⚰️ Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting)

Public Bill Committees

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In a heated debate on the Terminally Ill Adults (End of Life) Bill, parliament members clashed over how assisted dying services should be structured and funded. Key concerns included whether the NHS or private providers should be involved, and the potential impact on the NHS’s core principles of improving health and treating illness. Some MPs feared that allowing private companies to profit from assisted dying could lead to unethical practices and inequality, while others argued for a model that would ensure services remain free at the point of use. The session highlighted significant disagreements and a lack of clear proposals on how the new service would operate, leaving many questions unanswered.

Summary

  • The session focused on the Terminally Ill Adults (End of Life) Bill, specifically discussing amendments and new clauses related to how assisted dying services should be provided and regulated.

  • Discussions revolved around whether the Secretary of State’s powers under the Bill could include changing the foundational duties of the NHS as outlined in the National Health Service Act 2006. This raised concerns about altering the NHS’s primary focus from improving health to including the provision of assisted dying.

  • Several amendments were tabled, including one to remove a clause allowing the Secretary of State to fund assisted dying services, reflecting concerns about the NHS funding such services without also increasing funding for palliative care.

  • Other amendments proposed restricting the provision of assisted dying services to charitable organizations rather than the NHS, arguing for a separation from traditional healthcare services to maintain public trust and prevent potential conflicts.

  • There was debate about the involvement of private providers in delivering assisted dying services, with concerns about profit incentives potentially conflicting with the ethical delivery of such a sensitive service. Some members argued for strictly public provision to ensure accountability and uniform standards.

  • Amendments also suggested requiring an impact assessment before implementing new regulations, highlighting the need to understand the effects on the healthcare workforce and NHS resources.

  • The session included discussions on the devolution implications for Wales, with proposed adjustments to ensure that the Bill respects the constitutional arrangements within the UK, especially regarding health as a devolved matter.

  • Throughout, there was a noted tension among members on how to implement assisted dying services while preserving the core values and operational integrity of the NHS, with fears about commercialization and the potential undermining of public trust in healthcare services.

Divisiveness

The session displayed a moderate level of disagreement, primarily centered around the provision and regulation of assisted dying services within the NHS and the potential involvement of private providers. The disagreements were evident in the debates over amendments and new clauses, particularly concerning the role of the NHS, the use of Henry VIII powers, and the ethical implications of private sector involvement in assisted dying services. While the discussions were robust and at times contentious, they remained within the bounds of parliamentary decorum and focused on substantive policy issues rather than personal attacks or extreme polarization.

Examples of disagreements include:

  1. NHS Involvement and Henry VIII Powers: Danny Kruger (Con) expressed strong opposition to the inclusion of assisted dying services within the NHS, arguing that it fundamentally changes the NHS’s founding principles. He criticized the use of Henry VIII powers in new clause 36, which would allow the Secretary of State to amend primary legislation, as a significant overreach. This was countered by Lewis Atkinson (Lab), who supported the new clause and argued that the NHS is well-equipped to commission such services, drawing parallels with other specialized services.

  2. Private vs. Public Provision: Sarah Olney (LD) and others raised concerns about the potential for private providers to profit from assisted dying services, which they argued could lead to ethical issues and a commodification of death. This was in contrast to views like those of Dr. Simon Opher (Lab), who argued that the distinction between private and NHS provision was spurious, as long as the service was regulated and provided by doctors under a code of practice.

  3. Impact Assessments and Clarity: There was disagreement over the lack of an impact assessment and the clarity of the proposed model for delivering assisted dying services. Sarah Olney and others criticized the absence of detailed plans, while Kim Leadbeater (Lab) defended the approach, stating that the specifics would be worked out through normal commissioning processes.

  4. Devolution and Welsh Provisions: Liz Saville Roberts (PC) highlighted concerns about the devolution implications of the Bill, particularly with respect to new clause 37, which she felt did not adequately address the constitutional arrangements between Westminster and the Welsh Government. This was acknowledged by Kim Leadbeater, who expressed willingness to continue discussions with Welsh authorities.

Overall, the session showed a clear divide on key issues related to the Bill, but the disagreements were expressed through reasoned debate and policy arguments, warranting a rating of 3 for disagreement.