Terminally Ill Adults (End of Life) Bill — New Clause 10 — No obligation to provide assistance etc — 16 May 2025 at 13:45

“except that section 1(2) of that Act shall not apply”.

“, unless the person has Down syndrome or a learning disability, in which case a registered medical practitioner must not initiate, suggest, or raise the matter of assisted dying with that person”.

“specific and up-to-date training on”.

“and section (Replacing the coordinating or independent doctor where unable or unwilling to continue to act)(6)(a)(ii)”.

“, or

“I helped them out of compassion - and I think that is what’s missing from our current law.”

“No registered medical practitioner or other health professional is under any duty…to participate in the provision of assistance in accordance with this Act”,

“not to be subjected to any detriment”

“No person is under any duty to participate in the provision of assistance in accordance with this Act.”

“A person who would not otherwise meet the requirements of subsection (1) shall not be considered to meet those requirements solely as a result of voluntarily stopping eating or drinking.”

“at least 60 people around the world have been euthanised or assisted in suicide”

“anorexia nervosa listed by name as a terminal condition.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 139, Q175.]

‘If, for instance, you say to a vulnerable patient who has just been told they have a diagnosis of terminal cancer, “Have you thought about assisted dying?”, I would suggest that stating it broadly like that is a form of pressure and that you are potentially unintentionally coercing that patient.’––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 75, Q93.]

“The freedom for a registered medical practitioner (RMP) to raise/discuss the option of seeking help to die in clause 4(2) is ethically problematic.”

“Professional advice regarding treatment will be received by the patient as a recommendation”,

“The thought of being locked in unable to communicate is not how I want to spend the last months of my life. To end my life on my terms when the time comes would give me comfort.”

“has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person”.

“we believe that the Bill as drafted is flawed, and the risks to older, vulnerable people, residing within social care environments are substantial.

We believe that any assumption by those drafting the final legislation that it is not intended for use by those living with conditions regarded as part of the ageing process, would be mistaken. Any legislation would be immediately tested and assumed to be accessible to such a cohort of people.

To that end we believe that in order to provide the necessary protections to such a vulnerable part of our society, the Bill must be explicit in its reference to older people living in residential services.”

“The Bill must take account of the current unfairness and instability at the heart of our social care system, and question whether such legislation can be introduced whilst such problems exist.

The Bill must recognise that an individual health/social care professional’s ability to remove themselves from the process of Assisted Dying is so difficult, that specific exclusion of the care home sector should be a feature of the Bill. In any case, organisations, and sites, should be given the ability to exclude themselves from the act of an assisted death without prejudice to their approval as providers of services to the state.”

“Those that fund their own care pay substantial sums, often saved for over a lifetime-including property wealth. These savings will have been set aside for retirement and to pass on to loved ones. Instead, they are used to fund the costs of their own residential care, and to substantially subsidise the state.

We see the real prospect that those that might fit the criteria for assisted dying under the Bill, but have no wish to accelerate their death, would feel an immediate dilemma between prolonging their own lives, and the future quality of life of their loved ones. For illustrative purposes, the six-month period stated within the current Bill would equate to between £25,000 and £40,000 of expense borne by an individual paying for their own residential care in the current system.

Failings in the system mean that older people who should not be in hospital are held there, causing a burden to the NHS, and Local Authorities face an ever-growing proportion of funding needed to support social care, without a proportionate increase in funding from central government.”

“During the pandemic, we saw the appalling attempts at a widespread use of ‘Do Not Attempt Resuscitation’ arrangements for older people. This is a clear demonstration that an existing broken system places a lower value upon the lives of older people than of others.”

“Relationships within residential care for older people are both professional and intimate. Carers, Care Leaders, and Service Managers are all competent health and social care professionals, but they are also friends and confidantes of those that live within social care services. The relationships are familial in the sense of contact for hours each day and the extension of support to ordinary, everyday issues outside the scope of normal healthcare professionals.

Our employees deliver loving care and build relationships in a way that residents come to depend upon and take comfort from. Such relationships are key to excellent care provision, and these important relationships enhance and prolong lives by providing a sense of purpose and place to older people.”

“In such a setting, it renders the ability for an individual to refuse to partake…as useless.

In an environment such as a care home, there is no way in which a professional could be fully ‘separated’ from assisted dying, should a resident they work with closely seek to enquire about or make a request.

