, I was often junior counsel and, by the time I stood up, all the best points had been taken. I feel a bit like that this morning.

I have some observations, the first of which is on what is in the Bill currently. My central submission is that the Bill does more than enough in this area, and that simplicity is what is required, especially when dealing with very complex and difficult subjects, which coercion is. There are two sides to the coin of coercion: one is about acts by third parties, such as family members or society at large, and the other is the individual making the decision.

Clause 1 is clear that, as part of the assessment made by the doctor, judge or panel, the person must have “a clear, settled and informed wish to end their own life”

voluntarily. That precisely echoes words from the Crown Prosecution Service guidance on whether to prosecute that is currently in operation. That guidance has been in use for some time, and it seems perfectly rational and logical to continue that.

The focus of the assessment should be on the individual and whether they make the choice freely. Clause 1 makes that clear, and I presume purposefully echoes the language from the CPS guidance. It then says it must be established that the person has “made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person into making it.”

That must of course be read with clause 26, which introduces a new offence: “A person who, by dishonesty, coercion or pressure, induces another person to make a first or second declaration, or not to cancel such a declaration, commits an offence.”

That carries a sentence of up to 14 years in prison.

I am trying to understand the expertise my hon. Friend is speaking from. Was he a criminal barrister?

I am very happy to share my CV afterwards. I practised as a barrister mainly in family law and Court of Protection law, but back in the day I also practised criminal law as a very junior barrister in the magistrates courts up and down the land.

I do not want to delve into the criminal element too much, because we are on clause 1, but it appears to me that the criminal offence set out in clause 26 is far stronger than the Suicide Act 1961, which talks of an act of encouragement. That is not included in clause 26, which talks about inducement—a much more holistic and wider concept than that of an Act probably drafted back in the late 1950s. In my submission, that brings the law far more up to date with modern concepts of coercion and pressure.

The hon. Gentleman is making interesting points. This is probably more a question for the Minister. I have been focused on clause 24, in terms of encouragement, but clause 26 obviously makes coercion and pressure a criminal offence. The hon. Gentleman says he thinks coercion includes undue influence; does it include encouragement?

I seek clarification of whether undue influence and encouragement are captured in clause 26. When I tabled the amendments, I assumed not. If it is the case, how does that interact with the Suicide Act, which already makes the encouragement of suicide a criminal offence, and is probably not—I have not checked, so I would have to look—consistent with this? That needs to be looked at. It is easy to say that undue influence is included in coercion, but it has a knock on impact on a lot of other things. We need to be really clear on that point.

My answer to the hon. Lady’s first question is yes. In my view, clause 26 covers undue influence and encouragement—I could go on to state why.

My reading of the Bill is that clause 24(3) essentially removes from the Suicide Act persons who are by all the other criteria eligible for assistance in death under the Bill. The Act that will be created is, in my view, stronger in any event. That is why—I genuinely mean this respectfully, because the hon. Lady made good points in an impassioned speech—this argument about encouragement in the Suicide Act does not follow through. What we have here is a much safer and more modern piece of legislation, which is reflective of what we all think of when we think of coercion and pressure.

Forgive me—I hope the hon. Gentleman will bear with me as I seek to understand this; he is obviously very learned in these matters. My understanding is that clause 24 takes out only the assistance piece, not the encouragement piece. I think the hon. Gentleman just said, if I am right, that encouragement now falls under clause 26, but encouragement is also captured in the Suicide Act 1961. That is my non lawyer interpretation of reading the Bill. I am not saying that is absolutely right, but I would appreciate it if he could clarify that.

My reading of the Bill—we are dealing with clause 1, but we will get to clause 24—is that clause 24(3) says: “In the Suicide Act 1961, after section 2A (acts capable of encouraging or assisting suicide) insert”, followed by the provisions in new section 2AA.

I have a question for the promoter of the Bill, my hon. Friend the Member for Spen Valley. We are having a lengthy conversation about coercion and pressure, and whether those two words are a catch all for things that can be much more subtle and nuanced. That is the point of the amendment, and it is the point that I will make when I speak to the amendment I have tabled. Clause 26 suddenly introduces new language, with the word “dishonesty”, which brings in another type of coercion and pressure. Could we rethink the wording of clause 1(2)(b), which refers to a person who “has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured”?

The words “coerced” and “pressured” are insufficient to cover the safeguards that we are asking for. They are not a catch all. We are asking for something much more nuanced, and for other words to be added, just as the word “dishonesty” appears in clause 26.

I did not draft the legislation, but my understanding is that the reason why the word “dishonesty” appears in clause 26—I do not know whether the Minister wants to comment on this—is that when there is a criminal offence, there needs to be a mens rea. The person who has committed the offence needs to have been intentional or reckless in doing so. As I say, I was a criminal barrister only very briefly; I am sure my law tutors are shaking their heads.

The principle of statutory interpretation means that by mentioning one thing, we exclude others, so it is my understanding that having the terms coercion and pressure in the Bill excludes undue influence. Will my hon. Friend, who has clearly gone through this in detail, also comment on the fact that section 2A of the Suicide Act says that encouragement includes pressure?

With respect, I think my hon. Friend is wrong: it is certainly not an exhaustive list of factors to be taken into account. The courts—this is why we have a common law system—interpret the language used in legislation.

To build on that, I referred to the Court of the Appeal earlier, but when it comes to someone giving their organs, I think from the age of 12 or 13—I will try to find the reference—the words “undue influence” are used in the legislation. It comes back to the crux of my argument; I would like to understand why my hon. Friend is so concerned, from a legal perspective, about putting in the words “undue influence”, when they already appear in legislation.

The issue I have is that if we open the door to all different types of terminology, it will never end. The law is best served when it is clear, simple and straightforward.

Will the hon. Gentleman give way?

Let me just make this key point. Members have raised the case of Re T. I must admit that I do not know that case, but I believe it is a 1992 Court of Appeal case about a refusal of treatment, so it is 33 years old. The law has moved on. As the Minister said earlier, the terminology of coercion and pressure is much more modern, and is used in legislation that has been drafted in the last decade, rather than the Suicide Act drafted in the 1950s and that Court of Appeal case from the early 1990s.

Last night, I briefly went back to my law books—I sound like I am really missing my old job—and looked into where the concept of coercion is used across different jurisdictions and areas. This is what I read: “Coercion is a phenomenon the courts have experience of handling. Generally, coercion as a concept in our law involves applying pressure, whether physical, psychological or moral, to force someone to act against their free will or better judgment. This pressure can manifest in various forms, such as threats of intimidation and undue influence, and is recognised across criminal, family, consumer and contract law.” It is used in forced marriage legislation. It is used in criminal legislation. Case law has made it very clear that coercion is used interchangeably with duress, defined as a constraint on a person’s choice.

I feel that we are dancing on the head of a pin. The law has been drafted by one of the most senior parliamentary draftspeople. The Government Minister has confirmed that the Ministry of Justice deems this to be a sensible course of action if this legislation is to proceed.

Does my hon. Friend agree, as Max Hill did in oral evidence, that it would be helpful to have definitions of the three concepts in clause 26? Although we are discussing an earlier clause, it is important to thread the needle with this statute and ensure that we are looking ahead, as the hon. Gentleman has rightly pointed out.

That sounds very sensible—I think my hon. Friend is talking about her amendment.

I am so glad that the hon. Member has spoken, because this is a really important conversation. I appreciate that we are getting a little ahead of ourselves, so I will be quick before the Chair tells me off. Section 2A of the Suicide Act includes pressure when it talks about encouragement. That is why it is so useful to have this conversation—because that could mean that encouragement is captured by clause 26. There is some work to be done. I stand by the amendments—it is really important that we have them on the face of the Bill—but, when we get to the relevant point in Committee, we need to think about the interactions of clauses 24 and 26 with the Suicide Act. I am sure that the Ministers will want to look at that, but we may need to be very clear what is included in what, which may require some things in the Bill so that there is no ambiguity. Does the hon. Gentleman agree?

Yes. As I say, the amendments are perfectly reasonable; it is sensible to raise them and it is good that we are having this conversation. I have looked into this carefully and I take it seriously. I feel that the square is squared—or the circle goes all the way round, to mix my metaphors—but that does not mean that we should not look into this further when we get to the relevant clauses.

I am worried about the constant suggestion that we look at these issues later. The fact is that we do not know what the Bill will look like later. We do not know what amendments will be tabled or what will be agreed. It is always possible to revisit amendments that have been passed in the earlier stages if subsequent amendments make them otiose. The point is that we should not pass this opportunity to strengthen the Bill if we can.

On the point that the hon. Member for Rother Valley was discussing with my hon. Friend the Member for Reigate about the Suicide Act explicitly referring to pressure as a subset, as it were, of encouragement, that Act specifies that encouragement is the general, catch all term and includes pressure. I think the hon. Gentleman is suggesting, and other hon. Members have suggested, that it is the other way round: that coercion or pressure somehow include encouragement. Surely encouragement is the broader term—it exists in the current law on suicide. What is the problem with using that term in addition to coercion and pressure, consistent with existing law? It is a broader and more sufficient term.

On the first point, in fairness, the hon. Member for Reigate was talking about a clause that we are going to consider and the link between two different criminal offences in the 1961 Act and clause 26 of the Bill.

On the second point, the Bill—to coin a political phrase—needs to be fit for the future. The language used in legislation over the last decade when we are considering coercion—I use that word automatically because that is the language we use now—is much more appropriate than “encouragement”, which is slightly archaic, to be honest. Perhaps we need to look at the Suicide Act as well—although not in this parliamentary term; that is for the second term. [Laughter.] I have nothing further to add.

I rise to speak to amendments 113 to 115 and 118 to 121, which would require steps to be taken to establish that a person seeking assistance has not been manipulated by another person.

The amendments would require the co ordinating doctor to ascertain whether, in their opinion, the person has been manipulated, and would account for additional ways that a person can be influenced by another person into choosing an assisted death. Pressure and coercion may leave an individual feeling that they have no choice but to take that path; however, manipulation can make the person think that they made the choice themselves. Coercion is an overt and clear means of controlling someone, whereas manipulation is a hidden, psychological and deceptive means of control.

The definition of manipulation in the “Oxford English Dictionary” is:

“The action or an act of managing or directing a person…esp. in a skilful manner; the exercise of subtle, underhand, or devious influence or control over a person…interference, tampering.”

It is controlling someone or something to one’s own advantage, often unfairly or dishonestly. Although there is not much regulation of manipulation in the law, there is an increasing argument that it should be regulated. In Eric Posner’s paper “The Law, Economics, and Psychology of Manipulation”, he argues that manipulation

“has always been regarded as wrongful, an indirect form of fraud, by common law courts and government regulators.”

In his paper “Fifty Shades of Manipulation”, Cass Sunstein argues that, despite the fact that manipulation is rarely policed in law, the argument for legal responses to manipulation is strong.

“Manipulation” is a term that we have in law. It is mainly used in relation to fiscal crime, but also in relation to genetic science. I argue that “manipulation” should and could be included in the Bill.

We are all in this together. We all want the safest Bill possible, so we should defer to the legal side to form the safest language. I am not a specialist on this legal subject but we all want the same thing and we are arguing about words on which we perhaps just need to take advice, to make the safest possible Bill.

rose—

In response to the intervention of my hon. Friend, we are here to make the Bill as safe as possible, but this is a new thing. When the Bill returns to the House, I have to make a decision on whether to support a new Bill that is of such huge magnitude to our communities and the whole country. This Committee is the only process available to us, and words matter.

I support the amendment tabled by my hon. Friend the Member for Broxtowe. The concept of manipulation, as she set out, is very important. I come back to the issue of abuse, particularly in respect of women. I have never heard the phrase “Fifty Shades of Manipulation”—that is an interesting one—but this happens every day, across society. I encourage people to talk about these words. We, as parliamentarians, benefit from that: we are better people for understanding other experiences, because different people bring different experiences to this conversation. I have certainly learned a lot, and it strengthens the House itself when we speak from positions that we have debated. That is the whole purpose of us being here. I am not concerned by talking about adding language—I hope my hon. Friend the Member for Broxtowe shares my view—because that is point of us being here in the first place.

To reply to my hon. Friend the Member for Stroud, I understand that the writers, promoter and sponsors of the Bill want it to be as simple as possible. The thought is that if we make it as simple as possible, there is less room for confusion and misinterpretation, but there are times when we can make things so simple that we allow far too much interpretation. Words such as those that the hon. Member for Reigate wants to be put into the Bill are really important. Manipulation is really important. Coercion and pressure are not measures of every type of controlling behaviour that happens to individuals.

I am very supportive of the sentiment behind my hon. Friend’s amendments, and she is making some really good points. Again, the question is about the simplicity of the language that goes in the Bill. The CPS guidelines on coercion and coercive control includes behaviour that is “highly manipulative such as: ‘love bombing’ where the suspect will intermittently do what appears to be loving acts, seeking to present these as interrupting or negating the course of conduct”, so there is language in there about manipulation. I hope that provides some reassurance that manipulation is seen to be part of the broader concepts of coercion and coercive control in the eyes of the law.

I thank my hon. Friend for looking that up so swiftly. I still think that those additional words need to be included in the Bill. “Coercion” and “pressure” are used as a catch all for manipulation, but the Bill does not allow people who are using it in their everyday life—doctors, clinicians, nurses and social workers—to understand that.

I thank my hon. Friend for being so generous with her time. To come back to the CPS’s terminology, does she agree that, in an ideal situation, the Bill would be so safe that we would not need to look at that CPS definition? The Bill would be so tightly defined that nobody could be prosecuted for coercing somebody into taking the option of assisted death.

I absolutely agree that we do not want people not to understand what the Bill allows them to do or not do. We spoke earlier about making the Bill simple enough for professionals to understand so that they know how to deal with particular instances, but it is not here to make life easy for professionals; it is here to ensure that anyone who is vulnerable—anyone who has six months to live, or for whatever other reason—is protected.

A continuous theme of our debates and all our conversations is that we must make safeguarding as tight as possible so that people are protected. I believe it is not too much to ask to include those additional words to ensure that the wording is as tight as possible and protects the people who need our protection every single day.

It is a pleasure to follow the hon. Lady. May I say how much I agree with what she has been saying and the purpose of her amendments, which I will be supporting if we get the chance, as I will the amendments in the name of my hon. Friend the Member for Reigate?

I do not want to repeat what I said yesterday, but my general point is that we make decisions in a context. We are directly influenced by the people around us. I want to highlight the very powerful phrase that my hon. Friend used. She said that love can shroud decision making, and the influence and pressure that is applied to us can be shrouded in love.

Professor House, who gave evidence to us, talked about the enmeshment of people’s decision making with the influence of their loved ones and people around them. The fact is—hon. Members have made this point—that power dynamics in families are complicated, and where there is an imbalance of power, there is risk. The Bill implicitly acknowledges that through the safeguards that it attempts to create, but I do not think they are strong enough.

I know that my right hon. Friend the Member for North West Hampshire is concerned that strengthening the Bill in this way will create an opposite risk, which is that a family member who was behaving perfectly properly could somehow be dragged into a prosecution, or that the application would be denied on the basis of a reasonable conversation that had taken place between loved ones—“My darling, do you think I should do this?” It is a lovely fictional conversation, a sweet exchange between a loving couple, but saying to somebody that you agree with the decision they have made and that you would support it, or that you are content with it or understand it, is not the same as undue influence—it is not even the same as encouragement. It is similar to the debate we will be having in due course about the role of the doctor making an overt suggestion of an assisted death, rather than consenting to a suggestion that has been made by the patient.

My hon. Friend is asserting that those two things are different, but obviously, those assertions would be tested in court. If a person were to appear in front of the co ordinating doctor and say, “Doctor, I want an assisted death and my husband thinks I should do it,” is that interpreted as encouragement? Is it support? Under the current legal framework, that would be interpretable and inquirable. However, as I said to my hon. Friend, I am not necessarily nervous that families would be dragged into some kind of legal conflict. I am concerned that they would seek to not get there at all, because the insertion of those words would make them so nervous about the conversation that they would become guarded.

We know from other jurisdictions that over time, people will come to understand this process. As I will refer to during our debate on the next grouping, they will also start to understand what they should not say, if we put into the Bill that there are things that will play negatively if they are revealed to the relevant authorities. My concern is that unless we keep the Bill simple and clear, and leave families and medics the space to have free, frank and open conversations that—from the medical point of view—cover the full range of options, we will start to restrict and police the conversation, and therefore make it that much more difficult.

The risk of gaming—of patients playing the game, and doctors seeking out words to say or not say—is an issue throughout the Bill. That is a general problem with the Bill; thankfully, it is not just a free for all. However, in the scenario that my right hon. Friend suggests, that is exactly my concern: if the patient says that their spouse agrees with them or encourages them, that should be a red flag. Under the current Bill, it is not clear that it would be. There is no obligation on the doctor to record that there has been undue influence or to push back, because at the moment, the doctor is looking only for evidence of coercion. As I will come to later, that bar is too low to use, so if the doctor hears those words, I would like him or her to start asking questions, to push back, and to satisfy himself or herself that there has been no overt encouragement or undue influence. That is the point of what we are trying to do.

To come back to an earlier point—I want to make these points, simply because it is really important that we get them on the record—my hon. Friend the Member for Rother Valley talked about undue influence and encouragement perhaps being archaic terminology. However, just last year, the Digital Markets, Competition and Consumers Act 2024 cited undue influence, as did the Anatomy Act 1984. Acts passed by Parliament in the last few years have used that terminology, so does the hon. Member for East Wiltshire share my concern about the resistance to having those words added to this Bill?

The hon. Member is absolutely right—undue influence does exist in law, including in laws that have been passed very recently. I recognise that the hon. Member for Rother Valley is not impressed by laws that are more than 10 years old, but I hope he might be satisfied that a law passed last year is sufficiently up to date and modern for him to regard as morally valid. Undue influence is an existing term, and we should apply it in this case.

