Baroness Finlay of Llandaff (CB)

My Lords, I will now speak to this rather large group of amendments, many of which were simply consequential, so I have withdrawn those to focus the debate. I ask noble Lords who may have questions to kindly allow me to explain the whole process rather than interrupting the sequence. We took extensive evidence in our Select Committee and had many briefings critical of the panel process as written in the Bill. The Royal College of General Practitioners clearly stated that any legislation must ensure that: “Any assisted dying service should be seen as a standalone … service … and … not be deemed core GP work”. It is clear that: “Any assisted dying service would need to be separately and adequately resourced and … not, in any way, result in a de-prioritisation of core general practice, or palliative care services”. The promoters of the Bill themselves have said that the voluntary assisted dying service must be clearly defined and not complicated. The model proposed here would meet those essential criteria and improve safety, providing legitimacy with an expert multidisciplinary panel. Bureaucracy is simplified; it avoids burdening family or treating for clinicians, and it provides statutory separation between assessment and the process of causing death. The effect of the scheme is to provide clarity by strengthening the process so the request goes directly through a genuinely multidisciplinary panel involving rigorous assessment, strong conflict of interest rules, clear statutory guidelines and clear norms for the collection of data—and, in the event of doubt, there is potential court involvement. This creates a higher level of professionalism and greater legitimacy for the person. There is also a clear framework for the panel procedure. Unlike the proposed ADR panels that we previously debated in the Bill, these panels are genuinely multidisciplinary across relevant specialties. The major effect of this is to remove individual doctors assessing in isolation and the risk of “doctor shopping”. There is also a new scheme for licensing and regulating assisted death services, as well as strict regulation of the lethal substances used to bring about an assisted death. This would decrease the risk of dispensing errors, as the process of dispensing approved lethal substances is closely monitored. These amendments move the provision of accurate information to the patient and the assessment of eligibility up front in the Bill. The assessment is all undertaken by a defined group with expertise across different disciplines. Clinicians looking after the patient, irrespective of whether they support or do not support the provision of assisted dying, would continue with their duty of care to the patient and family throughout the process. Thus, the patient would continue to have their usual clinicians look after them, as always, while in parallel they could be assessed for eligibility against the criteria to be established in a statutory code of practice. Let me explain: Amendment 143 would require the independent commissioner to support the new multidisciplinary panel workings, retain records for at least 10 years, support research and report to Parliament. Amendment 266 would ensure the panel members’ independence. Amendment 192 would signpost the person to the panel, because an assisted death is not a medical treatment. The person can obtain accurate, up-to-date information including, in Amendment 232, how to initiate the process. Amendments 333 and 334 describe the panel’s make-up and its process. The panel would have a lawyer, a social worker or psychologist, a specialist in end-of-life care—all of whom would have at least 10 years’ clinical experience—and an administrator, plus a consultant specialist in the disease of the person and, if required, the option to co-opt up to seven members. Their statutory duties relate to licensing, or declining, the provision of lethal drugs or poisonous substances. They can refer to the High Court if in doubt. Amendment 233 would clarify that two panel members conducting a documented hearing must go to the patient. The proposed new clause in Amendment 615 explains how the assisted dying service that comes into operation when a person’s assisted death has been approved would execute its functions in complying with a person’s wishes, including the safe transport of dispensed substances. Amendment 551 describes a neutral professional of experience who, once an assisted death was approved, could help the patient by ensuring that all correct processes were followed, deal with complications, collect all data and notify relevant persons of the death. This would avoid the difficulty of a doctor being tied up waiting for the person to die after ingesting the lethal drugs. The Oregon data shows that sometimes this can be prolonged. Amendments 552 and 702 would determine a designated regional pharmacy to link to the assisted dying service to improve safety in the dispensing and transport of lethal drugs or other poisons and the disposal of any unused substances. Amendment 552A in the name of my noble friend Lady Hollins improves my Amendment 552 by seeking to ensure compliance with regulatory safeguards. Amendments 704 to 706 relate to the limits on regulation-making powers, and Amendment 707 covers devices. We do not know what these devices are, but they are referred to in the Bill. Amendment 698 would require all lethal substances to be compliant with MHRA regulations and the Misuse of Drugs Act. Amendments 556 and 643 would require the GP to be notified of the process. Amendment 654 would ensure completeness. Amendments 667, 760, 761 and 767 would make it clear that the involvement of a health or social care professional in the assisted death service was separate from their health or social care employment and that their employer must know of their involvement. This is a separate service that must not jeopardise the care of other patients. However, Amendment 710 to the clause on the regulation of approved substances would give effect to the recommendation of the Delegated Powers and Regulatory Reform Committee, on which I sit—although I should say that I am not speaking on behalf of the committee—to remove the most sweeping of the Henry VIII powers in the Bill. I do not consider the amendment of the noble and learned Lord, the sponsor, to my amendment to be adequate. Others may wish to comment. All my remaining 56 amendments in this group are consequential and have been written to ensure that there is clarity throughout the Bill as to the effect of these changes. This is not vexatious.