🩺 Terminally Ill Adults (End of Life) Bill (Eighteenth sitting)

• The Public Bill Committee discussed the Terminally Ill Adults (End of Life) Bill, focusing on amendments to Clause 5 about the qualifications and responsibilities of the coordinating doctor in the assisted dying process.

• Amendments were proposed to exclude physician associates and doctors in training from acting as coordinating doctors due to concerns about their level of experience and expertise required for such a sensitive role.

• There was a strong emphasis on the need for specialized training and clear regulatory frameworks for doctors involved in assisted dying. The amendments aimed to legally require the Secretary of State to establish regulations on the training, qualifications, and experience needed for doctors.

• Training requirements discussed included assessing a patient’s capacity and detecting coercion or pressure from others, with specific proposals for mandatory training in domestic abuse, coercive control, and financial abuse.

• Additional proposals included training tailored for autistic people and those with learning disabilities, recognizing the unique needs and vulnerabilities of these groups in the context of end-of-life decisions.

• Concerns were raised about the potential for private providers to offer assisted dying services, leading to suggestions for transparency over financial arrangements and a need to understand the full implications of these services.

• The debate highlighted the need to differentiate between NHS and potential private services, emphasizing that the service should be available through the NHS, but also acknowledging the complexities of funding and remuneration.

• Language accessibility was addressed, with amendments proposed to ensure Welsh language proficiency among practitioners in Wales when needed.

• There were discussions on respecting the devolution settlement, with proposals to adjust the Bill to allow Welsh Ministers to have equivalent powers to the Secretary of State in matters relevant to Wales.

• The session demonstrated a commitment to ensuring that any legislative changes are robust, with adequate safeguards in place to protect vulnerable individuals and to make sure that the process respects the patient’s autonomy and the ethical responsibilities of healthcare professionals.

The session exhibits a moderate level of disagreement among the participants, warranting a rating of 3 out of 5. The disagreements primarily revolve around the specifics of the amendments to the Bill, rather than the overarching principles of the legislation itself. Here’s a detailed breakdown of the disagreements and their nature:

1. Amendment 290: There was visible disagreement and a formal division on this amendment, which sought to exclude physician associates and doctors in training from acting as coordinating doctors. The vote resulted in 9 ayes and 13 noes, indicating significant opposition to the amendment. This highlights a disagreement on the qualifications and roles of medical practitioners involved in the assisted dying process.

2. Amendment 335: Another formal division occurred for this amendment, which aimed to specify that the required training should be ‘specialised’. The vote was closer with 8 ayes and 14 noes, showing a clear desire among some members to define training more rigorously, while others were content with the existing provisions.

3. Amendment 359: There was some contention around the requirement for the coordinating doctor to have conducted a preliminary discussion before witnessing the signing of the first declaration. Although the amendment was defeated with 3 ayes and 19 noes, the discussion around it indicated differences in opinion regarding the process and involvement of doctors at various stages.

4. Amendment 360: Disagreement surfaced around the transparency of remuneration for doctors providing assisted dying services. The amendment sought to mandate public annual statements, and the debate around it showed differing views on the necessity and impact of such transparency.

5. Welsh Language and Devolution: The proposed amendments to involve Welsh Ministers and address the Welsh language elicited different views. There was disagreement on the extent to which Wales should have separate provisions due to the devolution settlement. The right hon. Member for Dwyfor Meirionnydd eventually withdrew these amendments after acknowledging the need for more specific discussions with the Government.

6. Operational Model: There was confusion and disagreement regarding whether assisted dying should be an NHS or private service. This was evident in the discussions around amendments 360 and 361, with differing interpretations from different members, indicating a lack of consensus on how the service should be delivered.

While the session shows clear points of disagreement, these are mostly centered on operational details and technical amendments rather than fundamental opposition to the Bill’s concept. The respectful nature of the debates and willingness to collaborate on refining the legislation suggest a moderate level of disagreement rather than deep polarization.