On that point, and in response to the comment made by my hon. Friend the Member for Bradford West, although I stand to be corrected by my hon. Friend the Member for Rother Valley, I do not think that he said that undue influence was an archaic term. I think it was the word “encouraged”.

If we are going to rule out the word “encouraged” on the basis of archaism, I do not know what we are going to do with the language. It is a perfectly acceptable term. We are still governed by the Suicide Act, to which the Bill refers and in which context it is framed, so it is appropriate to remember that the Act specifically prohibits encouragement and includes pressure within that concept. The two terms co exist in the same section of the Suicide Act, so the idea that we cannot have more than one word, and that that is somehow confusing, is wrong.

In the light of my hon. Friend’s points, I have an interesting fact that he might enjoy: “encourage” was added to the Suicide Act by the last Labour Government in 2009, and replaced “aids” and “abets”, so it is not that archaic.

My goodness, 2009 might be in the mists of history for the hon. Member for Rother Valley, but it was the last Labour Government. That is very good to know, and I am grateful to my hon. Friend.

The hon. Member for Spen Valley made the point, which is quite often made in defence of the Bill, that there is currently no framework to spot coercion, therefore the Bill creates greater protections for people. The fact is that, as the hon. Member for Bradford West said, there is no law that currently allows assisted dying, so no framework is necessary to prohibit encouragement or inducement to an assisted death—the opportunity does not exist. I think everyone must acknowledge that, if we pass the Bill, we may open up a new avenue for abuse, and it is necessary that the Bill close it off. That is right and appropriate.

Coercion and abuse no doubt go on and are tragically common, but the answer to that problem is not to legalise assisted suicide and put a regulatory framework around it with limited protections against coercion and influence. We have to deal with the terrible cancer of abuse and coercion that exists in our society, as the hon. Member for Bradford West said. If we are concerned about undue pressure in families, that should be our social mission. If we are to have an assisted dying law, let us make it as strong as possible. As I say, we are potentially opening up a new avenue for abuse within families.

For me, the law needs to change for a number of reasons, and we will talk about some of them as Committee proceedings continue: autonomy, dignity, personal choice and bodily autonomy. In terms of this issue, we heard from families who faced police investigations as a result of a loved one taking their own life. Not only were they dealing with the trauma, grief and loss of their bereavement, but they faced often months and months of police investigation. In the oral evidence sessions, we heard from Pat Malone, who was in that situation after his brother took his own life. Surely the hon. Member has to acknowledge that that is a problem. It is not the only problem, and it is not the only reason for the Bill, but he has to acknowledge that we as legislators have a duty to correct it.

I am sure that the hon. Lady will acknowledge that those investigations will still happen, because not everybody who commits suicide will be subject to the Bill; not everybody who is terminally ill and wants to take their life with the assistance of their loved ones will be caught under it. I am sure she acknowledges that it is therefore still appropriate to have safeguards against assisted suicide outside the law—in fact, the Bill strengthens those safeguards. Those will still continue. I also regard it as appropriate and necessary to have a law against assisted suicide, for all the reasons that we have been discussing.

The hon. Lady is right that it is appropriate for Parliament or the authorities in general to ensure that cases such as those we have discussed, and that have been powerfully testified to us, are handled sensitively. In an overwhelming number of cases, the police do handle them well and sensitively. It might be that we need to improve the guidance around prosecution, and that is an important question. I certainly do not want the families of people who have taken their own lives to be harassed and chased through the courts, and I think we would all agree on that. In that respect, the guidance for the CPS and the police will always evolve.

The hon. Member may recall that we heard from the former head of the CPS in the oral evidence sessions, and I asked him whether the Bill would address concerns about such prosecutions. I absolutely agree with my hon. Friend the Member for Spen Valley that we want to address that. However, this Bill is not the route to address those issues unless they fall into that six month bracket.

I think that is right. I do not accept the claim that this Bill is somehow a response to the problem of abuse, coercion or the pressure to end life in families. Tragically, in jurisdictions that have an assisted dying law, the number of unassisted suicides—suicides that happen outside of the law—go up, because no law can catch all the people who might want to take their own lives. Thankfully, there is no blanket support for any assisted suicide; all the jurisdictions have some restrictions.

More significantly, if the state said that some people’s lives are not worth living and that it is an acceptable choice for them to end their own life—which is not what the current law says; we have legalised suicide, not actually endorsed it—by passing a law that endorsed the choice of some people to take their own life, we would be sending a signal that we agree that some people’s lives are not worth living. The social consequence of that is clear in the evidence from other jurisdictions: suicide in the general population goes up as a result of an assisted dying law.

On that point, the evidence does not clearly show that there is a direct relationship between those two things; there are other factors and no way of knowing that. On the concept of ending one’s own life and giving people the choice under the provisions of the Bill, what would the hon. Gentleman say to people who frame that concept very differently—as a way to shorten their death? Those terminally ill people, in my experience—I have met many of them now—do not view this as a way of ending their life, because they want to live, but the reality is that they are dying and want to take control of what their death looks like. How would he respond to that?

First, there might not be a causal link between assisted suicide laws and the increase in unassisted suicides in those places, but there is such a clear correlation that it is difficult to understand what else might be going on—unless there is something in the water in Canada, Australia, New Zealand and the Netherlands that is not there in other countries. It might be that those countries have such a disrespect for the frail, elderly and ill that they are taking their lives. However, I think there would be a direct social impact from the signal that this law would send into our culture, which is very concerning.

I hear the hon. Lady use that phrase quite often about people wanting to shorten their death rather than their life, but I am afraid to say that it is absolutely meaningless. We are here to make law. Death happens: you are either alive or you are dead. People might want to shorten their death, and might use that phrase, but what they are doing is shortening their life. There is no conceptual difference and certainly no legal difference between those two things. Trying to say that some people’s motivation for suicide is legitimate and some people’s is not makes no sense. This law will allow them to shorten their life and have assistance in committing suicide, and there is no other way to describe it in any terms that make sense. I do not regard the distinction that the hon. Lady makes as valid.

Our obligation to ensure that the Bill sets out what it is claimed that we all want it to do, which is to ensure that people are not pressured unduly into taking an assisted death, means that we should put that in black and white. The hon. Member for Rother Valley said that the current term is more than enough, and we had a bit of an exchange about that. I emphasise that it is a clear principle of the statutory interpretation of law that courts will look at not just the words that are in the Bill, but the words that are not. The decision to include some words and not others is regarded as significant by courts. If the term coercion is there but not influence, it is appropriate for the courts to conclude that influence was not intended by Parliament. It might be the case that the term coercion is interpreted to include influence, but if so, let us make that clear.

I am grateful to the hon. Gentleman for giving way while he is in full flow. One of the areas that I have been confused about in this debate is that the Minister said—I have no reason to dispute it—that coercion is a clear term, so the courts know where they are with it, because they are already dealing with it. However, we have also heard from proponents of the Bill that it is about making life easier for the professionals who are involved. I mention that because, overhanging all of this is the fact that the Bill as it stands—as it passed Second Reading—has a High Court judge intervention. We are told that an amendment is coming that will remove that for a potential panel of professionals—

Order.

The Chair adjourned the Committee without Question put (Standing Order No. 88). 

Adjourned till this day at Two o’clock. 

The Committee consisted of the following Members:

Chairs: Peter Dowd, Clive Efford, Sir Roger Gale, † Carolyn Harris, Esther McVey

† Abbott, Jack (Ipswich) (Lab/Co op)

† Atkinson, Lewis (Sunderland Central) (Lab)

† Campbell, Juliet (Broxtowe) (Lab)

† Charalambous, Bambos (Southgate and Wood Green) (Lab)

† Francis, Daniel (Bexleyheath and Crayford) (Lab)

† Gordon, Tom (Harrogate and Knaresborough) (LD)

† Green, Sarah (Chesham and Amersham) (LD)

† Hopkins, Rachel (Luton South and South Bedfordshire) (Lab)

† Joseph, Sojan (Ashford) (Lab)

† Kinnock, Stephen (Minister for Care)

† Kruger, Danny (East Wiltshire) (Con)

† Leadbeater, Kim (Spen Valley) (Lab)

† Malthouse, Kit (North West Hampshire) (Con)

† Olney, Sarah (Richmond Park) (LD)

† Opher, Dr Simon (Stroud) (Lab)

† Paul, Rebecca (Reigate) (Con)

† Richards, Jake (Rother Valley) (Lab)

† Sackman, Sarah (Minister of State, Ministry of Justice)

† Saville Roberts, Liz (Dwyfor Meirionnydd) (PC)

† Shah, Naz (Bradford West) (Lab)

† Shastri Hurst, Dr Neil (Solihull West and Shirley) (Con)

† Tidball, Dr Marie (Penistone and Stocksbridge) (Lab)

† Woodcock, Sean (Banbury) (Lab)

Lynn Gardner, Lucinda Maer, Jonathan Whiffing, Committee Clerks

† attended the Committee

Public Bill Committee

Wednesday 12 February 2025

(Afternoon)

[Carolyn Harris in the Chair]

Terminally Ill Adults (End of Life) Bill

Clause 1

Assisted dying

Amendment proposed (this day): 23, in clause 1, page 1, line 19, after “coerced” insert “, unduly influenced”.— (Rebecca Paul.)

This amendment would include the absence of undue influence for the making of a person’s decision. This reflects the changes proposed in Amendments 24 to 33.

Question again proposed, That the amendment be made.

I remind the Committee that with this we are discussing the following: Amendment 82, in clause 1, page 1, line 19, after “coerced” insert “, encouraged”.

This would add a lack of encouragement to the list of requirements for a person to make a decision to request assistance. This reflects the changes proposed in Amendments 83 to 92. Amendment 113, in clause 1, page 1, line 19, after “coerced” insert “, manipulated”.

This amendment reflects the changes in Amendments 114 to 115 which require steps to be taken to establish that the person seeking assistance has not been manipulated by any other person. Amendment 24, in clause 7, page 4, line 14, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 83, in clause 7, page 4, line 14, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 114, in clause 7, page 4, line 14, after “coerced” insert “, manipulated”.

This amendment requires the coordinating doctor to ascertain whether, in their opinion, the person has manipulated. Amendment 25, in clause 8, page 4, line 37, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 84, in clause 8, page 4, line 37, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 115, in clause 8, page 4, line 37, after “coerced” insert “, manipulated”.

This amendment requires the independent doctor to ascertain whether, in their opinion, the person has manipulated. Amendment 26, in clause 12, page 8, line 13, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 85, in clause 12, page 8, line 13, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 27, in clause 13, page 9, line 33, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 86, in clause 13, page 9, line 33, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 28, in clause 18, page 12, line 26, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 87, in clause 18, page 12, line 26, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. New clause 5—Encouragement— “(1) For the purposes of this Act, ‘encouraged’ means an act capable of encouraging suicide which would constitute an offence under section 2 (Criminal liability for complicity in another’s suicide) of the Suicide Act 1961.

(2) A person is not rendered ineligible to request assistance to end their own life on the basis of— (a) an act of encouragement that they were unaware of when requesting and going through assisted dying, or (b) an act of encouragement which was not specifically directed at that person.”

This amendment provides a definition of encouragement is consequential on Amendments 82 to 92. Amendment 29, in schedule 1, page 25, line 22, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 88, in schedule 1, page 25, line 22, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 118, in schedule 1, page 25, line 22, after “coerced” insert “, manipulated”.

This amendment adds a requirement to the first declaration for the person to declare they have not been manipulated. It is linked to Amendment 113. Amendment 30, in schedule 2, page 27, line 11, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 89, in schedule 2, page 27, line 11, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 119, in schedule 2, page 27, line 11, after “coerced” insert “, manipulated”.

This amendment requires the coordinating doctor to sign a declaration that to the best of their knowledge they believe that the person has not been manipulated. It is linked to Amendment 113. Amendment 31, in schedule 3, page 28, line 9, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 90, in schedule 3, page 28, line 9, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 120, in schedule 3, page 28, line 9, after “coerced” insert “, manipulated”.

This amendment adds a requirement to the declaration that independent doctor has to sign, that they to the best of their knowledge they believe that the person not been manipulated. It is linked to Amendment 113. Amendment 32, in schedule 4, page 29, line 5, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 91, in schedule 4, page 29, line 5, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 121, in schedule 4, page 29, line 5, after “coerced” insert “, manipulated”.

This amendment adds a requirement to the second declaration for the person to declare they have not been manipulated. It is linked to Amendment 113. Amendment 33, in schedule 5, page 30, line 22, after “coerced” insert “, unduly influenced”.

This amendment is consequential on Amendment 23. Amendment 92, in schedule 5, page 30, line 22, after “coerced” insert “, encouraged”.

This amendment is consequential on Amendment 82. Amendment 122, in schedule 5, page 30, line 22, after “coerced” insert “manipulated”.

This amendment adds a requirement to the declaration that coordinating doctor has to sign, that they to the best of their knowledge they believe that the person not been manipulated. It is linked to Amendment 113.

This morning, we adjourned in the middle of an intervention. I do not know whether the hon. Member for Banbury wants to resume it.

I think I had got to the end of it. I will let you carry on, sir.

Okay. I am grateful to the hon. Gentleman for his intervention.

We have received significant written and oral evidence on how common it is, sadly, that vulnerable people experience this sort of subtle coercion—the undue influence from which we all want to ensure that people are protected. The lawyer Tamasin Perkins was referenced earlier, but not fully quoted. She is a private wealth disputes partner, so deals with a lot of complexities around people’s deaths. She has said: “Coercion can be very difficult to spot as a legal professional (and for medical professionals too)…the real influence occurs behind closed doors.”

She went on to talk about “frailty and vulnerability…a too close involvement in the decision making process, or a sudden and inexplicable change of heart.”

All that is often teased out only through the course of the quite in depth relationship that a lawyer can form in the course of supporting somebody to settle their financial affairs. That is not what is proposed in the Bill. The law firm Scott Bailey has made the point that “sadly, we all too often speak to individuals who do not realise they are victims until they talk to us about their relationship”.

While the Bill correctly seeks to protect people from direct coercion, indirect coercion is much harder to spot, as is the coercion that people apply to themselves, which we will come to in the next group of amendments. I recognise that the Committee and the promoter of the Bill, the hon. Member for Spen Valley, have taken pains to ensure that we prevent coercion. I put on the record my support for the amendments in the name of the hon. Member for Lowestoft (Jess Asato) about the importance of providing training to all the professionals involved with coercive control, but I am not sure that training will be sufficient. It is important to insist that doctors who assess such applications are required to look directly for these particular forms of influence.

Let me explain our concerns as crisply as I can. At the moment, encouraging suicide will remain illegal under the Bill. That is an important principle. Clause 24 specifies that to assist someone to die according to the processes of the scheme set out in the Bill will not be treated as assisting suicide. The implication is that encouraging assisted suicide remains illegal. To the point made earlier by my right hon. Friend the Member for North West Hampshire, if we are worried that there might be a chilling effect due to the concept of encouragement still being illegal, logically the Committee should amend clause 24 to explicitly allow encouragement in order to prevent such a chilling effect. Either encouragement is okay, and we allow it as a concept, or we do not.

Forgive me, but I think my hon. Friend might have misunderstood me. My point was that the more we attempt to police discussions in families, the more guarded they will become; it was not necessarily that we should specifically authorise encouragement, or whatever he has suggested. He referred a moment ago to professionals being able to have conversations with individuals freely about their circumstances, their thinking, and how they had come to their decision. I am concerned—there are relevant amendments in the next grouping—that families will interpret these words in such a way that they start to talk about things they should not say. They might think, “I’ve got to be very careful not to do this or say that; because of the state of my body and the disease that is ravaging it, I am determined that I want an assisted death, and I am going to make sure that I do not say anything wrong in the discussion.” The more that we police it, the less likely people are to be open and free in their conversations, both within their families and with the professionals we want to assess them.

I recognise my right hon. Friend’s argument. The fact is that encouraging assisted suicide is theoretically illegal—in fact, it will be illegal under the Bill—so there is already that potential for the policing of conversations. If it is concluded that a family member has encouraged somebody to an assisted suicide, that would be illegal, because that has not been specifically allowed. The law already specifies that it is illegal; we are concerned about ensuring that that is fully checked for in the early conversations that people have with their doctors—that the applicant does not simply have to get over the coercion bar, but that they have to get over this lower but just as important bar around the potential for encouragement and undue influence. If my right hon. Friend is concerned that the concept of encouragement will have a chilling effect on family conversations, he should legislate accordingly, so as to prevent it from being used at the later, criminal stage.

We need to think about this in practical terms. If the word “encouraged” is included in the Bill, a co ordinating doctor may feel that it is their duty to say to somebody, “Has anybody encouraged you to take this decision?” They will use that specific word, rather than have a general conversation that is designed to detect coercion, which, as has been pointed out, covers the concept of encouragement or undue influence.

My hon. Friend may think that that point is semantic, but we have to remember that the words will be interpreted relatively literally, certainly in the early stages after the passage of this legislation. To ensure that they are within the bounds of the law, a doctor may feel that they have specifically to say, “Have you been encouraged to do this?” That will then start to be interpreted by families in the way that they respond. What we really want is instead a general discussion, which is where, in my experience, professionals are expert at teasing out the understanding and motivation of individuals.

If my right hon. Friend just wants a free and easy, free flowing discussion that has no specific questions that need to be asked or answered, there should not be any requirement for them to be testing for coercion. There is already a requirement to ensure that there has been no coercion and that the person is making the decision voluntarily. That imposes an expectation that they would be asking a specific question to the applicant. Personally, I think it is appropriate to ask the applicant, “Have you been encouraged? Has influence been put upon you?” If the answer is, “No, it’s all fine; my wife agrees with me, but I have not been encouraged to it,” then the test is passed.

rose—

rose—

I will give way first to my hon. Friend and then to the hon. Gentleman.

