🙏 Terminally Ill Adults (End of Life) Bill (Twenty-fourth sitting)

• The session focused on the Terminally Ill Adults (End of Life) Bill, discussing various amendments to Clause 13, which deals with the “Confirmation of request for assistance: second declaration.”

• An amendment was proposed to exclude a person from a shortened second period of reflection if they had voluntarily stopped eating and drinking. This was withdrawn after discussions suggested it was not suitable at this stage in the process.

• Other amendments were made to clarify the timing and requirements of the second declaration in the assisted dying process, ensuring that the coordinating doctor must be satisfied with the declaration immediately before witnessing it.

• A significant debate centered on whether a palliative care referral should be mandatory for patients likely to die within a month of their declaration, highlighting the need for integrated support alongside the assisted dying process.

• The session also considered amendments to Clause 14, regarding the cancellation of declarations. Amendments were passed requiring the coordinating doctor to notify the Commissioner if a declaration is cancelled, emphasizing the importance of transparency and monitoring.

• Discussions around Clause 15 focused on the use of proxies to sign declarations, resulting in amendments requiring the reason for proxy use to be recorded, aiming to enhance safeguards against coercion.

• Amendments to Clause 16 addressed the recording of declarations and statements, introducing a new term “recordable event” to streamline record-keeping processes, vital for monitoring the legislation’s impact and effectiveness.

• Clause 17 saw an amendment ensuring that the cancellation of declarations is effectively recorded with the patient’s GP practice, crucial for maintaining clear medical records.

• Clause 18 was heavily debated, particularly around the amendment to require the coordinating doctor to remind patients they can cancel their declaration right before self-administering the lethal substance, aiming to preserve patient autonomy until the last moment.

• Another amendment in Clause 18, which sought to remove the provision allowing doctors to assist with ingestion or self-administration, was opposed by some members, arguing it might force patients to die earlier than necessary due to physical limitations.

The session exhibits a moderate level of disagreement among the Members of Parliament. This rating is based on several key indicators of disagreement observed throughout the session, including debates over specific amendments and broader philosophical and practical concerns regarding the legislation itself.

1. Debate Over Amendments: There is a clear division on various amendments proposed. For instance, amendments such as amendment 457 (concerning the second period of reflection and the voluntary stopping of eating and drinking) and amendment 316 (regarding automatic referral to palliative care) are debated with differing opinions on their necessity and potential impact. Sarah Olney eventually withdraws amendment 457, indicating some level of concession but also underlying disagreement on the issue’s importance and timing.

2. Philosophical Concerns: Danny Kruger raises philosophical objections about the nature of autonomy and the distinction between assisted suicide and euthanasia, particularly with his argument regarding amendment 463. He challenges the logic behind the distinction, suggesting that it might lead to euthanasia in the future. These comments generate discussion and disagreement, notably from Kim Leadbeater, who argues that there is a significant difference in the involvement and moral responsibility of medical professionals in these scenarios.

3. Practical Concerns: Members such as Danny Kruger and Naz Shah are vocal about the practical implications of the legislation, particularly concerning the safeguarding of vulnerable people and the need for additional checks and balances. Kruger’s amendment 462, which seeks to ensure patients are reminded of their ability to change their mind at the last moment, is a practical measure that he feels is necessary but which also leads to a discussion on its relevance and utility, given existing provisions.

4. Concerns Over Autonomy and Safety: The session includes discussions about the need to respect patient autonomy while ensuring their safety and the safety of the process. This is evident in debates about the use of proxies (amendments 321, 431, 473) and data collection and record-keeping (clause 16). While there is a fundamental agreement on the importance of these aspects, the specifics and mechanisms proposed lead to disagreements among members.

5. Agreement on Aspects of the Bill: Despite the disagreements, there are instances of consensus, such as Kim Leadbeater’s acceptance of certain amendments (like amendment 321) and Danny Kruger’s support for amendments that he believes strengthen safeguards, even if he continues to object to other aspects of the Bill.

Overall, the session shows a balance of disagreement and cooperation. The disagreements primarily revolve around the details and implications of specific amendments rather than the overarching principle of the Bill. However, the discussions are thorough and sometimes impassioned, reflecting a moderate level of disagreement among the members.