Imagine a scenario where an individual living in social care is at the point where they will be provided with the approved substance to bring about their own death: In a care home, this is likely to be in their own room, which will be in close proximity to many other older people who live within that setting. It will be commonplace and understandable that the magnitude of the event will mean that the individual will wish to have company and comfort up to and immediately before/during the period in which the substance is taken.

A request for the company of a care professional will create a substantial moral dilemma for that person, profoundly so if they are individually opposed to Assisted Dying.”

“Even where they are not, it will mean that they will intimately witness the death of someone with whom they have a strong bond, with that death having come about through facilitation, rather than naturally.”

“The scenario is made worse by the prospect of an assisted death not resulting in a quick nor painless death. There are examples from other jurisdictions of significant complications leading to painful deaths and deeply traumatic experiences for loved ones. Social care professionals should not be exposed to the risk of such experiences.”

“to consider the unworkable nature of individual exclusion from the processes of Assisted Dying for social care professionals. Consequently, specific exclusion of the care home sector should be a feature of the Bill. In any case, organisations, and sites, should”-

“be given the ability to exclude themselves from the act of an assisted death.”

“A difficult subject for most of us to contemplate, but in his particular case the possibility of assisted dying would have given him much comfort.”

“Unless you are actually affected by something as desperate as MND, you cannot understand what it really means to have such an option.”

“I have gone into those communities and I have spoken to them about this Bill. What they say overwhelmingly to me is, ‘We’re scared. We’re really fearful that this is going to result in a disproportionate impact on our community. We have seen that through covid and we’re so scared.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 187, Q245.]

“Almost every week, one of the first things I have to reassure patients about is that I cannot legally do anything to shorten their life. This is front and centre of the fear for those patients and we see it all the time.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 190, Q247.]

“There are some proceedings, though civil in form, whose nature is such that it is appropriate to apply the criminal standard of proof,”

“Guy had always been a bit of an old cowboy, and he always said that he wanted to die with his boots on. I am proud to say that that is what he did. At the end, we were holding hands, and I said to him, ‘Don’t be afraid.’ He said, ‘I’m not afraid,’ and he winked at me just before he closed his eyes.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 258, Q334.]

“Those who had a wish to hasten death were 18 times more likely to also feel suicidal”.––[Official Report, Terminally Ill Adults (End of Life) Bill Public Bill Committee, 30 January 2025; c. 275, Q359.]

“We know that effective palliative care can change a terminally ill person’s point of view from wanting to die to wanting to live.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 70, Q84.]

“Notably the proposed mechanisms of decision making are not in line with good clinical and professional practice… Parliament must address these critical issues in the legislation or risk failing to protect vulnerable patients and uphold the integrity of clinical practice.”

“real concerns about the practical and legal implications”

“do not know much about or have not heard of palliative care”,

“the person has a clear, settled and informed wish to end their own life”

“It is not clear what a psychiatrist’s role on a…panel would be”.

“Panels are to determine referrals in public”.

“The chair of a panel may, at the request of the person to whom a referral relates, decide that the panel is to sit in private.”

“severe pain and discomfort that cannot be reasonably relieved”

“No health professional shall raise assisted dying…unless that person has first raised it.”

“You have the right to be involved in planning and making decisions about your health and care with your care provider or providers, including your end of life care, and to be given information and support to enable you to do this.”

“A person is not to be treated as unable to make a decision unless all practicable steps to help him to do so have been taken without success.”

“capacity is a very serious consideration in our concern.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 178, Q232.]

“For some psychiatrists who wish to conscientiously object, this would constitute being involved”

“We are deeply concerned about the risks of coercion and undue influence. In particular, people with Down’s syndrome and intellectual disabilities are at significant risk of coercion and undue influence, in part because of their need to trust and rely upon caregivers and medical professionals.”

“The Mental Capacity Act was created to safeguard and support people who do not have the capacity to make decisions about their care or treatment or matters like finances. Should the Bill become law in England and Wales, implications for both the Mental Capacity Act and Mental Health Act need to be considered.”

“can reasonably be expected within six months”,

“the registered medical practitioner must ensure that the person has no remediable suicide risk factors which pose a significant risk to their life”

“a significant risk to their life”

Debate in Parliament |