I completely recognise what my hon. Friend says, but there is another way to deal with the issue. Encouragement is already illegal. The other option is that we decriminalise it through in clause 24, but right now the Bill does not do that. That is why we are saying that we need to have the word “encouraged” in clause 1. There are other ways to do it, but until someone tables an amendment to clause 24 to decriminalise encouragement —I do not think that anyone has—then amendment 82 is very logical, and brings together all the legislation in a coherent way.

I am very grateful to my hon. Friend.

The issue in this interesting debate between the hon. Member and the right hon. Member for North West Hampshire is whether the assessment is of the person making that decision—have they been coerced?—or of actions of a third party. Someone cannot themselves be encouraged; someone else encourages them. It may very well be the case that an individual making a decision has been encouraged to do so, but the issue for an assessing doctor, panel or judge is surely whether that person’s ability to make the decision has been affected. That is not about their being encouraged; it is about whether they have been coerced. That is the differentiation between the two concepts. The concept of coercion is a much better way of ensuring the assessment is about the person’s ability to make the decision, not about third party factors.

The hon. Gentleman makes an important point. However, as we discussed earlier, the terms of the Suicide Act 1961—which explicitly include the term “encouragement”—include pressure. The understanding and interpretation of “encouragement” include the effect of the encouragement, which is that someone has been persuaded by a third party to take this step, whereas the principle of the Bill is that people are acting entirely autonomously.

This is a really interesting discussion, but it misses the point of how clinical people assess coercion. What we really do not want is a tick list saying, “Confirm that you have not been encouraged” and so on, on a piece of paper. It is a much more open discussion. To get to real coercion, we have to leave it completely open. We follow the flow of the patient’s conversation. I do not think that any particular words will help in that context.

I am grateful to the hon. Gentleman for stating so clearly the ultra libertarian position: “Leave it all open; trust the doctors—allow them to conclude if there has been any problem.” The implication of the Bill is that some questions will be asked, appropriately, but I do not think the questions are quite tight enough. I am afraid to say that I disagree with the hon. Gentleman’s suggestion that leaving it “completely open”, as he puts it, to doctors would be safe.

To pick up the points made by the right hon. Member for North West Hampshire and the hon. Member for Reigate, my understanding of the discussion we had this morning and where we now are is that it would be an offence under the Suicide Act to encourage a loved one to commit suicide when they have nine months left to live but that it would not be an offence under the Bill to encourage a loved one to take assisted death when they have six months left to live. My understanding is that the hon. Member for Reigate is saying that, whether we do it now or in later clauses, we should try to bring the two pieces of legislation in line with each other on the term “encouragement”.

There is a certain confusion about the extent to which encouragement of assisted suicide—assisted dying, under the terms of the Bill—would be legal or not. The Bill does not decriminalise encouragement either to an assisted suicide, which is an assisted death within the scope of the Bill, or to an unassisted suicide—suicide outside the scope of the Bill, as it were. What we have heard, and certainly the implication of the Bill, is that encouraging either would be illegal in principle. The purpose behind the amendments would be to ensure that the doctors doing the initial assessment are obliged to check and satisfy themselves that there has not been encouragement.

I might have missed it this morning, but what definition of “encouragement” are the hon. Gentleman and the hon. Member for Reigate proposing to use? Having looked at various definitions myself, I do not think that there is a definitive legal definition, but please correct me if I am wrong. Some definitions that I have seen include: to encourage somebody, to give someone confidence or to support someone to do something. Are we saying that it would be wrong to give someone the confidence or support someone to do something? That would feel very wrong and very different from coercing someone to do something.

On the point about encouragement, I am grateful to my hon. Friend the Member for Reigate for reminding me that her new clause 5 specifies a definition of encouragement: “an act capable of encouraging suicide which would constitute an offence under section 2”

of the Suicide Act. Encouragement is encouragement—the term exists in the Suicide Act already. It exists in case law and in statute, so the term is what it is.

I am very open minded on these issues, but are the amendments trying to stop someone giving someone else confidence or supporting them to do something? That would feel wrong.

We are suggesting that an application in which the applicant has been encouraged—or coerced, unduly influenced or manipulated—would not be acceptable. The assessing doctor must confirm that there has been no encouragement. That is the purpose of the amendment. I hope that satisfies.

I just want to understand this, so that I can appreciate the amendment in full. I believe that my hon. Friend—he will correct me if I misheard—spoke of encouragement effectively being pressure: that there is the act of encouragement and then an individual being pressured into making a decision that is not in their best interests. We have talked much about coercion but if that is my hon. Friend’s position, can he elucidate why the words “or pressured” are not sufficient to deal with the issue that concerns him?

The value of the word “encouragement” is that it is broader than simply “pressure” or “coercion”. In response to the points made by the hon. Members for Spen Valley and for Rother Valley, the purpose of these amendments is not to criminalise the pressure—there are other clauses that address that question—but to ensure that somebody cannot proceed with an assisted death if the doctor concludes that that person has been subject to encouragement, manipulation or undue influence. The word “encouragement” entails that they have made their decision on the basis of that encouragement—that is the clear implication. I hope that is helpful.

It may be that I am a dense former surgeon, so please help me, but could my hon. Friend the Member for East Wiltshire give an example of what, in the definition of “encouragement”, would be broader than “pressure”? If we are not saying that supporting somebody through this process is acceptable, what would be a specific example where “encouragement” comes into this that would fall outside the scope of “pressure”?

I am trying to ensure that there will be a sufficiently broad scope that doctors must be obliged to check that there has been no undue influence, pressure or encouragement. An example would be an elderly person who has been actively encouraged: it has been suggested in all love, and possibly with perfectly decent motives in the mind of the person applying the encouragement, that it would be best for them, their family and society as a whole if they would expedite their death—earlier than would otherwise happen in the natural course of things. “Encouragement” is a more comprehensive term and concept than “pressure” or “coercion”.

Our concern is that a doctor applying the current test in the Bill will simply look for evidence of direct, fairly forceful pressure or coercion, as it is understood in the more heinous cases, with which we are all familiar, of partners applying coercive control or direct abuse. We obviously all want to exclude that, and it is already excluded. What we are concerned about here is the more insidious, subtle and—I am afraid to say—widespread pressure that the evidence from our witnesses told us about. We are concerned that it is not possible to ensure that people will be protected if the terms currently in the Bill stand.

I am concerned that the hon. Member did exactly what we are in danger of doing by saying, “Whether it’s under influence, whether it’s pressure, whether it’s coercion, whether it’s other things.” We are in danger of using these words interchangeably, as he just did. That is not what the law needs. The law needs certainty, with clear expressions. I think that the hon. Member also said that encouragement is a broader form of pressure, but who is saying that? Is he saying that? Is the hon. Member for Reigate saying that? Is that a legal summation? I am not entirely sure where encouragement fits in with these other points.

I am not sure that we are going to satisfy each other on this point. A lot of the evidence that we have heard conclusively asserts that there is a widespread problem of families applying—and I do use these terms fairly interchangeably—undue influence, encouragement and manipulation. Pressure and coercion form a subset of those terms. They are at the sharp end—the more obvious forms of encouragement and manipulation. Those terms exist in law, and this certainly exists in society, as we have heard from Members and witnesses. It feels to me entirely appropriate and consistent with the principles of the Bill that we are trying to ensure that the new law will only be available to people who are acting entirely autonomously, without having been in any way—however subtly—the victims of any sort of undue influence. That is the purpose of these amendments.

Earlier, the hon. Member gave some examples of subtle encouragement or undue influence. If an elderly person has only one living relative, and they could benefit from their will, the encouragement could be so subtle. They could say to their dad or mum, “This an option available for you,” and not necessarily encourage or talk about palliative care. I know that is a conversation we will come to when we discuss later amendments, but this particular point is about people being driven in a certain direction, and that is so subtle.

As a mother to my children, I encourage them to do certain things, because I want to have that control over their behaviour because they are children. It is a normal thing to do. But when it comes to life or death, as a responsible parent it is my job to get them to think like I do or how I want to shape them. I think it is that subtle. Does the hon. Member agree that it is so subtle that sometimes we have to put it into the letter of the law to make sure it is there consciously, as opposed to expecting people subconsciously to understand the words “under coercion”?

I emphasise that the basis of the Bill, despite what many campaigners might want, is not one of total autonomy. The Bill requires us to have some responsibility towards the applicant, and not simply to say “Do you want it? You can have it.” There are already provisions in the Bill that put an obligation on the assessing doctors and then the judge not so much to conclude that it is in the person’s best interests—I am afraid it does not have that stipulation—but it does seek to insist that they make their own decision.

As the hon. Lady said, many people make a decision and might not even be fully aware themselves that they are the subject of undue influence. They may be being deceived by their loved ones. Their loved ones might be deceiving themselves about the pressure they are putting on them, but let us just talk about a genuine intent to persuade, which does happen. In answer to the question, “Have you been coerced or pressured?”, the patient may say, “No, of course not.” But if they are asked, “Have you been encouraged?”, they might say, “Actually, yes, I have.” That should raise a very significant red flag, and it is absolutely appropriate and sufficient at that point to say, “I’m sorry, but I don’t conclude that this is an autonomous decision.”

To conclude, I refer back to the debate we have been having since the news broke two days ago that there will be an amendment to scrap the judicial stage that is currently in the Bill. If there were a High Court judge sitting at the end of this process, as we were promised and as was understood by the House when it voted on Second Reading—if there were a judge sitting over each individual case, rather than sitting at the head of a national assisted dying commission, and if there were a judge sitting in court reviewing the case properly—there might arguably be no need for the amendment on undue influence.

It is possible, as the Minister explained, that coercion would sufficiently capture the more insidious undue influence and encouragement we are concerned about. It is possible that we could strengthen the definition of coercion through guidance, or through further definition in the Bill. But if we are going to have a panel, and not a court or a judicial process at all, it is even more necessary that we insist on added protection.

Surely, as I thought I heard the hon. Gentleman say on the radio yesterday morning, it is better to have expertise of this nature involved in the process. On the issue of coercion and the evidence that we received from psychiatrists—which was more in terms of capacity, but on coercion as well—and certainly from social workers, the Association of Palliative Care Social Workers was very clear that this is what they do. Surely the hon. Gentleman has to agree that by involving those people in the process, we are strengthening the issues he is concerned about.

At the risk of debating an amendment that has not even been tabled yet and that will come later in the Bill—I wish we were able to see it—the hon. Lady is absolutely right: I do indeed believe it would be very helpful to have as many professional eyes on each case as possible, so I welcome the suggestion of more experts. I am not clear what they will be yet, and in fact I support amendments that will insist on psychiatric assessments, but those need to come earlier.

It is appropriate and absolutely right—not necessarily for this clause, but for the one we will come to shortly on assessment—that there should be as many professional eyes on the case as possible, but there does need to be a judge at the end of the process. That is certainly what the House of Commons voted for, and I think it is what the public would require. In the absence of that—if there is not going to be a judge applying this somewhat legalistic definition of coercion that apparently should include all the more insidious forms of influence that we are concerned about—in my view it is even more imperative that we specify very early that the first doctor who sees the patient must ensure that there has been no undue influence, manipulation or encouragement.

Before I call Minister Sackman, I remind Members that “you” refers to me, not the person they are speaking to. Can we be very careful with the use of “you”?

I know that Members will be eager to engage, and have already engaged, in a robust discussion about the issue of safeguarding, and how best to protect and prevent individuals from being forced or coerced into seeking assistance to end their life. As my hon. Friend the Member for Aberafan Maesteg has said throughout the debate, I will not be offering a Government view on the merits of any proposed amendments tabled by Members. Instead, I will offer some observations on the legal and practical effects of the amendments, to assist Members in undertaking line by line scrutiny.

As a starting point, we have heard a series of concepts discussed in this debate, including manipulation, pressure, coercion, undue pressure and encouragement with coercive ends. There is a range of terms that some Members have used interchangeably, and fairly so. It is important to say that there is a consensus that all those things are unacceptable; the point, and the Government’s view, is that the current provision in clause 1(2)(b) would cover that behaviour with the currently used terminology “coerced or pressured”.

Amendments 23 to 33 set out to include consideration of whether a person has been unduly influenced, in addition to having been coerced or pressured by another person, in the determination of whether that person is accessing assisted dying voluntarily. As I have already indicated, the Government’s view is that the terms “coerced” and “pressured” would cover the term “unduly influenced” as it is understood. If the Bill is voted into law, the guidance and training for the healthcare professionals who would apply the tests would need to be developed to cover that sort of behaviour in this specific context.

Similarly, amendments 82 to 92 and new clause 5 seek to introduce an additional safeguarding requirement that a person has not been encouraged into undergoing the assisted dying process. It is important to contextualise the amendments, which would introduce this new safeguarding requirement into all the relevant clauses of the Bill where a doctor—or a court or panel, if that is what transpires—must already make an assessment as to whether the person has the relevant capacity, has a clear and settled wish, is making the declaration voluntarily and has not been coerced or pressured by any other person into making it.

I have listened to the debates about what encouragement may or may not mean in this context. As I understand it, new clause 5 states that the definition of encouragement is that which would constitute an offence under section 2 of the Suicide Act 1961. In reality, that Act does not specifically define encouragement in legislative terms, so there is a risk that the definition becomes somewhat circular. As I will come to in a moment, as with the terms “coercion” and “pressure”, the meaning given to “encouragement” by the courts, where it is not defined by Parliament, is its natural meaning.

I now turn to amendments 113 to 115 and 118 to 122. Let me deal first with amendments 113 to 115. As the Bill is currently drafted, registered practitioners who act as co ordinating and independent doctors are required to establish that the person seeking assistance has not been coerced or pressured. People seeking assistance to end their own life are also required to confirm in the first and second declarations that they have not been coerced or pressured. The amendments seek to add an additional requirement to establish that the person seeking assistance to end their own life has not been manipulated by any other person into making the decision.

As with the other amendments in the group, there is a risk in introducing additional or overlapping terminology —the right hon. Member for North West Hampshire referred to “embroidering” the legislation with terms such as “unduly influenced” or “manipulated”. As a general principle, and in order to preserve the integrity of the statute book, where a term is not given a statutory definition, it will be understood that Parliament intended the term to have its ordinary meaning. Indeed, that is how the courts will interpret it.

Many of us on the Committee are first timers. My understanding is that in a normal Government process we would have gone out to consultation. We are talking about coercion and undue influence, and undue influence in particular is not something that does not appear on the statute books in other legislation, as the Minister may recall I said earlier. We would normally go out and consult and speak to charities, particularly domestic violence charities.

As many Members have said throughout the last few days and this morning, we know that terminology changes. We did not previously have the vocabulary of coercion and the words that we have today. When was the last time, for any Bill—apart from in respect of Domestic Violence Act 2021 under the previous Government—that we actually went out to consult people? Given that there is no impact assessment, which we are so desperately missing and which is a huge chunk of this issue, I want to understand how we can be sure, and how the Government can come here and be absolutely sure, that this will work, given that this is a whole new concept.

This is not domestic violence, with which we have some familiarity. We had one Select Committee inquiry in 2015, and my understanding is that it did not produce anything conclusive either to support or not to support the concept of assisted dying. We have not had the debates to tease this out. Other Members may be much more familiar with these concepts, but will the Minister comment on that?

To bring it back to the specific debate about the amendments, the terms “coercive” or “coerce” and “pressure” appear in the criminal law and have broad definitions. That is how they have been interpreted by the courts. Others have referred to section 76 of the Serious Crime Act 2015, which created an offence of controlling or coercive behaviour. In that context and the relevant Bill, Parliament chose not to make a specific legislative definition, but the way in which it has been interpreted, in accordance with its natural meaning, has vindicated the proposition that a broad meaning is given to those terms. For example, that offence could include coercive behaviour such as repeatedly putting somebody down, telling them they are worthless, seeking to control their daily routines or isolating them from friends and family to put pressure on them. As my hon. Friend says, we understand those sorts of behaviours in a much broader way in a changing society.

Will the Minister give way?

I am going to make a little more progress; we will come back to that in a moment. It is really important that we have these concepts in other parts of criminal law and other parts of our legislation. I come back to the point that we run a risk, which runs counter to the intent that lies behind the amendments, if we add additional language into the Bill. I will develop that point and then take further interventions.

As we have seen, clause 1 includes the terms “pressured” and “coerced”. The ordinary meaning of the word “pressure” is the use of persuasion or intimidation to make someone do something. There are broad types of behaviour, many of which have been eloquently brought into this debate, that would come within that. The ordinary meaning of the word “coerce” is to persuade someone to do something against their best interests by using force or threats. That could be subtle or it could be very blatant, but the word “coerce” is understood in that way by our courts and in other areas of our legislation. One can readily see how an act of manipulation such as in the examples used earlier, or the exertion of undue influence—I think the term “unduly pressured” was used—would all fall within the terms “coerced” and “pressured”. That is the settled view of the Government.

There is a consensus that none of these things, including applying undue pressure, are desirable or acceptable in this or any other context, but there is a risk that adding terminology does not do what hon. Members intend, which is to create more safeguards. The risk is that by adding new words, those tasked with applying and interpreting legislation, if it comes to court, will assume there must be some specific reason for their inclusion. They will assume that the words must have some meaning distinct from the other words in the list—coercion and pressure—notwithstanding the fact that, on their natural meaning, the terms overlap and, in the Government’s view, are inclusive of those sorts of behaviours. That risks the effect of narrowing the interpretation of the words used rather than inviting our courts to give them their usual expansive meaning.

In turn, that risks casting doubt on the current interpretation of those words in existing statutes such as the Serious Crime Act, which created an offence for coercive and controlling behaviour, and limits any read across on interpretations from previous decisions into the application that we are debating. In short, it may actually serve to limit, not to add, to the safeguards in the process. It may risk adding confusion and uncertainty where what is already provided for in clause 1, with the words “coercion” and “pressure”, are simple, readily understood, expansive definitions that would cover precisely the behaviours that I think the hon. Members who tabled the amendments are concerned about.

I think the Minister just suggested that if we were to amend the Bill, there would be some kind of unfortunate knock on effect with other legislation, which would thereby be weakened. I hope the argument being made is not that we should leave this Bill weaker in order to protect other legislation. We need to get this right.

