🧑‍⚖️ Terminally Ill Adults (End of Life) Bill (Twenty-second sitting)

• The Terminally Ill Adults (End of Life) Bill was discussed in a Public Bill Committee session. The session focused on the detailed examination of Clause 12 and related amendments and new clauses.

• The session highlighted a shift from the original judicial oversight by the High Court to a new multidisciplinary panel approach. This change was noted to fundamentally alter the Bill from its form at Second Reading.

• Concerns were raised about the feasibility of staffing the new panels with sufficient numbers of psychiatrists and social workers, who are already in high demand.

• There was debate about the operational details of the panels, including whether they should be adversarial or inquisitorial, with clarification that the panels would be inquisitorial.

• The panel’s reliance on potentially hearsay evidence and the lack of specific guidance on “exceptional circumstances” were points of contention, as these could influence significant decisions.

• Several members expressed worries about the absence of a mechanism for family or other relevant parties to appeal panel decisions, particularly in cases where they may have vital information regarding coercion or the patient’s condition.

• Amendments were proposed to allow appeals if a panel’s decision was wrong or unjust, aiming to balance patient autonomy with family rights and prevent wrongful deaths.

• The standard of proof required for panel decisions was discussed, with suggestions to use the “beyond reasonable doubt” standard due to the gravity of the decisions being made.

• Concerns were also raised about the impact of the Bill on people with learning disabilities and the need for clear guidelines on how panels would assess their eligibility.

• The session underscored the importance of ensuring that the process does not overly burden terminally ill patients, with suggestions to allow pre-recorded evidence for those unable to attend physically due to pain.

• The role of a new Voluntary Assisted Dying Commissioner was introduced, with questions about whether there would be separate commissioners for England and Wales.

• The lack of oral and written evidence on the new panel system was noted as a concern, as was the resource and capacity implications for implementing the new system.

The session of the Public Bill Committee discussing the Terminally Ill Adults (End of Life) Bill showcases a moderate level of disagreement among the members. While there are clear differences in opinion and constructive criticism of the proposed legislation, the interactions remain largely respectful and focused on procedural and substantive details rather than becoming highly contentious or polarized. Here is a detailed explanation of the disagreements observed in the session, along with examples:

1. Disagreement on the Role and Composition of the Panel: There is significant debate about the nature and function of the proposed panel that would oversee the eligibility for assisted dying. Rebecca Paul voices concerns about the panel’s role and whether it is better than the initially proposed High Court oversight, questioning the feasibility of staffing the panel with enough qualified professionals. Kim Leadbeater clarifies that the panel is inquisitorial rather than adversarial, which leads to further discussion on how the panel would function practically.
   • Example: Rebecca Paul critiques the panel’s lack of judicial oversight and raises concerns about the undefined role and strain on social workers and psychiatrists.
2. Appeal Processes and Family Involvement: There is disagreement over the provisions for appeal, particularly about whether family members should have a right to appeal a decision, and in which direction the appeal should be allowed. Rebecca Paul argues for a mechanism allowing family input, citing cases from other jurisdictions where families were not adequately involved. Conversely, others like Jake Richards argue that families should not have the automatic right to appeal, emphasizing the autonomy of the patient.
   • Example: Rebecca Paul’s amendment seeks to give family members the right to appeal a decision to the Commissioner, which draws considerable debate from members like Kit Malthouse, who express concern about potential family interference undermining patient autonomy.
3. Standard of Proof and Judicial Review: Members debate the standard of proof that the panel should use, with Rebecca Paul advocating for a ‘beyond reasonable doubt’ standard akin to a criminal trial, while Jake Richards and others argue that such a high threshold might not be practical for the panel’s function.
   • Example: Rebecca Paul’s mention of the need for a ‘beyond reasonable doubt’ standard provokes debate, with Jake Richards questioning how a panel could be ‘sure’ without exhaustive investigation into a patient’s life.
4. Practical Concerns and Resource Management: There are discussions around the practicality of the proposed system, including concerns from Daniel Francis about the resourcing needed for panels and the potential delays involved. He also highlights the lack of procedural clarity in involving families and handling cases involving learning disabilities.
   • Example: Daniel Francis raises concerns about the capacity of consultant psychiatrists and senior social workers, questioning whether the system would be adequately resourced to handle cases in a timely manner.
5. Philosophical and Legal Underpinnings: Disagreement also emerges on the philosophical basis of the legislation, such as balancing autonomy with safeguarding against coercion or undue influence. Jack Abbott contends that an inquisitorial approach is more appropriate than an adversarial one, while Danny Kruger argues for the legitimacy and rigour provided by a judicial process.
   • Example: Jack Abbott defends the panel’s composition and function, emphasizing the importance of an investigative rather than adversarial approach, which sparks a debate with Danny Kruger over the need for judicial oversight.

Overall, while there are clear points of contention and differing views, the disagreements are more procedural and detail-oriented than fundamentally oppositional, leading to a rating of 3. This score reflects the balance between constructive critique, the search for clarity and improvement of the legislation, and general acceptance of the need for some form of assisted dying process.