The assisted suicide Bill Committee scrutinising Kim Leadbeater’s Terminally Ill Adults (End of Life) Bill met for its fifth week of sittings last week to continue its line-by-line scrutiny of the Bill.
On 11 and 12 March, MPs on the Committee made the decision to remove the High Court safeguard, trumpeted by Bill sponsor, Kim Leadbeater, before the debate at Second Reading, making her Bill different from all other assisted dying legislation anywhere in the world.
Instead, the relevant clause, which has now been removed, will likely be replaced by an assisted suicide panel. The Committee will consider whether to add the “Assisted Dying Review Panels” to the Bill during debate this week.
High Court judge safeguard rejected
Despite facing a major backlash against proposals to remove the centrepiece High Court safeguard from her assisted suicide Bill, Kim Leadbeater proceeded to remove the flagship safeguard by joining colleagues in voting to successfully remove the Court approval clause from the Bill.
In the build-up to the vote in November, Leadbeater boasted her Bill has “the strictest safeguards anywhere in the world”, highlighting the High Court judge safeguard as evidence for this. This provision in the Bill was repeatedly positioned by Leadbeater and her allies as a key component of the Bill.
Leadbeater has proposed that the flagship High Court safeguard will be replaced by what has been labelled by media outlets as a ‘death czar’ who will oversee panels, dubbed the ‘death panels’, that will include a more junior legal figure, a social worker and a psychiatrist.
Legal experts have been very critical of the new plan, highlighting several major issues with the new proposed replacement.
The panels will include a social worker and psychiatrist and risk taking them away from their frontline work in areas where there are already major shortages.
Opponent of the assisted suicide Bill Danny Kruger MP suggested that the removal of the High Court safeguard revealed that the intent of the architects of the Bill was not that the Bill might be restricted to a select few, but that state-assisted suicide would be widely available.
“I think the High Court stage was recognised as popular and as useful to the campaign to get the Bill through the House of Commons. It was predicated specifically on the point, which was clearly communicated and understood by the public, that this measure of assisted dying is intended for very few people. It is for the most exceptional cases: people at the very end of their life, in desperate circumstances, in desperate pain and suffering. Very few people need it. However, I believe this change is predicated on the real intent of the Bill: far wider eligibility than just that tiny group”, he said.
During the debate, MPs were highly critical of the proposed panel and its apparent ‘quasi-judicial’ operation. Kruger said “This is not a tribunal. It would not sit in a judicial capacity. Its members would not take oaths in the way that members of a tribunal do. They are not appointed through the independent appointments process that tribunals have. This is a multidisciplinary team masquerading as some sort of final judicial stage, without the proper accountability of a judicial stage”.
“This is an enormous change to the Bill and totally transforms it, but we did not have the opportunity to hear evidence on it” he added.
Leadbeater confirmed such concerns, stating that the proposed panel is “not a judicial entity. It is a panel—it is not a court”.
After the removal of the High Court safeguard a group of 26 Labour MPs opposed to the Bill wrote “The scrapping of High Court oversight for the assisted dying regime breaks the promises made by the proponents of the Bill”.
“It fundamentally weakens the protections for the vulnerable and shows just how haphazard this whole process has become”.
“It does not increase judicial safeguards but instead creates an unaccountable quango and to claim otherwise misrepresents what is being proposed”.
“The new panel process can be held in private, won’t have the powers to make witnesses appear before it or take evidence under oath”.
“They will inevitably drain public services of vital frontline staff without any idea of how much this will cost the taxpayer or any assessment of its impact upon the vulnerable”.
Amendments rejected
Amendment to prevent doctor shopping rejected: MPs on the assisted suicide Bill Committee rejected amendments (458 and 303) that aimed to prevent or limit ‘doctor-shopping’. In its current form, if a doctor refuses an application for assisted suicide, it is permissible for the person seeking an assisted suicide to find another doctor who may grant their request.
Kruger explained that doctor shopping “is not a hypothetical concern. We have seen it take place in other jurisdictions. An understanding develops that some doctors are more likely to grant an application for an assisted death. That is totally natural. Professor Preston said in oral evidence to us: ‘People go doctor shopping—they are going to multiple doctors until they get the right answer'”.
He went on “According to an official report in 2021, one Oregon doctor wrote one eighth of all the prescriptions for assisted death. I met a doctor in Canada who had performed hundreds of assisted suicides. It was her whole practice; that was what she did, and people knew to go to her”.
His amendment to restrict doctor shopping was rejected by 20 votes to 2.
Amendment to remove the requirement to examine all of a patient’s medical records before assisted suicide rejected: Kim Leadbeater amended her own Bill (201) so that doctors would only have to look at those records “appearing to the doctor to be relevant”.
Amendment to inform patients of the risks and nature of complications that may occur during assisted suicide rejected: MPs rejected multiple amendments (305 and 362) that would have required a doctor “to explain the risk of possible complications to the person” seeking assisted suicide.
In making the case for his amendment on complications, Kruger explained that “assisted dying does not offer a risk-free death. In Oregon between 2012 and 2022, there was an 11% complication rate. Reported side effects included regurgitation, seizures, and surviving lethal drugs. Nine patients have regained consciousness after taking assisted suicide prescriptions. Half of all deaths in Oregon took over 53 minutes, which was the median time. The longest took 137 hours. It is not guaranteed that someone will have an uncomplicated, easy or indeed pain-free death”.
“Those who do believe in it have to answer this question: what does a doctor do if a patient is exhibiting distress and not dying—do they bring them back to life, expedite their death or do nothing?”, he asked.
Labour MP Naz Shah complained about the lack of available data on the complications that can arise from assisted suicide drugs. “In the usual sense, complications are side effects from medications. We have research and literature given to us and we understand the potential side effects. In this instance, we do not have a yardstick. I do not know whether the Minister can speak about the Government’s intentions—it would be helpful to have an impact assessment—and whether any research has been done in this area” she said.
MPs argue for and against family involvement in decision for assisted suicide
MPs including Conservative MP Rebecca Paul and Danny Kruger argued that there should be a legal route for family members to provide evidence and be heard by the assisted suicide panels.
Paul said “My point is that the family should be listened to and should have a route to legally provide information to the panel. Right now, they have no right to do that”.
Kruger said “If we see cases where somebody dies by assisted suicide, and the first thing their child or parent knows about it is they are told to come and collect the body, that will be a scandal. That has happened in other countries”.
Kim Leadbeater suggested that families who had concerns about the process of deciding that a loved one was eligible for assisted suicide could take out an injunction to challenge the decision if they thought it necessary.
Pro-assisted suicide MP Kit Malthouse argued against any formal involvement of the family of a loved one dying by assisted suicide since the person wishing to end their life may be obstructed in doing so.
“It is none of your business”
Pro-assisted suicide MP Rachel Hopkins argued against an amendment that would have required that the person requesting assisted suicide be asked why. She said this was a means “to police the conversation” and said “To a certain degree, the patient may think, ‘So what? Do I have to tell you why? It is none of your business why I want to pursue this legal course of action down the line'”.
An amendment to ask a person why they want an assisted suicide “would actually lessen the individual’s autonomy and their right to choose what, if the Bill passes, will be a legal course of action” she said.