I have another suggestion, which I would be grateful if the Minister could elucidate a little more. The fact is that no official definitions of coercion or pressure that exist in statute either. The definition of coercion that she used—what case law has taught us coercion means—and the examples she gave of people essentially exerting coercive pressure on partners would, of course, be captured by the Bill currently but, as we have heard, there are circumstances that would not meet that threshold but that we all agree would be unacceptable. The only way to capture properly those examples of people being encouraged and unduly influenced into an assisted death is by making it clear that that is what doctors are required to look for.

I revert to the point I have made a number of times; I would be grateful for the Minister’s response to it. The Suicide Act, which the Bill amends, explicitly uses the term “encouragement” for what people should not be subject to, and pressure is a subset of encouragement. It is not the other way around. Encouragement is not captured in pressure; pressure is captured in encouragement. Why do we not acknowledge that encouragement is the correct catch all term for all the sorts of undue influence we are trying to protect against?

On the hon. Gentleman’s first point, there is no suggestion that we should somehow accept any weaker form of provision in this Bill to protect other parts of the law. Having said that, he would well expect me, as a Government Minister, to be concerned with the integrity of our statute book as a whole.

It is because the Government take a holistic view of how the criminal law and other areas of our law operate and define these concepts, and how they are read across the piece, that we make our contention in respect of these particular provisions, because the terms “coercion” and “pressure” are given their natural meaning and are expansive. In the Government’s settled view, they would be inclusive of the types of behaviour that are described in the amendments before us—namely manipulation, undue pressure and the sort of encouragement that I think, when he keeps coming back to it, the hon. Gentleman is referring to, which is not encouragement in a benign way as might exist between two perfectly supportive family members in a normal conversation, but the sort of encouragement that is intended to lead to coercive ends.

The hon. Gentleman says that pressure is a subset of encouragement; the Government’s view is that coercion and pressure would cover off the other behaviours that are described in the amendments. It is not necessary to include those additional concepts, because it risks sowing confusion that somehow they are not included in the concepts of coercion and pressure.

I want to understand the Minister’s point about multiple words. We have the Digital Markets, Competition and Consumers Act 2024, referring to both coercion and pressure, and undue influence is also included. Those three terms are used in the same Act. Undue influence is also included in multiple additional statutes—over 10, including the Anatomy Act 1984, which is about people leaving their body to medicine for the purposes of tests and so on. Is the Minister saying that those are bad Acts, because they could confuse people? That is the test we are applying.

I am certainly not saying that those are bad Acts, and I do not want anyone to quote me as saying that. We could in theory sit here and come up with a whole set of terms that would be descriptive of types of pressure and coercion. We have come up with a number of those, including “undue influence”, “manipulation” and “unduly pressured”. There are other types of behaviour that we might seek to describe. Indeed, if one refers to the Crown Prosecution Service’s guidance in respect of the offence in section 76 of the Serious Crime Act 2015, there are a whole load of descriptors of different types of behaviour. We could name and enumerate all those different types of behaviours, but, in the Government’s view, that is not the best way to create legislation that is workable.

It is the Government’s settled view that the words “coercion” and “pressure” cover off the types of behaviour that Members suggesting these amendments would wish to include. The risk is that such amendments create more confusion and shed more heat than light, if you like. Indeed, there is then the risk that the definition of coercion is narrower than it in fact is under our law as it is understood in our courts and in the body of common law and case law, which has been developed in construing those sorts of terms.

We are still on clause 1, and we have spoken a little about the interplay between clause 1 and later clauses, particularly clause 26, which engages the criminal offence as drafted in the Bill. I want to stress that while the procedural clauses 1, 7, 8 and 12 may use the same language as the criminal offences in clause 26, they are conceptually distinct, as others have noted. Although it is right that a court could be expected to construe legislation as a whole, case law in relation to one provision will not necessarily flow through directly to a later provision.

It may be helpful to illustrate that with the word “encouragement”, which has been raised. As we know, it is an offence to encourage or assist a person to commit suicide. As the hon. Member for Reigate pointed out earlier, it will continue to be so if the Bill is passed, outside of the specific exemption in the Bill. It is generally also an offence to encourage or assist a person to commit any other offence under the Serious Crime Act 2007. Specifically, it is an offence to do an act capable of encouraging or assisting suicide or another offence. The term “encouraged” is not defined in either statute. While it is true to say that section 2A(3) of the Suicide Act—which was added in 2009—clarified that doing an act that is capable of encouraging suicide includes a reference to a person doing so “by threatening another person or otherwise putting pressure on another person”, that was intended to be illustrative of the meaning of “encouraged” in that context; it does not serve as a general definition.

Within the Bill, it is important to keep in mind the difference between the procedural requirements—which is what we are discussing in this group—and the criminal offence requirements. Adding words to one provision because they are found in a criminal offence elsewhere risks, in the Government’s view, unintended consequences. Adding “encouragement” to the procedural clauses is perhaps an example of this.

From listening to the discussions we have had today, I do not understand that anyone on this Committee intends that those being genuinely supportive of another family member’s behaviour, which might be considered encouragement in that sense under the procedural clauses, ought to render an application for an assisted death invalid and prevent a terminally ill adult under the provisions of this Bill from seeking assistance to end their life. The difference between encouraging a person to engage in the legal route and encouraging a person to end their life in another way is crucial.

With those considerations in mind, it is the Government’s view that with the Bill as drafted, the courts will, in all likelihood, give the terms “coerced” or “pressured” their natural meaning and that this will ordinarily cover the additional terminology that is being proposed. It is, of course, for the Committee to decide whether these amendments should form part of the Bill, but I hope that my remarks will have provided some assistance to the Committee.

On a point of order, Mrs Harris. The Minister gave a brilliant speech in support of the Bill as it stands, so I simply do not understand how, having explained so clearly why she believes that the amendment is inappropriate, she can claim to have a neutral position on it. This is not in any way personal; she made a very good speech and she ended it with—

Order. That is not a matter for the Chair.

Okay. I am sorry to hear that.

I will speak briefly because we have had a thorough discussion about these issues. I completely understand the sincere intention behind these amendments. It is clear from the fulsome discussion we have had that colleagues across the Committee agree that undue influence and manipulation should be covered by the Bill—as should all types of coercive behaviour. The question is, “How?” I feel reassured by comments from legal colleagues and the Minister that the language currently used in the Bill—“coercion” and “pressure”—covers these additional concepts, as those terms appear in existing criminal offences, and the statutory guidance from the Home Office in 2023 along with the Crown Prosecution Service legal guidance cover the broad range of coercive behaviours. It is up to hon. Members to decide whether to push these amendments to a vote. I am understanding of the intention and appreciative of the comprehensive debate that we have had.

I thank all Members for their contributions. I echo the hon. Member for Spen Valley when I say that this is one particular case where we all agree on what should be happening functionally and practically. We have had some quite technical arguments today about the meanings and definitions of certain words and how they would apply. It has been a constructive and interesting debate. As a first timer to a Bill Committee, it has been a great experience.

It is clear from the evidence received and the contributions from Members that subtle coercion is something we are all concerned about and recognise needs to be dealt with. We have heard powerful stories today and from witnesses in recent weeks, so it is incumbent on us to listen and take action. One of the points that resonated with me yesterday was that made by the hon. Member for Bradford West. I am now paraphrasing a little bit: essentially, she said that we are not legislating for a perfect world where everyone is treated equally; that our society is filled with inequality, and we must legislate for the reality, not for the rose tinted version that we would all prefer. Coercion and undue influence does happen more commonly than we might think, and it is hard to detect. It is therefore vital that when we go through this Bill, we always have the most vulnerable at front of mind. It is not about when everything works perfectly, as intended, for the very small group of people who would benefit from the Bill, but what happens when it does not work, and the impact on a potentially bigger, more vulnerable group. That is the crux of our roles here today.

I thank the Minister for her very informative and helpful speech setting out the Government’s position on legalities of the various definitions. There will, however, be different legal opinions on this. I sought advice from former Attorney General Victoria Prentis KC, who takes a different view. I am very aware that when it comes to going through the courts, there will be different interpretations and views. I am not a lawyer, so I do not know which is right, but I do know that if I put this amendment on the face of the Bill, it is there and it is safer. That is where I am coming from on this. I reiterate that we do see these terms “coerced”, “pressured” and “unduly influenced” in various bits of legislation. Those words are chosen for specific reasons. It is important to note that.

On encouragement, I am going to talk again about the purpose of the amendment. Right now, under the Suicide Act, assisting someone to commit suicide is a crime, but encouraging someone to commit suicide is also a crime. Clause 24 of the Bill decriminalises the assistance piece to allow legalisation of assisted dying, but it does not decriminalise the encouragement piece. I have tabled amendment 82, because we need to address that. The clause is limited to the provision of assistance and does not include the encouragement of a person to end their own life.

I understand the concerns of my right hon. Friend the Member for North West Hampshire about how “encouragement” could be interpreted, which is a really good point. I also take the point that although it is referred to in the Suicide Act, there is no clear definition, so we are relying on case law. If we all came to this with a blank bit of paper, we might come up with different laws. However, we have laws that are already in place, and that is why I have tabled this amendment. The reality is that encouragement of suicide is a criminal activity right now, which is why we need to address it here.

On undue influence, the Minister set out that the amendment is not legally necessary. The hon. Members for Rother Valley and for Penistone and Stocksbridge gave interpretations of this point, but I gently point out that they contradicted each other, which shows how complicated the situation is. Different people will have different views. The hon. Member for Penistone and Stockbridge said that “undue influence” is a term in equity, and that it is not proper to have it as part of the criminal offence of coercion in clause 26, but the hon. Member for Rother Valley said that coercion in that provision does not include undue influence. Does that not show that the legal meaning of the Bill is unclear and would benefit from some clarification?

Amendment 23 on undue influence first appeared on the amendment paper on 21 January, almost three weeks ago. My understanding from those who were previously in government, including at the Ministry of Justice, is that when an MP tables an amendment that is legally unnecessary, the Government would seek to meet them, together with Government lawyers, to explain why the Government believe the amendment is legally unnecessary and to give them time to reflect. It is my understanding that, with respect to the amendment in the name of my hon. Friend the Member for South Northamptonshire (Sarah Bool), that was not done. She met the Bill’s promoter, the hon. Member for Spen Valley, on Monday, but they did not discuss the amendment on undue influence.

Similarly, my amendment 82 on encouragement appeared on the amendment paper on 4 February, over a week ago, and I have had no communication from either the Government or the Bill’s promoter about it. The first time I or my hon. Friend the Member for South Northamptonshire have heard that our amendments might be legally unnecessary or problematic is today. When formulating my amendment, I had the benefit of advice from former Attorney General Victoria Prentis KC, who has written a letter to The Times endorsing it; the Minister will appreciate that I would not want to withdraw my amendment without the benefit of further advice from her, so I will press it to a vote.

However, if there are any points of technical drafting relating to the amendment that the Government would like to deal with through tidying up amendments, I would very much welcome that. What has come out of this conversation is that it is not straightforward or clear; there are some things that need to be thought through, including the interactions between clause 24 and clause 26 and the various definitions, so that we are being really clear. I am open to doing that in the most suitable and appropriate way.

I am interested in what my hon. Friend said about not having had conversations with the Government or the promoter about the details of these amendments. I could understand that if this was purely a private Member’s Bill, but the fact is that the Government clearly are involved; we have heard it said today very clearly that the Minister supports the text of the Bill as it stands. Is my hon. Friend aware whether the Government have directly fed into the drafting of the Bill or discussed with the Bill’s promoter the appropriate response to these amendments? Does she agree that, if so, it would have been appropriate, as she suggests, to have had conversations with her or the other hon. Members who are moving these amendments, in order to do what normally happens in the course of a Bill’s process and convey the Government’s position ahead of the debate so that, if it is appropriate for amendments to be withdrawn or for concessions to be made by the Government or the promoter to amend the Bill in due course, that could have happened—rather than hearing today for the first time that the Government object to these amendments? Does she agree that that would have been an appropriate process?

I agree that that would have been helpful. We have spent many, many hours today debating these amendments, and having had advance notice would have allowed some reflection and appropriate advice to be taken. If, indeed, the Minister’s position is right, I could have looked at withdrawing the amendment or tabling a new one. However, I have not had time to do that, so I am in a situation where I have to follow the advice that I have had. I think, if the Minister is right, having this on the face of the Bill is potentially a little messy because we would be duplicating, but that is not a massive downside from my perspective, whereas the upside is that, if she is wrong and I and the advice that I have had are right, we would be ensuring a higher level of safeguarding in this Bill.

The hon. Member said that my hon. Friend the Member for Penistone and Stocksbridge and I contradicted each other. I did not quite understand the logic of her argument; I do not deem that we contradicted ourselves one bit. I also want to push back on the point about process. Let us just step back: we have been debating for a number of hours some very sensible amendments, and that is exactly what this Committee is meant to do. I am new here, the hon. Member is new here, but it seems to me that it is exactly right. She has tabled an amendment, we have had good debates on all sides, and the Government Minister stood up and gave the Government’s view of the workability of the Bill and whether the amendment is necessary. Is that not what this process is meant to be doing?

I thank the hon. Member for that point. I mean no disrespect in identifying a contradiction. A lot of us have talked quite differently about different things today and I have found it a fascinating debate.

With respect to process, like the hon. Member, I am new to this. My understanding from speaking to other Members that have been in this place much longer than I have is that it does not normally work in this way. I welcome the debate; we have had a helpful and interesting discussion. As I said, some issues with clauses 24 and 26 have come out; when the appropriate time comes, we need to tighten them up. That is a useful technical point that we have teased out today.

The point we are making is that if it is really clearcut that something does not work from a legal perspective, it would surely make sense to try to get ahead of that, give advance notice and have the discussion beforehand. At the end of the day, we want to make sure that we spend all our time and effort on the amendments that will improve the Bill. We are all here to improve the safeguards on the Bill and make sure that the piece of legislation that goes before Parliament, when the time comes, is as good as it can be. We are all in the same place on that objective.

I am not sure whether the hon. Member contacted me to meet—if she did, I am very sorry; I must have missed that message—but other members of the Committee and Members of the House have asked me to meet with them, and I have met with them and had discussions. If she contacted me asking to discuss her amendment, I apologise.

I can confirm that I did not contact the promoter on this. My understanding is that if something is not legally coherent, it would normally be the Government who would contact the relevant MP to have that discussion and allow that reflection. That was the point I was trying to make; my apologies if I focused on the promoter more than I should have. I always enjoy meeting the promoter of this Bill.

I thank the hon. Lady for the work she has done today. As a fellow new Member who sat on the Employment Rights Bill Committee, I can tell her that we debated many amendments from both sides. Sometimes, they arrived from both sides on the day and we had to absorb them on the day.

Order. Those points are not relevant. We are discussing the amendment.

Okay. Would the hon. Lady not agree that it has been an extraordinarily rich discussion that reflects our ability to build on the oral evidence that we heard the week before last to develop amendments that reflect that evidence in an extraordinary scenario? This discussion is among the most deliberative that we have had.

Order. We are having a lot of conversations about the process. [Interruption.] Can the hon. Member sit down, please? There are a lot of conversations about the process and none about the amendment. Can we stick to the amendment?

I thank the hon. Lady for her intervention and very much agree that we have had a rich conversation. We have taken much away from it.

In closing, the amendments that I am pressing to the vote are about whether we think that someone who has been unduly influenced or illegally encouraged should be eligible to be assisted to die. I hope all Committee members can agree that that should not be the case and will support my amendments.

Question put, That the amendment be made.

3|0|8|15|The Committee divided:|Question accordingly negatived.||0|0

Amendment proposed: 82, in clause 1, page 1, line 19, after “coerced” insert “, encouraged”.—(Rebecca Paul.)

This would add a lack of encouragement to the list of requirements for a person to make a decision to request assistance. This reflects the changes proposed in Amendments 83 to 92.

Question put, That the amendment be made.

4|0|8|15|The Committee divided:|Question accordingly negatived.||0|0

Amendment proposed: 113, in clause 1, page 1, line 19, after “coerced” insert “, manipulated”.—(Juliet Campbell.)

This amendment reflects the changes in Amendments 114 to 115 which require steps to be taken to establish that the person seeking assistance has not been manipulated by any other person.

Question put, That the amendment be made.

5|0|8|15|The Committee divided:|Question accordingly negatived.||0|0

I beg to move amendment 94, in clause 1, page 1, line 20, at end insert “, and (c) is acting for their own sake rather than for the benefit of others.”

This amendment requires that a person requesting assistance must be acting for their own sake, not the benefit of others. This amendment reflects the proposed changes in Amendments 95 to 104.

With this it will be convenient to discuss the following: Amendment 235, in clause 1, page 1, line 20, at end insert “, and (c) is acting for the primary purpose of avoiding physical pain.”

This amendment, along with Amendments 236 to 245, seeks to ensure that the primary motivation of the patient is to avoid physical pain. Amendment 95, in clause 7, page 4, line 15, at end insert “, and (h) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 236, in clause 7, page 4, line 15, at end insert “, and (h) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235. Amendment 96, in clause 8, page 4, line 38, at end insert “, and (f) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 237, in clause 8, page 4, line 38, at end insert “, and (f) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235. Amendment 97, in clause 12, page 8, line 14, at end insert “, and (i) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 238, in clause 12, page 8, line 14, at end insert “, and (i) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235. Amendment 98, in clause 13, page 9, line 34, at end insert “, and (e) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 239, in clause 13, page 9, line 34, at end insert “, and (e) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235. Amendment 99, in clause 18, page 12, line 26, at end insert “, and (d) is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 240, in clause 18, page 12, line 26, at end insert “, and (d) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235. Amendment 100, in schedule 1, page 25, line 22, at end insert— “3A I am doing so for my own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 241, in schedule 1, page 25, line 22, at end insert— “3A I wish to be provided with assistance to end my own life for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235. Amendment 101, in schedule 2, page 27, line 12, at end insert “, and (c) the patient is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 242, in schedule 2, page 27, line 12, at end insert “, and (c) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235. Amendment 102, in schedule 3, page 28, line 10, at end insert “, and (c) the patient is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 243, in schedule 3, page 28, line 10, at end insert “, and (c) is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235. Amendment 103, in schedule 4, page 29, line 5, at end insert— “7A I am doing so for my own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 244, in schedule 4, page 29, line 5, at end insert— “7A I make this second declaration for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235. Amendment 104, in schedule 5, page 30, line 22, at end insert “, and (d) the patient is acting for their own sake rather than for the benefit of others.”

This amendment is consequential on Amendment 94. Amendment 245, in schedule 5, page 30, line 22, at end insert “, and (d) the patient is acting for the primary purpose of avoiding physical pain.”

This amendment is consequential on Amendment 235.

I rise to speak to support the amendment in the name of the right hon. Member for Braintree (Mr Cleverly), because I believe there is a need to include it in the Bill to ensure real protections against coercion.

Before I get to the substantive nub of the conversation, I want to understand something that I have just experienced. Again, the Chair might want to guide me and I am happy to take guidance. I am trying to understand this because we are all relatively new to the process, as is the Minister who responded earlier, the hon. and learned Member for Finchley and Golders Green. It appeared to me that the Government had a position on the amendments that were tabled. I recognise that my hon. Friend the Member for Rother Valley has set out that that is how debates happen, but actually, that is not my experience of how amendments are tabled in this House. We have notice of amendments. They are not tabled on the day, apart from manuscript amendments. They are tabled before the House rises, which gives us enough time to respond to those amendments, take advice on them and so on.

Order. That is not in scope of the Bill. Please stick to the amendment.

But in sticking to the amendment—

Order. I am not having a conversation. Stick to the amendment. It is out of scope; I have been informed by the Clerk.

Thank you, Mrs Harris. Sticking to the amendment, can I ask whether the Government will have already taken a position on it before I get to the end of my speech? Can they not share that before I make my speech? Is that within the scope of the conversation?

I would suggest that you contact the Minister directly and ask the question, and perhaps she can give you a written response.

Can I not ask for it now while we are in the debate?

We are debating this amendment, and we are sticking to this amendment. You moved an amendment —can you please continue to speak to that amendment?

I am happy to debate, Mrs Harris, but I am trying to understand because this is new to me. If I speak to the amendment and the Minister already has a position, I would value knowing that position, because otherwise it feels pointless for me to debate it.

I have already said that you can talk about the amendment and not anything else. Could you speak to the amendment, or we will move on to the next speaker?

Okay, I am happy to turn back to the amendment.

This issue is far too serious for us to overlook. I do not believe that many people, including medical professionals, are properly trained to recognise coercion or undue influence. To illustrate, I will refer back to my own experiences, like I did yesterday. I have had many unfortunate experiences in my life, but they have certainly prepared me for this space. I was forced into a marriage at the age of 15. I was 12 when I went to Pakistan, and although I was not physically bound or coerced in an overtly aggressive way, I was coerced none the less. I made the decision not for my own sake but for the benefit of others. At the time, I did not think for myself but for the benefit of my extended family members. It was clearly not my choice, and I understand that now. The power of influence from people we often trust and rely on in our everyday lives, especially when seeking their advice, can often lead to life changing consequences. In the case of the Bill, it would be life ending consequences.

In my forced marriage, and in those of others, because they do happen up and down the country, we can look back and realise what led us to make decisions that were neither in our best interests nor of our own choosing. Although my marriage occurred when I was under age, many people are coerced into forced marriages even in their late 20s and 30s for the benefit of others. The burden of holding family relations together, making other people happy and seeking approval can push a person into a forced marriage—something they never wanted. In my case, it was about keeping relationships between siblings and extended family intact, and the pressure fell on me, as a 15-year old child. But me being 15 then is beside the point; the fact is that this happens today.

We have legislated on forced marriage in this place, but it still happens. I speak to the police regularly about such issues as so called honour based violence—violence against women and forced marriage, in particular, because of my experience. It still happens, and my local police force tells me that it happens. It might be less common today, but it happens. We have failed to protect people from that coercion. We have made laws in this House, but there have been very few prosecutions as a result of the Forced Marriage (Civil Protection) Act 2007. We raised huge awareness over the past 20 years—certainly since I was 15, which was a lot longer ago—but that has not stopped it happening.

How can we move the Bill through Parliament without including safeguards for those who, in the end, may take their own life because they feel like a burden to others, or because there is a benefit to others? That happens. That is the reality. In his expert evidence, Professor Allan House, an academic liaison psychiatrist who has done decades of research in this field, pointed out that in marriages there is often one dominant partner and one passive partner; the passive partner may lean on the dominant one, or be coerced into acting in their best interests. Without amendment 94, and many others that ensure proper safeguards, how can we be certain that a partner who has a diagnosis and appears to be freely choosing assisted dying is not under that kind of pressure?

We have a duty to protect all vulnerable people who might be put at risk by the Bill. I do not necessarily want to repeat the arguments from before, which related to different amendments, but they apply throughout the Bill, and we will no doubt be talking about the same things repeatedly as we go through the different clauses. Vulnerable people include people who do not want to take up the time of their children who have to care for them, or those who believe that it would be better for everyone else if they were no longer alive.

On the point of people feeling that they are a burden, one moment that stood out in the oral evidence was that, although the Western Australian Government’s own statistics show that 35% of people opting for assisted dying cited being a burden as their reason for doing so, the practitioners who offer assisted dying to people were not aware of this fact. I had to clarify it for them. Is that part of my hon. Friend’s motivation for supporting the amendment?

It is very much in support of that, and I want to tease out what my hon. Friend just said, which is important. One conversation we are having is about being a burden—my hon. Friend referred to the evidence that we heard—but another side to that is that when people feel like a burden, somebody benefits from that. That benefit is what the amendment teases out. That is what I want to understand.

I completely understand where the hon. Lady is coming from, but this is the conflict between someone feeling like a burden because of their own personal choice and autonomy, and how those might impact other people in their surroundings. Does she accept that among the reasons that many people might want to access an assisted death is that they do not want to lose that autonomy? That is not necessarily anything to do with feeling like a burden on other people; it is about their own choice.

The hon. Member makes a valid point: it could be an absolutely autonomous decision. In an ideal world, that is what we would like to get to, but we are not in an ideal world.

I am grateful to my hon. Friend for giving way again, and I am sorry to interrupt her when her speech is in full flow. My response to the hon. Member for Harrogate and Knaresborough, which links to my previous point about Western Australia, is that we have been told throughout this process that clinicians can spot the signs of coercion and whether people feel that they are being manipulated. However, in Western Australia, the people administering assisted dying—who we are trusting, in this Bill, to be able to spot those things—were not aware that 35% of people in the state cited “being a burden” as their reason for going for assisted dying. That is my concern. Does my hon. Friend have a response to that?

My hon. Friend makes a very important point—because if we visit this issue afterwards, that person is dead.

I do believe that what was actually said in evidence was that one of the reasons was that the person felt a burden, but there were other reasons. From the Californian doctors, we heard that feeling a burden is not in itself a reason to approve an assisted dying request.

My hon. Friend is right, but the point I am trying to come back to is to do with those people who feel a burden; wherever they feel a burden, somebody is benefiting from that, because we are taking the burden away—there is ultimately a benefit to somebody.

We have talked a lot about people feeling a burden in terms of potential coercion, potential financial issues and all those things, but we have not discussed this in detail. It is important that we do so if we are to make this Bill, as my hon. Friend the Member for Spen Valley intends, the safest Bill in the world. It is incumbent on us to look at both sides. Just like in the earlier debate about whether we choose assisted dying or choose to take out the plug, ultimately the end is the same—it is death—but they are two different things. The amendment tabled by the right hon. Member for Braintree is very much about the question of who is benefiting from the person taking that decision.

The hon. Lady spoke movingly about her own experiences, which clearly fell into the category of benefiting others, with no benefit for herself. Can she elucidate how she envisages this amendment working in the following scenario? Let us say that in some years to come, this law is enacted and I have a terminal illness—I have six months or less to live—and I do not want to face intolerable pain and suffering in those last moments of life, but I also do not want my son or my wife to watch me suffer. They benefit from that decision, because they do not see me suffering, but I am also doing it for my own sake. How does the amendment fit into that scenario?

The hon. Member makes an important point. That is precisely why we need to have a conversation to ascertain that autonomy, which is what this comes back to—the whole purpose of this Bill is to give people autonomy. It is important that when benefit is being derived, it is not because they are a burden. We need to ascertain that that has been explored and was not about that, but that it is an informed choice and an autonomous decision. That comes back to the conversation around coercion, manipulation or whatever word we want to use; we voted down provisions on the term “undue influence”, but those are the words that apply.

In my understanding, this amendment is about having a conversation to probe what measures will be in place to ascertain what that person is actually saying. I would not wish that experience on the hon. Member, but he could be in that situation, and make that informed choice and be able to demonstrate that—again, we discussed the amendment from my hon. Friend the Member for Broxtowe on the word “demonstrably”. I am very keen to have those conversations, and that is the purpose of this amendment.

The point about conversations is really important. I wonder how many conversations my hon. Friend has had with terminally ill people, their family members and children, because I have had quite a few, like the example given by the hon. Member for Solihull West and Shirley, over a number of years now. It is so important to recognise that it is about the individual’s autonomy, but we cannot take away the fact that their loved ones may also derive a benefit in a way that the hon. Gentleman elucidated. Can my hon. Friend see how so many of us here want clarity, but do not want to put at risk an individual’s autonomy with a very subjective decision?

I am sure my hon. Friend did not mean to suggest it in that way, but I feel slightly taken aback by the questioning of whether I understand the importance of this. I remind hon. Members that nobody in this room has had a forced marriage apart from me. That does not mean to say that they do not have empathy when I share my experience. To suggest—

Will my hon. Friend give way?

Let me finish. Perhaps my hon. Friend did not mean to question whether I understand and appreciate it, but it suggests to me, does anybody? Yes, we heard witnesses. We heard evidence. I have heard about it in my own friendship circles. I had a young intern with me not so long ago who had cancer. We talked about this, when I decided to come on to this Bill Committee. A dear friend of mine lost her husband and asked me to support this Bill because of his experiences. I speak to doctors regularly. I have had one parent who died of cancer; the other survived cancer. I have had recent deaths; my own father was in a hospice, and others were in a hospice. To be really clear, I do not think the importance of autonomy is lost on any Member on this Committee or in the House. It is because of that importance that I agreed to take part in this Committee.

I hope that my hon. Friend will accept that I was not questioning her ability to understand the importance of the matter. I wanted only to place on record the importance of having those conversations and to ask whether she recognised that. I am really pleased that she has had so many conversations. That is why so many of us are here and want to see the change in the law, but we do not want to tie it so tightly that it would reduce the autonomy of an individual.

I am grateful that we have been able to have this conversation as we have done. I share my hon. Friend’s concern. Equally, I am also concerned that we may now not have a judge’s oversight on this. There is potentially an amendment seeking to replace that with a panel of experts, which we will not get to debate until we have seen it.

Returning to amendment 94, tabled by the right hon. Member for Braintree, I have already talked about Professor Allan House’s contribution. The importance of the issue is not lost on the House. This includes people who do not want to take up their children’s time. As the hon. Member for Solihull West and Shirley suggested, there is that conversation to be had with families, no doubt. We speak from the privileged position of being able to have those conversations. In an ideal world, we would all be equal, but we are not.

The one thing that covid taught me was what my hon. Friend is alluding to. Hon. Members heard yesterday a bit about my family situation. I have a child who will never walk, will always be in nappies, will always need to be fed, and will always need to be dressed. During that period, no carer was allowed in the house, and as people know, my wife was also having chemotherapy —thankfully, she successfully recovered. As the carer, who everyone is reliant on, I saw that power imbalance. Everybody in my house was reliant on me during those three months—no one was allowed in the house, my wife was having chemo and my daughter needed round the clock care, so to speak. That is the position, which is why I understand this wording. That is the imbalance, whereby somebody could realise that this change in the law now gives them the power to release the burden of their loved one, not for any other reason—that they want their suffering to end—but because they want their loved one to have their life back. I do not know whether my hon. Friend has any comments on that.

I thank my hon. Friend for his valuable intervention. He speaks from his personal experience, and this place and this debate are richer for having those experiences shared. It comes back to the comment made by the hon. Member for Solihull West and Shirley; this is about where there is autonomy. This is about people who make that informed choice without coercion, loss of autonomy, undue influence or encouragement. We are talking about those people; we are not talking about those who do not fall into that category.

Those of us in this House know of inequalities that exist in our communities for disabled people, women, or people with mental health illnesses. We already know that; this is about safeguarding and making sure that we are exploring the reasons why, to safeguard those who do arrive at those conclusions—at that decision of autonomy—so that, should this Bill be passed and become law in two years, we as a Committee will know that we have tried our hardest and our best to support my hon. Friend the Member for Spen Valley to make it the safest Bill in the world.

I am very sympathetic to the amendment, which aims to tackle a mischief that we are all worried about, but there are two fundamental problems. The first, which builds on the intervention from the hon. Member for Solihull West and Shirley, is this issue of deciphering if an action is for your own sake or the sake of others. It is a philosophical question: is there ever really a selfless act? Even if we take an act that may be deemed to be for someone else, it may be because we want that person to receive some pleasure, joy or relief, so in my mind there is a danger that this could become a tautology.

Secondly—I hope that you might be able to comment on this—is there not a danger that we are then putting it on doctors and others in this process to undertake an assessment of welfare? When you are deciding whether something is for an individual’s sake, you are making some determination, are you not, as to what is in their best interests? That directly conflicts with the principles of the Bill, which is all about autonomy and an individual’s choice, rather than others saying what you should and should not do.

Order. I have no comment to make—“you” again.

Forgive me, Mrs Harris. I apologise profusely.

If we are talking about welfare, I would have thought that this Bill would have included welfare checks, which are absolutely crucial. My definition of welfare encompasses the whole being, with the person at the centre. In this case, welfare would mean putting somebody with a terminal diagnosis at the centre of what service provision looks like, be it for assisted dying or a care pathway through palliative care.

rose—

I am happy to give way if my hon. Friend wants to elaborate.

Order. Before the hon. Gentleman starts, can I ask for short interventions, please, not speeches?

What I meant by a welfare decision is a paternalistic view, whereby medical practitioners and others say what is in the best interests of an individual, rather than the individual themselves.

I appreciate the clarification and the explanation. I do not feel that having doctors doing this is a contradiction of this Bill at all, because if we go by the letter of the Bill and how it is set out, when a doctor offers those choices, whether it is assisted dying or palliative care, they are giving a choice of welfare options to their patients. That is my understanding, and I am not sure that this is contradicts with the Bill in any way, shape or form.

I have answered my hon. Friend’s first question; can he remind me of his second?

My question was building on the intervention made by the hon. Member for Solihull West and Shirley. It was about whether there can ever be a selfless act.

If we make philosophical and idealistic arguments, we will not be able to legislate on anything. Philosophically, there are people in this House who wear red, blue, green or the colours of smaller parties. We are all different in our positions philosophically. For me, this process is about legislating as well as we can to put safeguards in place that are as strong as possible. I cannot get into that debate because it would not apply to the legal aspect.

To move away from the theoretical, like my hon. Friend the Member for Rother Valley I am sympathetic to what this amendment is trying to do. To give a practical example, let us say that I have been given a terminal diagnosis and say to the doctor, “I personally do not want to go through pain and agony over the next few months, but I am also thinking about my family—I do not want them to suffer alongside me.” I would therefore fall under the definition in this amendment—the hon. Member for Bradford West is shaking her head, but the reality is that I would—because I would also be acting for the benefit of others; I have cited that alongside my own physical pain as a potential reason that I want to do this. As I say, I am sympathetic to what the amendment is trying to do, but I feel that the way it is written would inadvertently include a huge amount of people who are doing it for their own motivations, but clearly the reality of life is that we consider other people as well.

The hon. Member makes a valid point that it would ultimately benefit others. It would—that is a given—but that was not my reading of the way the amendment is drafted. My reading was that “only for your own benefit” means that someone is not being driven by the benefit of others, financial or otherwise. From the point of view of autonomy, if someone chooses to make that decision, of course others will benefit. I take the point that there appears to be a contradiction, but that is not my understanding of how the amendment is written and it is not what I am talking about.

My hon. Friend mentions the word “only”, but that word does not appear in this amendment. That is the issue: we are opening this up. The amendment says: “acting for their own sake rather than for the benefit of others.”

In my example, I cited the benefit of others as potential reason that I might seek this.

The hon. Member makes valid point. Maybe the Government would be able to mop this up if this amendment was accepted. That can happen—it is not beyond the scope of Government or the Ministers present.

I am grateful for this debate, particularly as lots of people who, on Second Reading, were happy to pass the Bill through to Committee wanted the debate to happen. We should all welcome that, as I know the promoter of the Bill, the hon. Member for Spen Valley, does. I am grateful that we are here.

I will move away from the philosophical debate and return to what I said before lunch: this is about not just the role of the individual—though that is clearly important—but what we see as the role of the state and what we are comfortable with the state allowing. I see this amendment as very much linked to that. Does my hon. Friend the Member for Bradford West think there is something in that—about whether the state is happy for people to cite the benefit of others as a reason for opting for assisted dying?

I thank my hon. Friend for his intervention. That is not something I had spoken to the right hon. Member for Braintree about. Thinking about it, his point is valid: there is always an overlap in terms of whether this is the state interfering or not interfering. In this instance, it is about the state and legislation protecting the individual and ensuring that an autonomous decision, which is what we are trying to get to, was reached, without any coercion, undue influence or subtle manipulation—whatever word we choose to use in these proceedings—and not for the benefit of others.

Too many arguments that I hear in support of the Bill seem to assume that all those who seek assisted dying will do so as a matter of autonomy—as a free choice. Honestly, it would be much easier to support the Bill if that were true, and I sincerely wish it were, because we would not have the issues we have been talking about all today and yesterday. However, we must pay heed to those who do not live their lives in that way. We in this House have a duty to protect those who feel like a burden to those close to them—or who are made to feel like a burden, whichever route that may take, and we have had plenty of conversations about that.

The amendment tabled by the right hon. Member for Braintree would permit doctors to halt an application for assisted dying if they had good reason to believe that an applicant was not acting for their own benefit.

Would inserting the line in the amendment not also give us another opportunity to assess the patient’s capacity? Under the Mental Capacity Act 2005, a person should be able to “understand” and “weigh” the information, so does having this line not also help us to assess a person’s capacity?

I agree with my hon. Friend’s point. We are not dealing with capacity in this amendment, but I agree that every one of these extra checks and balances would also support the exploration of capacity and would definitely strengthen those conversations with any patient.

The amendment tabled by the right hon. Member for Braintree would not be a perfect safeguard. As we know in this House and across society, nothing, including legislation, is absolutely foolproof. There will be people where, despite the best efforts of the NHS, despite having palliative care and despite having people in these positions, things will be missed. Unfortunately, that happens.

Before I make my closing remarks, I want to come back to where I started—forced marriage. We heard from Dr Jamilla about inequalities and how to spot coercion. There is an added layer to all of this when it comes to women, and also when it comes to people from ethnic minority backgrounds, who already have an inherent distrust, which was magnified during covid.

When it comes to domestic violence, we also know it is harder to spot the coercion, because of the conditioning and the cultural conditioning. My personal conditioning was very different, and it took me until my 30s—years into my adulthood—to recognise it and call it out, despite being an active campaigner against domestic abuse and having access to amazing campaigners in the UK. Going back to Dr Jamilla, some of the conversation she has been having around this issue is about people having that distrust. Coming back to the amendment, we must be able to point out—to draw out—that “benefit of others”. It is harder to spot, so there have to be safeguards.

This amendment, and all the amendments we have talked about today, would benefit the Bill; they would strengthen it. They would in no way, as the Government have suggested, weaken or confuse it or the people applying it.

Can the hon. Member elaborate on what the amendment would add that previous amendments we have debated would not?

The issue for us in the conversation on this amendment is that we have talked about coercion, undue pressure, undue influence, encouragement and all that, but we have not talked about the benefit to others. It is simply a different conversation; it is about understanding that a person has been coerced and so on, but also for what reason. What is the benefit to others? That is my understanding of the amendment, and that is why I am speaking to and supporting it.

Unfortunately, the Bill as it stands does not have all the necessary safeguards for all those who see themselves as burdens to others, and that is why I support the amendment.

I have listened very carefully to the hon. Member, who represents the fine town of Bradford, and to her personal experiences, which have coloured her view. I understand that of which she speaks, and she might be interested to know that I was the author of the first ever violence against women and girls strategy in the country when I was at City Hall. I dealt closely with harmful cultural practices in that strategy, so I do understand the difficulties she elaborated with detecting and combating the influences to which she referred. However, I am going to disappoint her, because I am going to explain why I believe that the amendments make that more difficult and run the risk of making the Bill less safe.

I should mention first, though, that she said that we are dealing with notions of autonomy and trying to achieve a position where people seeking an assisted death do so as a matter of free choice, and she is exactly right: that is what we are all about and trying to achieve. However, as I hope I can illustrate, the amendments may make that more difficult on three levels.

We have talked a lot over the last few hours about precision and novel terms in legality. My first issue with the amendments is the lack of that precision. For example, what does “physical pain” mean? Is it all pain? Is it something as minor as a headache? Is it perceived or actual pain? Is it fear? Does fear become a physical pain, or is it a mental pain?

In the closing stages of bowel cancer, for example, a number of things may happen and a number of things may cause somebody to die. They can have a perforated bowel caused largely by a blockage, as I am sure my hon. Friend the Member for Solihull West and Shirley would say. That would be incredibly painful and lead to peritonitis and organ failure, which eventually leads to death. However, there is a situation where a blockage in the bowel causes a person to vomit effectively semi digested food and faeces. Is that painful? I do not know whether that is a classification of physical pain. It is certainly uncomfortable and unpleasant, but is it actually painful? I find that the definition of “physical pain”, undefined as it is, and which may be a matter of degree, injects complexity for doctors and lawyers in their assessment of the motivation of a person seeking assisted dying.

Similarly, I do not really know what “benefit” means in the amendments dealing with that. Does it mean financial benefit? Does it mean emotional benefit? Is it perceived or real benefit? Does the doctor have to assess whether a third party is actually getting benefit? Let us assume that it is emotional benefit and that I say—I think it is perfectly legitimate, as my hon. Friend said, for me to say this—“I do not wish my child to witness, know or even learn that the way I died was from the fungating tumours in my neck bursting and,” as we heard on Second Reading, “me drowning in my own bodily fluids. I do not want to get to that stage, and I do not want to burden my child with that.” Do I have to say to the child, who is perhaps an adult child, “How do you feel about it? Are you going to benefit from this or not?” They will respond, “Absolutely not. I want my dad to live as long as possible,” or, “I want my dad to have what he wants to have.”

It is very difficult in these circumstances—do not forget that this will be crawled over by lawyers and doctors—to understand what is actually meant by “benefit”. These are new words—novel concepts—that are being introduced into the law. I did look to see whether there were similar circumstances elsewhere in legislation, and I could not find any. To me, they inject an element of complexity into what we hoped would be, as we discussed earlier, a settled and comprehensible legal framework, in which doctors have previously operated, and should operate into the future. As I say, my first objection is that the amendments inject novel concepts that are largely undefined and that may be actual or perceived, both by the person who is being assessed and by those who are presumably to be in receipt of the benefit.

I am afraid there is also—I am not sure, particularly on the amendments tabled by my right hon. Friend the Member for Braintree—a question in my mind about where my “sake”, whatever that word means, collides with someone else’s “benefit”. As the hon. Member for Ipswich said, if it makes me happy—if part of my dying is me taking satisfaction in the fact that I am not burdening my children with the emotional trauma of watching me die in horrible circumstances—is that for my sake or for their benefit?

The right hon. Gentleman is making a powerful speech. In response to the comment by my hon. Friend the Member for Ipswich, people can have, and will have, an incidental benefit when somebody with autonomy makes a decision. The Government could table tidying up amendments to clarify that and make this amendment stronger, if it gives an extra safeguard for those who are seeking assisted dying, should the Bill become law.

I understand what the hon. Lady is saying, but I am afraid that the amendments do not say that. Even if they did, there would be some difficulty, because you are asking for a further level of complexity in what should be, we hope, a decision made between doctor and patient, in private and confidential circumstances where sensitivity is needed and where we are asking medics to tease out motivations from individuals. I hate to use a pejorative word like “woolly”, but I find the lack of precision in the language troubling. I think it will create yet more complexity and jeopardy for doctors and lawyers.

I just wondered whether the right hon. Member shares my concerns that the amendment would end up in the territory of legislators and parliamentarians almost trying to act as thought police, when we should be respecting the autonomy of people in the decisions they make.

I am grateful to the hon. Gentleman because he brings me to my second point, which is exactly that—autonomy. We heard in oral evidence, and it comes through from some of the written evidence, that people’s motivations for seeking an assisted death are often a mixture—a cocktail—of different reasons. Some are about pain, and some are about trauma, for them and for others, but the overarching motivation is always this notion of control. What people seem to be most concerned about is, “If I contemplate my end, I want to have some kind of say, as I get to the end, about what it will be like. That end may be a variety of different outcomes.”

As my hon. Friend the Member for Solihull West and Shirley, or any of the doctors in the room, will know, if someone is dying of bowel cancer, any number of things may kill them. Palliative care is able to help with some of them, but not others. In my experience, the notion in people’s minds is that, as they approach that point, they just want the reassurance that they can control it and have the option, if they so wish. That is often their primary motivation. As the hon. Member for Bradford West said, there may be ancillary results and reasons why people want that control, but the primary purpose is control.

My right hon. Friend says that the primary purpose is control, and that is certainly the argument made by some of the most passionate advocates of this sort of legislation. However, does he recognise that, in the majority of cases, in jurisdictions where this is legal, being a burden is a primary cause for people to seek an assisted death? People request an assisted death explicitly for the purpose of not being a burden on others. If my right hon. Friend is content with that because he respects their autonomy, and he thinks that that is an acceptable reason for people to want to die, that is fine, and let us say so. However, I do not think it is acceptable to hide behind the idea that we are talking about people who simply want to control their own passing. In fact, many want to do this because they are concerned about being a burden on others.

I will make two points in response to my hon. Friend. First, I am not sure that it is entirely accurate that burden is the primary purpose. It is certainly the case that when people going through this process in other jurisdictions are surveyed and rank their reasons, burden may be one. We heard that in some of the evidence that we had from overseas, but as I said at the start of my remarks, it depends what we mean by “burden”. Personally, I think it is perfectly legitimate for me to want to spare my children from witnessing, knowing or even learning that I may have died in a particularly unpleasant way. I may therefore wish to go a few weeks before that eventuality and say goodbye to them, gathering them around my deathbed—we heard very movingly about this from one of the witnesses—to say farewell while I still can, before my body is ravaged by the final stages of the disease that is destroying me. I do not think that relieving them from a traumatic burden is anything negative.

Does the right hon. Gentleman not accept that “burden” here encompasses many different types of burden. One that weighs heavily on many of my constituents is financial burden—in particular, the cost of care at the end of life. That is very directly something that they would wish to relieve their children and descendants of. Does he not accept that the word “burden”, while I hear what he says about it being imprecise, nevertheless contains many different examples, rather than just the one to which he referred?

The hon. Lady is quite right, and she makes my point very neatly for me: the language here is so wide ranging that it could be anything. Other provisions in the Bill deal with exactly the concerns she expresses. A specific part of the Bill talks about people benefiting financially and how they may not participate. We had a long discussion about coercion and pressure.

I am delighted that the right hon. Gentleman has made that point. Inserting the amendment—and the language of, and focus on, “benefit”—in a paragraph that deals with the two criminal concepts of coercion and pressure, actually undermines the existing focus of the paragraph. Does he agree that it is better and stronger to keep the focus on the two criminal concepts, which would require the mens rea—which I think some colleagues are indicating—and the actus reus, and that that is not achieved by inserting the language about benefits?

I am grateful to the hon. Lady, who has made the case much more eloquently than I could have done. She is quite right. We have heard endlessly from witnesses and others that simplicity is best, and that by inserting this kind of complexity, we create yet more difficulty.

I have two other things to say. From the point of view of autonomy, the amendments are trying to police the thoughts of the individual who comes forward in a way that, as I said, may mean that they become guarded in conversations with their physicians. One of the things that I have learned over the past 10 years or so, and that we have heard from witnesses, is that many people who are in extremis at their end are very determined that they will achieve a death other than what nature has laid out before them. That determination comes through from those who go to Switzerland, often in the teeth of the wishes of their family. They will go in secrecy, not telling anyone, because they do not want to put anyone else under threat of criminal prosecution.

We have heard lots of stories over the years—some were mentioned on Second Reading—of people who have killed themselves in terrible circumstances, again, secretly determined that they will not go through that end. My concern is that if we insert such amendments into the Bill, we start to police the conversation in a way that means that people determined to achieve an assisted death will do other than have a free and frank exchange in a sensitive way with their physician. Instead, they will try to tread the path to get what they want.

For example, if the issue was physical pain, the conversation might go: “Why do you want an assisted death?” “Well, of course it is just the pain. It’s all the pain. That is all I want—I’m just frightened about the pain.” “Are you doing it for the benefit of others?” “No—absolutely not! I am doing it completely for myself.” We can see how people might start to modify their conversation, rather than having what should be a sympathetic, empathetic, conversation between doctor and patient about where they should go.

My concern is that, as with a previous grouping, this attempt to micromanage and police the conversation, at the same time as attempting to police the way people should be thinking, threatens the whole concept of assessment and relationship, which we have heard about from many physicians—that is done on a daily basis in not dissimilar circumstances, where life and death is at stake. That complexity and those extra layers, in my view, start to make the Bill less safe.

I want to pick up on the right hon. Gentleman’s point about wanting patients to be able to have a free and frank conversation with their doctors. In a hypothetical scenario, someone suffering from a terminal illness and in the last six months of their life might say to their doctor, “I would like to explore an assisted dying option.” The doctor asks, “Why is that?” They say, to hark back to my previous example, “Because I want to save my children the cost of my end of life care bills.” How does the right hon. Gentleman think the doctor should react in that circumstance, given that that is a free and frank explanation of the person’s reasons?

The Bill makes it quite obvious that the doctor would not regard that as a legitimate reason to give people an assisted death, if that was their only purpose. As we said before, however, most people have a range of purposes for seeking an assisted death. In my view—certainly in my experience—the primary one is always having the option of control at the end.

Will my right hon. Friend explain what the doctor would do if he or she did not think that there was an appropriate reason to approve the death? The Bill simply requires there to be a settled and informed view. As the hon. Member for Richmond Park says, the motivation might be that the person wanted to save their children the care costs—at which point the doctor, if they could not find evidence of coercion, would say, “Go for it. That is a perfectly good reason.” Is that not the case?

It would depend on the circumstances of whether the doctor perceived that the request was made under pressure or coercion. Pressure or coercion can be financial as well as emotional. I would expect and hope that a doctor would question a motivation on that basis. The point, however, is that we have to be very careful about making a law that attempts to police the thoughts of individuals. My concern is that if we start to delineate to an ever more exacting degree what is and is not acceptable as a motivation, we will start to steer people down a road on which they try—this phrase has been used—to game the system to get what they want.

As many of us know, because we have seen it, we live in an age of social media where it is perfectly possible to go on to the internet to get advice about how best to apply for certain benefits and welfare: how someone can best fill in a form, answer certain questions or go through a personal independence payment assessment to get what they want, even though that may not be appropriate for them.

I have no doubt that if, as it develops, we delineate the issue in such a way that there are certain things one should say and certain things one should not, we will run the risk of limiting the conversation that the doctor can have, in a way that is not safe.

Obviously, we do not want people gaming the system, but I would rather that there were a system, even if it were gamed, than to have no safeguards whatever—which, I am afraid to say, is the case with this Bill. The only coercion that the doctor is looking for is coercion from other people; we do not think that that barrier is strong enough, but it is about coercion from outside. But internal coercion—people saying, “I want to do this to save my family care costs, and not just the sight of me in agony”—would be perfectly acceptable under the Bill. Is my right hon. Friend content with that?

I am not sure that that would be perfectly acceptable under the Bill; I would be interested to hear what clause my hon. Friend has in mind. As we have discussed, financial coercion is a well perceived concept. As we have heard from other Members, it can be subtle and implied. That will be for practice guidelines, but as far as I can see it is perfectly well covered in the legislation.

I am sorry to push my right hon. Friend further but to reiterate my point, we are not talking about external coercion. We are talking about the explicit motivation of somebody with a settled and informed wish that they want to die to save their family the cost of their care. My understanding is that the Bill would allow that. Does he agree and is he content with that?

That is not my interpretation of the Bill, no. I would not be content for that to be somebody’s primary purpose—of course not. My point remains: we run into dangerous ground when we start, by legislation, to try to police the thoughts and motivation of an individual, other than in trying to detect external pressure from others. I am concerned that the amendments run us up that dead end.

Surely, if we are policing the thoughts of the individual seeking to avail themselves of the service, we are working actively against that individual’s autonomy?

That is exactly my point, and the point on which I was going to conclude. All of the Bill is designed to put control in the hands of dying people as they face what they regard as an undesirable ending to their life. We are trying to do so within the scope of safeguards that protect those who are vulnerable and not able to make a decision freely for themselves.

If we continue down the line of inserting this kind of complexity into the system, I am afraid that we run the risk of creating a very narrow channel for people to navigate. That will mean either that they feel forced to navigate it in a particular way or that they cannot navigate it at all, which will serve to restrict the conversation between assessing medics and patients in an undesirable way. For those reasons and because of the legal imprecision with which they are drafted, I am afraid I will be opposing the amendments, well motivated though they are.

The purpose of the amendments, and the reason why I am supporting them, is that they make the Bill honest. They will make the Bill do what the public think it does and is the reason why so many people around the country and in Parliament have supported it: because they understand it to be for exactly the purpose specified in the amendments. In fact, the amendments add safeguards that at least two strong supporters of the Bill in the House of Commons—I will not mention them—thought were already there. Those people have gone on the record stating that these safeguards exist in the Bill, but they do not.

We need to acknowledge motivation. As I said in my exchange with my right hon. Friend the Member for North West Hampshire, my concern is that the absence of recognition of motivation is a significant lacuna in the Bill. Earlier—or perhaps it was yesterday—my hon. Friend the Member for Solihull West and Shirley sought to draw a distinction between a depressed person who wants to die because of their terminal illness and someone who wants to die because of their depression. But in the Bill as it is written, there is no requirement for any causal link between the terminal illness and the desire to die. Under the Bill, someone’s reason for wanting to die does not need to be linked to the terminal illness; in fact, no reason is required. The Bill is totally neutral—in fact, it is silent—on the whole question of motivation. My hon. Friend also talked in an intervention about people who want to end their lives because of suffering and pain—again, that is not mentioned in the Bill. I will come to that shortly when I discuss amendment 235.

There is no reason required to see a clear, settled and informed wish. As discussed earlier, I recognise that there are safeguards intended to detect coercion or pressure, but that does not include people putting pressure on themselves. It is important to consider people’s motivation in situations such as the example given of somebody who wants to spare their family the ordeal—the trauma—of witnessing a bad death. Those sorts of people do not write in to us, by the way. Evidence has been submitted by many people who have experienced the trauma of having watched their relative die badly, but there is also the experience of people whose relatives have been through an assisted death.

I was talking earlier to the noble Baroness Finlay, the former chair of the National Council for Palliative Care, who cited evidence heard by the Commission on Palliative and End of Life Care. A man requested and received an assisted death in the Netherlands for the explicit purpose of sparing his son from seeing him degenerate and die badly. The son was desperate for his father to stay alive—he wanted to go with him through the ordeal—but the father refused. The impact on that young man has been significant, traumatic and destructive.

Even if the patient wishes to do something for the sake of their children, it is not necessarily the case that that will happen or that it will be a good thing. Children can be traumatised by such decisions. Crucially, we should insist that the Bill does what it aspires to do and what many of its advocates have set out clearly over many months. Its purpose is to help people to die, specifically to avoid terrible pain and suffering—but crucially, for themselves and not because they fear that they will be a burden. The fact is that many people do feel that they would be a burden.

I pay tribute to the hon. Member for Harrogate and Knaresborough, who has intervened a couple of times this afternoon and made a very coherent argument about the importance of autonomy. I think he was suggesting—my right hon. Friend the Member for North West Hampshire hinted at this, too—that it is an appropriate decision if a person seeks an assisted death because they do not want to be a burden on others.

In fact, that point was made by people giving evidence to us from abroad. Some of the Australian witnesses—and, I think, the American witnesses—openly said, “Why not? This is consistent with people’s autonomous choice, and if they want to die to save their children’s inheritance or to prevent them from seeing them suffer, that is legitimate.” I would like more people to say openly, as a reason to legalise assisted death, that that is appropriate and that nobody should object—that the judges, doctors and everyone else should nod that through. I do not think that was the sense of the House on Second Reading and I do not personally think it is the view of the public, but if people think that is an acceptable reason to legislate for assisted dying, let us hear it.

I want to emphasise the point about the number of people who genuinely seek an assisted death because they feel that they are a burden on others—not for their own sake, but to save their loved ones money or to avert their distress. A very large number of people—I said most, but I correct myself; I think it is getting on for half of the relevant people in Oregon, Canada and elsewhere—cite burden as the reason for seeking an assisted death.

I note in passing—I hope the Committee will pay attention to this point—that I am concerned that we often feel we are legislating into a vacuum: we pass a law, it will apply, and that is that. As I said yesterday, the law is a teacher and has a direct cultural effect on society. It is very noteworthy that in countries where there is data on motivation, the number of people seeking an assisted death because they feel that they are a burden has risen significantly. It all started, naturally enough, with just the very desperate cases that we are all familiar with and we all understand the rationale for, but the number rose sharply. In the early years, between 12% and 34% across those four jurisdictions cited being a burden as a reason for seeking an assisted death. That has gone up to between 35% and 59% in the four jurisdictions—from around a quarter to around a half in terms of people who seek it. We could pass this law for the small number of people we think we want to help, but in due course many more people will avail themselves of an assisted death because they feel they are a burden.

I welcome the broader debate, but I am very conscious that the amendment does not actually use the word “burden”. It talks about someone “acting for their own sake rather than for the benefit of others.”

Although the broader debate is welcome, it is important to look at the detail of the amendment.

That is fair enough. The amendment seeks to insist that people will have an assisted death for their own sake. What we are trying to exclude is the opposite of that—that they are doing it for others. The principal reason why people want an assisted death, if they are not being coerced—which we have already sought to exclude—is that their own internalised view that it would be better for other people for them to do so.

Will the hon. Gentleman give way?

We want to ensure that people decide for their own sake—I will give way in a moment; this is a good opportunity to make this point. The hon. Member for Ashford referred to the Mental Capacity Act, which we have retained as the basis of the capacity test. The Bill would introduce a version of the best interests consideration, which, as we discussed yesterday, will not be triggered in the Bill because that consideration is not triggered if there is capacity—and if there is not capacity, things do not proceed.

I think it is appropriate that the people making the decision have some consideration of their best interests. I understand that we want to make this all about autonomy, so perhaps a better description is a self interest consideration. That is what the amendment requires doctors and, later, the judges to conclude: is the person making the decision in their own interests, for their own sake? Are they doing it for themselves? If they are doing it for other people, that is problematic.

I want to make two points that reflect on the oral evidence that we heard. I cannot remember exactly which witness it was, but someone said something along the lines of there being something quite British about feeling a bit like a burden. That point really stuck with me, because we say it all the time and that was the point made by the person giving evidence. When we talk about the amendment in the context of someone acting for their own sake or for the benefit of others and whether that means that they feel like a burden or otherwise, I think that is something to bear in mind. Might the hon. Member reflect on the fact that people who die natural deaths also feel like a burden at the end of their life? So when we talk about stats pertaining to that, how do we decipher between the two?

I am very conscious that people feel like a burden at the end of their life. It is quite right that at the moment the system says, “No, you are not. You have value. You might feel a burden, but we want to sustain your life until its natural end. If you want to withdraw or decline treatment, that is your autonomous choice, but we do not recognise you as a burden.” It is very important that the British state does not tell people or confirm to people that they are a burden, which is what we would do in the Bill.

To the point that the British people are very self effacing, I should say that I suspect we would be at extreme risk from this law. I think many people would indeed feel like a burden. If we pass this law, we are explicitly saying, “Yes, you may well be a burden and it might well be right for you to seek an assisted death.” My right hon. Friend the Member for Braintree, who tabled the amendment, makes the powerful point that a right to die should not become a duty to die. Nobody wants that. Nevertheless, the implication of a law that confirms that people may seek to get the state’s help to kill themselves—not for their own sake but because they feel a burden to others—is incredibly dangerous for our society and for our culture. I would be very concerned if we proceeded with it.

I will now conclude on the amendment before quickly talking about pain. It addresses the motivation of doing things for one’s own sake. I do not underestimate the difficulties. My right hon. Friend the Member for North West Hampshire has stated a number of them at least, as have other Members.

Implementing this safeguard will be difficult, but the fact is that the Bill’s sponsors have already put enormous faith in doctors and judges, or other experts, to detect external coercion and make all sorts of judgments—to ferret around in people’s minds and in their lives to understand what they are doing. We have to consider how best to implement this safeguard, but at the moment the Bill does not even say that asking for an assisted death for other people is something that should be protected against. That is wrong, and it is right that we make the amendment.

I will proceed quickly to a few points about the amendments in the name of my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), which specify that the purpose of seeking an assisted death must be the avoidance of pain. They would make the Bill honest. The point has been made repeatedly by advocates in the media and in Parliament, including in our evidence sessions, that the reason why we need an assisted dying law is that so many people die terribly. My right hon. Friend the Member for North West Hampshire has referred to some of that today, and he did so very powerfully on Second Reading too.

Sir Nicholas Mostyn made a fairly unarguable case that if we are honest about what we are trying to do here, it is unclear why we have a period of prognosis as a qualifying factor: why should people have to be within six months of their death in order to qualify if we are concerned about the avoidance of suffering? If the logic of the Bill’s proponents and the argument for it is followed through, of course it should be only about the avoidance of pain. I recognise that “suffering” is a more complicated word, but I do not agree with my right hon. Friend that pain is too difficult to determine. The motivation of avoiding pain is straightforward. It should be simply about pain, and unless someone is a full blown ethical egoist who believes there should be no restrictions on someone seeking the assistance of others to take their life—

The hon. Gentleman may remember the speech that I made in the Chamber about my own experience of extreme physical pain, and indeed extreme physical suffering, as a child. The level of morphine that I needed was so high that my skin began to itch. I would not have voted for the Bill to proceed to Committee if it had been based on suffering. I voted for it because it was defined very tightly around the language of terminal illness. With the greatest respect to the hon. Gentleman, I think he undermines that case by arguing that we should move to the extremis and focus on pain. We all want to ensure that the Bill gives people the choice to seek assistance with six months’ terminality, set among other choices, including the ability to palliate and achieve other support at the end of life. I am afraid that the amendments would undermine that and, for the reasons that I set out on Second Reading and have just highlighted, I do not support them.

I remember the hon. Lady’s very powerful speech on Second Reading and I fully recognise that, which is why I said that I recognise that including suffering would be problematic. I understand her point about pain as well. I think we need belt and braces. If we are going to do this, we should have strict restrictions on prognosis, because I want to restrict the time limit. I could go further than six months; we keep hearing about people in the very last stages of their life, and I think it should be restricted to them, but I also think the purpose of seeking an assisted death should be consistent with all the arguments that we keep hearing about people suffering terribly at the end from an agonising death, and we need to restrict it to those cases as well. It should be for people at the very end of their life, for the avoidance of suffering terrible pain. Those are the reasons that the public, in so far as they do support the Bill, support it—they support it for those reasons only.

In my experience, often the reason people talk to me about assisted death—obviously, it is not legal at the moment—is fear of uncertainty at the end of life. That is one of the major things. For example, if someone has a bronchial tumour, it might suddenly haemorrhage, causing them to die by drowning in their own blood. That is something that people will do a lot to avoid. That is not pain; it is something else. As the right hon. Member for North West Hampshire mentioned, a tumour on the carotid artery can suddenly bleed catastrophically. That is not pain, but it is another reason for doing it. I believe it is that fear of what might happen at the end of life that drives most of this. Sometimes it cannot, but usually pain can be palliated —there are many ways to do that—but that fear of what will happen cannot be. We must not do this just for pain.

The amendment would require people to request an assisted death for the purpose of avoiding pain. If the purpose is to avoid the pain of the death that the hon. Gentleman described, they would qualify under the amendment. I want to push back slightly. I recognise that he is a doctor and I am not, but the case that was cited on Second Reading has been refenced a number of times. I want to look more closely at it, because I have heard from a number of professionals that the account given was not reflective of the usual course of events for that illness. I am sure that, as a doctor, when people say that they fear that sort of death, he does not confirm that it is likely to happen to them.

I want to come to the reality, as I understand it from the evidence, of the genuine opportunities that medicine gives to afford people a good death, which is what medicine should be about.

In carcinoma of the bronchus, it is a real risk—and it is a risk that oncologists will tell me and tell the patient. That is the sort of thing that people adopt assisted dying to avoid.

I am grateful to the hon. Gentleman.

For clarity, is my hon. Friend saying that he supports the amendments because he believes that the only reason that someone should have an assisted death is to avoid physical pain, not the circumstances that we have talked about—bursting arteries and fungating tumours—and therefore that if pain can be controlled, the notion of autonomy, control and choosing the time and place of my own death should all be dismissed?

The amendment is clear that the primary purpose should be to avoid physical pain. That needs no further clarification.

Let me turn to the discussion of pain. As I have said, the amendment would make the Bill honest and make it do what most people out there want it do. It would also have the great benefit, in my view at least, of reducing those who would be eligible for an assisted death to very a small number. I have heard the Bill’s advocates make the point repeatedly that we are talking about only a very small number of people.

The fact is that the most common reason for assisted suicide in other countries is not pain. Usually, in those countries, the law was passed on a wave of sympathy for people in agony at the end of their life, but most people do not seek an assisted death for the purpose of avoiding pain. The most common reason in Oregon, according to research there, is existential angst—emotional distress—not physical suffering. The Committee heard evidence from Western Australia that the most common reasons are loss of dignity, autonomy and the ability to enjoy life. In Tasmania, another place where there has been research, only 16% of people cite avoidance of pain as the reason for seeking an assisted death.

In my view, if we focused the Bill on pain, we could do even more to reduce the number of people who die in pain, because it should be even smaller than it is. Let me say a word or two about the palliation of pain. We have no doctors in the Committee who are on my side of the argument to make this point, so I refer to experts outside the room. Quite a lot of weight has been put on research published last year by the Office of Health Economics that said that 20 people would die every day in pain, even with access to palliative care. The point is often made that palliative care is wonderful—we all agree that it needs more resourcing and it should be more widely available—but even if it were provided brilliantly for everyone, a large number of people would still die in pain.

Without digging into the problems with the research, I simply point out that the methodology was very suspect. It assumed that people who receive hospice care are the same with respect to pain as people who do not. It just looked at the hospice population and extrapolated more broadly. That is, of course, ridiculous, because people in a hospice are much more likely to be suffering and to be experiencing bad pain; often, that is the reason that they are admitted to the hospice. That extrapolation was inappropriate.

The fact is that very few people would die in terrible pain if palliative care were good and widely available in the way that it should be. I want to reference some research about the genuine ability of pain relief to operate. We are all very familiar, and it is a terrible thing, with those a generation ago—perhaps our parents or grandparents—who died very badly. In fact, the Committee heard some evidence from witnesses about that. The fact is that pain relief has improved enormously just in the last generation. We are making great strides in analgesic medicine. The improvements in pain relief are enormous and significant, and it is something that we should be very proud of in this country. We are leading the way. We developed palliative care in the first place and we remain the world leaders in its development.

An overview of Cochrane reviews found that 19 out of 20 patients with moderate or severe pain who are given opioids experience a reduction in pain within 14 days. Opioids are very effective, but often people receive them much too late. Many of the stories that we are familiar with are of people who did not receive sufficient opioids at the time they needed them. To be most effective, palliative care should be provided at least three to six months before death. In the UK, the median time of referral is 48 days before death, and it is even closer to death for people with non cancer conditions. We are administering palliative care much too late, which helps to account for some of the terrible stories that we all know about.

It may be the case, and this point has sometimes been made, that hospitals or even hospices or doctors withhold the administration of pain relief because they are concerned about being in breach of the current law, and being accused of murder or of assisting in suicide. A helpful ten minute rule Bill was tabled by my right hon. Friend the Member for Gainsborough (Sir Edward Leigh) a month or two ago. It did not get anywhere, but it would have specified what is in fact the current law and the current guidance: there is no limit to the amount of morphine or opioids that doctors can administer. The hon. Member for Stroud, who is a medical professional, is nodding. There is no legal or clinical restriction on the quantity of morphine or other pain relief that can be administered.

What about people who do not respond to opioids or cannot tolerate them, which we hear about? There are many non opioid pain medications that can be used: neuropathic agents, non steroidal anti inflammatories and so on.

I think we are going slightly off topic. The hon. Gentleman is talking about pain control, not whether pain can be used as the sole criterion to qualify for assisted dying. I do not know, Mrs Harris, whether—

The Clerks are quite happy with it, but thank you for your assistance.

I always worry when the doctor is providing assistance. [Laughter.] No, I am grateful to the hon. Gentleman for trying to get me back on track.

We hear about morphine allergy, and I recognise that apparently it does exist, albeit very rarely. Patients with a morphine allergy can still receive opioid analgesics—there are different sorts of opioids—and there are case studies in the literature that show they can achieve good palliation.

As someone who lives with someone who has a very severe morphine allergy, I can assure the hon. Gentleman that those things do exist and are very real, and they create a huge sense of fear in people. Having met a terminally ill woman who is also allergic to opioids, I think it is really important to acknowledge that these are very real problems for people.

I totally acknowledge that. I fully recognise that, as I said, morphine allergy does indeed exist, but I am told that it is very rare. I hope that the hon. Lady’s relative will confirm that there are other things that can be done for people who suffer from pain if morphine is not appropriate.

I suppose that is the point that I want to make: no palliative care professional would ever say that they cannot help somebody in terrible pain. There is always something that they would like to do and always more that they can do to assist. The simple reality is that palliative care is improving so much that there is only an infinitesimally small number of people whom palliative care professionals would confirm they cannot help. I recognise that those people exist. I am not being naive or Panglossian and suggesting that palliative care can be perfect in all cases, but if we are serious about the purpose of the Bill, which is to help those whom palliative care cannot help, I suggest that that number will be very small.

I pay tribute to the hon. Member for York Central (Rachael Maskell) and to the noble Baroness Finlay, whom I mentioned. They are leading a commission on palliative care at the moment, which is a helpful corollary to the debate we are having here. They will make a series of recommendations, which I will not go into.

I want to conclude with this obvious point. I am repeating myself, in a sense, so I will be quick. If we are going to do this, let us be honest and straightforward about what we want to achieve. We want people who are dying in extreme agony at the very end of their life to avoid the pain of death and be able to avail themselves of this service. It is either that or we say, “No, we have no interest in people’s motivation for wanting it. We simply respect their autonomy. Unless we can detect external coercion,” which is the only thing that the Bill currently seeks to exclude, “and as long as a doctor can give confirmation that they have six months to live,” which is not difficult to get, “we don’t care why they’re doing it. We respect their wish, and whoever they are and whatever is going on behind the scenes, they can go for it.” We either have a Bill based on full autonomy—I think that is what some hon. Members genuinely believe we should do—or we try to restrict it to just those people who face an agonising death at the very end.

My hon. Friend makes a powerful argument, but if that is his intention, the amendment does not achieve it. It does not refer to agonising pain; it just refers to “physical pain”. On a scale of nought to 10, it could be one or two—it does not necessarily mean that it is nine or 10. While his intention is clear, can he explain how the amendment achieves that wish?

Well, perhaps my hon. Friend wants to come up with a further amendment, to strengthen it even more and say that we should restrict it only to agony or extreme pain. No, I am trying to be reasonable and say that the case made for the Bill, in public and I think in the public mind, is that its beneficiaries will be those who face terrible pain at the very end of their life, and if that is our intention, let us specify that. That is what the Bill does.

I do not believe that the intention of the Bill is simply about being able to have an assisted death because of pain. Nothing in the Bill says that. We heard evidence from Dr Hussain, who was against assisted dying, but she admitted that there are people for whom we cannot control the pain, so that is another point. The whole interpretation of the Bill is incorrect. It is not about pain at the end of life; it is about controlling one’s own death.

That is exactly my point. There are those who think that it should be just for people facing terrible pain at the end of life, but that is not what the Bill does, and it is not what the hon. Gentleman says it should do. He would like there to be a Bill that says simply, “If you want to take your own life with the help of the state, you should be allowed to do so.” That is the logic of his position. I do not see why there are any other safeguards—if we believe in absolute autonomy, that is where we are. It is either/or. Either this is a Bill for full autonomy, or there are safeguards to restrict it to the people whom the public are rightly concerned about: those who suffer terribly at the end of life.

The hon. Member is making a powerful argument, but there is a difference between trying to control external factors that may affect an individual making a decision and primary legislation that tries to regulate a person with capacity making an assessment of what is in their best interest. Can he think of any other circumstances in our society or our law where someone with capacity is restrained from making a best interest decision in primary legislation?

I am grateful to the hon. Gentleman because he highlights the absolute novelty of this law. We are proposing to do something completely unprecedented. As hon. Members have tried to argue over the last two days, it takes us into extremely dangerous waters with respect to the most vulnerable, so what we are trying to do, through what I concede are some fairly blunt instruments, is to write into the Bill some very strong and clear protections for the most vulnerable people. We have tried to do that in various different ways.

This would be novel. Of course, it is true that the criminal law currently recognises motivation—there are all sorts of aggravating factors that look into the motivation of an individual, so the law is not incapable of making that sort of judgment—but the hon. Gentleman is right to say that this would be a novelty. I am afraid the whole Bill is a novelty.

While the oral evidence was divided on many things, I think there was unanimity that palliative care is in need of serious improvement across the board. I do not think a single witness said that palliative care was good across the country and could not be improved significantly. I mention that, linking back to the comment from the hon. Member for Richmond Park, because we are looking to create this law in a situation where a serious risk has been identified of people choosing to opt for assisted dying because of a fear of care costs and so on. That is my concern, and I see this as a safeguard to prevent that. Is that the hon. Member’s view?

That is absolutely right. It is a very depressing fact that it seems to be the sentiment of the Committee that we should allow people to request and receive an assisted death for the purpose of saving their relatives money. That does seem to be what people are saying.

There is something called continuing healthcare, which would fund end of life care, if someone has a terminal prognosis of six months or less, so care costs would be covered by the state.

That is a fair point. I do not propose to push the amendment to a vote, but I hope that the point has landed sufficiently. There is a genuine concern that people will, as they do in other countries, with increasing regularity and in concerning numbers, seek to have an assisted death not with their own personal interests in mind but for the sake of others. That may be generous spirited of them, but it is not the purpose of this Bill as far as I understand it.

It is a pleasure to serve under your chairship, Ms McVey. This group of amendments focuses on the motivations of an individual who wishes to seek assisted dying services. As before, I will limit my remarks to observations about the legal and operational impact that these changes would have.

Amendments 94 to 104 would introduce an additional safeguarding requirement that would require that a person who wishes to be provided with lawful assistance to voluntarily end their own life must be acting for their own sake, not for the benefit of others. These amendments would introduce that new requirement into all the relevant parts of the Bill where a doctor or court or panel must, under the current provisions in the Bill, make an assessment as to whether the person has capacity, a clear and settled wish and is making the declaration voluntarily. These relevant points include, for example, the assessment of the first doctor—the co ordinating doctor—and that of the second doctor—the independent doctor. The amendments would provide that declarations set out in the schedules are, in consequence, also amended to reflect this new requirement.

With respect to the impact of introducing additional or overlapping terminology alongside the existing terms “coerced or pressured” currently in clause 1 of the Bill, such as “acting for their own sake”, there is a risk that this would cause uncertainty about their interpretation and application by the assessing doctors and the courts. The Minister of State, Ministry of Justice, my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman), has articulated the Government’s position in her previous contributions.

Amendments 235 to 245 are intended to refine the eligibility criteria of a person seeking assistance to end their life so as to ensure that the primary motivation of that person is to avoid physical pain. Consequential amendments are included to reflect that throughout the entirety of the Bill. If this refinement were to form part of the Bill, amendment 235 could exclude those who are suffering with a terminal illness for which physical pain is not a specific symptom. The likely effect would therefore be to limit those who are eligible to access assisted dying under this legislation to terminally ill persons with conditions that are likely to cause only physical pain. In addition to the generic risk of additional overlapping terminology causing uncertainty, the inclusion of these amendments would generate specific uncertainty, as it may be difficult to distinguish physical pain from other pain. It is also not clear whether the person needs to be in pain all the time or some of the time. As I said earlier, the Government have taken a neutral position on the substantive policy questions.

That speaks to my earlier point, where I was seeking clarification. I find that I feel very uncomfortable with this process, where the Government are very clearly taking a position, without having an impact assessment in place, on whether the previous amendments and the ones I am talking about would confuse the courts or create uncertainty. Perhaps the Minister can provide clarification, but my interpretation is that the Government are taking a view, not just sharing the position of the Government.

I thank my hon. Friend for that intervention. I will just take us back to the first principles. This is not a Government Bill; it is the Bill of my hon. Friend the Member for Spen Valley, who came top of the ballot for private Members’ Bills. She chose to bring forward this piece of legislation. The Government had absolutely no role whatsoever in drafting the legislation. The Prime Minister then made it clear that the Government will remain neutral in their position on the Bill. However, it is the constitutional duty of the Government to ensure that every Bill that passes through Parliament and secures Royal Assent is workable, deliverable, viable and coherent in terms of the statute.

How does that play into this Bill Committee? Members of the Committee who are not Ministers are here to debate the philosophical, moral, ethical and, in some cases, legal and perhaps clinical aspects of the Bill. Members of the Committee who are Ministers—namely myself and the Justice Minister, my hon. and learned Friend the Member for Finchley and Golders Green—are here to provide observations on the Bill with regard to its legal, practical, technical and operational impact, to ensure that we are doing our constitutional duty to deliver the objectives I just outlined to my hon. Friend the Member for Bradford West.

The answer to the question from my hon. Friend is that when my hon. and learned Friend the Justice Minister and I speak, we focus our remarks exclusively on the legal, practical, technical and operational considerations of the Bill. I assume that the Committee finds it useful to know what the Government’s position is on those matters. We do not opine on the philosophical, ethical or moral considerations that are at the heart of the Bill.

I thank the Minister greatly for his explanation. I am trying to separate the two points. I appreciate the role of both Ministers in providing the Committee with that guidance, as many of us are new to the process. What I am trying to understand, with respect to the amendment from the right hon. Member for Braintree, which I just talked about, is that the Government have asserted a view that the language included would create uncertainty.

Order. The hon. Member has asked a question and had a response. This Committee is not debating the Government’s stance. It is debating the Bill.

Can I come back to the amendment?

I am not going to take any more interventions. I will move on to Kim Leadbeater unless the Minister has not finished.

I cannot really comment, because I did not get the specific question that my hon. Friend asked.

Returning to the amendments before us, I will try to keep my comments brief, as we have had a thorough debate this afternoon. On amendments 95 to 104, I have spoken to the right hon. Member for Braintree and I know that these amendments seek to stimulate discussion, and I am very pleased that they have done that this afternoon. I also know that they come from a good place.

I have already discussed the additional safeguards around training that would be added to the Bill through new clause 8, which states that the Secretary of State must consult “persons appearing to…have expertise in matters relating to whether persons have been coerced”.

That would consolidate the existing measures in the Bill and, I hope, relate to the concerns expressed in the amendment to some degree.

More broadly, the reasons that someone might choose an assisted death may well include sparing those they love the pain of seeing them suffer, as we have heard this afternoon. That is certainly something that members of my family and people I have spoken to say would matter to them. That should not prevent the provision of assistance. It is surely for that person to decide.

During oral evidence, we heard powerful testimony from Liz Reed about her brother Rob, who had an assisted death in Queensland, Australia. Rob was 39 years old and had a young family when he was diagnosed with stage 4 terminal lung cancer. He was fit, young and healthy, and did not smoke. As well as taking back control at the end of his life, one of his main reasons for choosing an assisted death was so that his young family could remember him as the man and the dad he was. He was not afraid of death, but he was afraid of dying in an undignified and painful way; he was afraid of not getting to say goodbye to his wife and children, or them having to find him after his having had a massive heart attack. Surely we should not decide that that is not acceptable and understandable. It is a perfectly understandable reason for choosing an assisted death.

Liz told us that Rob “was able to change his mind, which he did, in terms of dates and when it would happen. His views and the views of his family were also taken into account and, through the process, he was treated like a person with autonomy whose choices were being respected.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 254, Q328.] If relatives were implicitly or explicitly coercing or pressuring someone, that would of course be very different—and that is covered by the Bill—but to prevent someone from wanting to consider their loved ones in their final weeks and months of life does not seem at all reasonable to me.

I have talked about training, which is important and feeds into the debate about the assessment of coercion and pressure—here, I refer again to my new clause 8. As we heard during the oral evidence, who is involved in that training is important. We heard from the Association of Palliative Care Social Workers. Its position statement on assisted dying states: “As social workers we bring a distinctive perspective and skill set. Our focus is on helping people to get practical needs met; to enable them and their families cope with the impact of serious illness and dying and to plan ahead”.

My understanding is that the judges’ views on capacity relate to the fact that there are only 200 qualified palliative care social workers in the country.

This point is about training, and so about hearing from the right people when it comes to the training of professionals. It is important that we ensure that the Secretary of State must consult such people, and I anticipate that organisations such as the Association of Palliative Care Social Workers would be consulted. The statement continues: “as well as protecting people from abuse, neglect and coercion at a time…when they are most vulnerable…Our expertise includes building trusting relationships, comprehensive knowledge of safeguarding”.

By looking at the training process, people’s motivations for seeking an assisted death would hopefully be considered.

Would the hon. Lady be content if somebody who had capacity chose an assisted death for the purpose of saving their family money?

Very few cases are as straightforward as that, and that is where conversations with doctors and professionals are really important. I think it was the doctor from California who said that if someone said to him, “I am doing this because I am a burden,” that would be a red flag. There would have to be a much more detailed, complex conversation with patients about what their motivations were, and it is important that we acknowledge, as medical colleagues have, what those conversations might look like.

But if the doctor concluded that they were doing it because they felt they were a burden, they would still be able to get the assisted death under the hon. Lady’s Bill. The only question is whether they have capacity. If they have been judged to have capacity, choosing to have the assisted death in order to save their family money would be acceptable under her Bill, would it not?

We are oversimplifying a complex situation and a difficult conversation. We have talked about coercion and pressure a lot. If someone says, “I just want it all to be over, because I feel like a burden”, that is the sort of conversation that doctors acknowledge would be a red flag. Those are complex, difficult conversations; we need the expertise that we would get by providing serious amounts of training around this issue so that those conversations can take place in a sensitive way.

This is my last intervention, I promise. I want to hear the hon. Lady confirm that under the Bill as currently drafted, after all these conversations have taken place, as long as the doctor cannot find evidence of coercion, they would be obliged to approve the assisted death, as would the judge and the judicial panel. If that is the case, and they conclude that a person has capacity and there is no evidence of coercion, no matter what conversations go on—if the person wants to do it in order to save their family money—the doctors and the judges would have to say yes.

I, again, refer the hon. Gentleman to my previous points; we are oversimplifying a really complex conversation, which would take into account lots of different factors for each individual. That is all I will say on that point.

It is really important that we are honest about what the Bill does. We are looking for a simple answer—yes or no. My hon. Friend the Member for East Wiltshire has very clearly set out the situation, and I know that the hon. Member for Spen Valley understands her Bill inside and out, so if she could give us a yes or no that would be really helpful.

Sorry, what was your question?

It is the same question asked by my hon. Friend the Member for East Wiltshire: would someone be allowed to access assisted dying if it was clear that they had capacity and their reason for it was simply not to cost their relatives financial expense or be a burden. It is important to be honest about what the Bill does. Is the answer to that yes?

I am certainly not being dishonest, which is the hon. Lady’s implication. I refer back to the complexity of those conversations, and the fact that safeguards will need to be in place to check for coercion, dishonesty and pressure. Ultimately, it comes down to a question of autonomy, dignity and choice for patients, but they are not simple conversations. I think it would be very unusual if the conversation looked how she is describing.

As a doctor, if I, under this legislation, came across someone who gave their main reason for ending their life as being that they wanted to save money for their family, that would come under pressure or coercion, even if it was from themselves.

It is really important to remember that, at the moment, there is no legal framework that checks terminally ill people’s reasons for ending their lives or shortening their deaths. That is why having this legal framework is so important. During the oral evidence sessions, Sir Max Hill told us that in his experience of working as Director of Public Prosecutions, he oversaw a number of cases to do with people travelling to Dignitas. He said: “In each of the 27 cases I considered, the deceased individual was already dead, and that is when the scrutiny started. The major advantage of the Bill…is that that will be reversed, and scrutiny will be before death.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 86, Q111.] The same applies to terminally ill people who have taken their own lives in this country. The only time that anyone checks for coercion, either internal or external, is when the person is dead. The Bill provides a robust legal framework, which is a significant improvement on things as they stand.

Dr Aneez Esmail, who changed his position on assisted dying as a result of his work as a professor of general practice, said in his oral evidence, “How is the law protecting anyone at the moment?…we don’t have a legal framework…it is actually very unsafe…a law…which produces safeguards, is a huge improvement on where we are at the moment.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 166, Q211.] I also worry about the subjectivity of this amendment. We know that the law likes certainty, rather than abstract concepts, such as doing something for one’s “own sake”, which seems somewhat abstract.

My hon. Friend has referred a few times now to us not having this framework. We do not have this framework because we do not have this law. Maybe she can help me to understand or correct me if I am wrong, but this framework does not exist because we do not have this law. For this law to exist, we have to have the framework. I am inferring from her a suggestion that she is somehow intervening for people who might be being coerced in a hospital setting or at the end of life in any case, but that is not the case.

I am not quite sure I understand the point. My point is that there is no law that is checking people’s motivations for ending their lives when they are terminally ill, and that is what this law would do.

I will make some progress, and come to amendments 235 to 245. As we have heard from witnesses, choice at the end of life is not just about physical pain, be it current or potential. It can also be about psychological suffering and mental torment as a result of being terminally ill —and it is of course about taking back control, bodily autonomy, dignity and choice. What about patients who are in severe mental torment and fear as a result of their condition, and terminally ill people who want the autonomy and dignity of taking back control at the end of their lives? Who are we to ask them to prove their level of physical pain or desire to avoid physical pain, and to deny them the choice in their final few weeks or months?

Dr Sarah Cox from the Association for Palliative Medicine said in her oral evidence:

“I accept that there will be people even with a very good palliative care system who would still choose assisted dying.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 78, Q100.]

We know that that is the case. Palliative care can be very effective, but it cannot manage all conditions. Dr Richard Osborne submitted written evidence to the Health and Social Care Committee two years ago, when there was an inquiry. He said:

“In my 30-year career as a Consultant Medical Oncologist…I have been responsible for the management of almost 10,000 patients, the majority of whom had metastatic, incurable cancer and died from progressive disease…I often personally led the end of life care for these patients, managing the multiple problems that emerge as cancer advances, and treatment is directed at symptom relief rather than disease control. From this experience I can confidently attest that assertions that Palliative Care services and techniques offer a universal panacea which smooths the terminal period of a person’s life in a way that eliminates all suffering are untrue.”

Dr Osborne refers to “multiple problems” for patients like this, not just pain. At what point does it become acceptable for them to request an assisted death to avoid physical pain, as amendment 235 suggests? The amendment talks about “avoiding physical pain”, but what if the patient is already in physical pain? Does that count? It seems unclear. Also, physical pain is very subjective, and as I have said, the law does not like subjectivity. Who would decide how much pain was enough to be avoided? As such, I think the amendment lacks clarity and undermines the choice that the Bill is seeking to offer dying people.

I call Naz Shah to wind up. It would be helpful if the hon. Member would indicate whether she wishes to push amendment 94 to a vote.

Yes, Mrs Harris, I do want to push the amendment to a vote.

In summary, the reference to “coerced or pressured” in clause 1 relates only to coercion or pressure by another person and does not cover internalised pressure. In written evidence, the Royal College of Psychiatrists said: “The Bill focuses on external coercion. That is, for example, coercion from family members with personal or financial motivations to hasten death. While this type of coercion may not always be clear, internal and societal pressures that may reach the threshold of coercion can be even more difficult to detect.”

I am not going to rehash that. I appreciate where we are at with this conversation. The royal college says that the Bill does not address “more subtle forms of coercion, such as where a person may internalise a feeling of being a burden to others. How might such internalised pressure be identified or responded to in this context?”

It is that important question that we are left with. It continues: “At what level would implicit or internal pressures amount to coercion? At what point would supporting a person to have capacity to make a decision to request assistance to die constitute coercion?”

That coercion may be used for the benefit of others.

That brings me back to the crux of this amendment: it is about the benefit of others. There is nothing to suggest that there would not be an incidental benefit for people; there can absolutely be an incidental benefit. For the avoidance of doubt, this amendment is not about that. We have had votes on adding language to the Bill, which I voted for. We have heard the Government responses, which I struggle with. Ultimately, I want to push this amendment to a vote because I feel that we need to strengthen the Bill. As it is, there are loopholes, and one loophole is one loophole too many.

Question put, That the amendment be made.

6|0|8|15|The Committee divided:|Question accordingly negatived.||0|0

Ordered, That further consideration be now adjourned. —(Bambos Charalambous.)

Adjourned till Tuesday 25 February at twenty five minutes past Nine o’clock.

Written evidence reported to the House

TIAB 357 Centre for Women’s Justice

TIAB 358 Dr Sue Smith, Consultant Clinical Psychologist, Cancer and Palliative care

TIAB 359 The Christian Institute

TIAB 360 Richard M. Doerflinger

TIAB 361 Association for Palliative Medicine’s Race Equity Committee

TIAB 362 Not Yet Dead UK

TIAB 363 Standing Together Against Domestic Abuse

TIAB 364 National AIDS Trust

TIAB 365 Presbyterian Church in Ireland

TIAB 366 Christians in Pharmacy

TIAB 367 Association of British Paediatric Nurses

TIAB 368 Dr Lucy Thomas

TIAB 369 Dr Thomas Parkes

TIAB 370 Patricia Haitink LLM, a former barrister and a doctoral candidate at the London School of Economics

TIAB 371 Euthanasia Prevention Coalition

TIAB 374 Professor Sir Chris Whitty oral evidence - point of clarification (supplementary)