Baroness Finlay of Llandaff (CB)

My Lords, Amendment 27 would ensure that the person in question has made independent contact for information from their local assisted death service provider and has not been subtly coerced or pressured by someone who thought they ought to consider an assisted death. Getting information to inform decision-making is crucial to supporting autonomy. Patients must be able to access all the details they need about an assisted death from a place that is not their primary source of care, their doctor. Having alternative independent sources of information for an assisted death gives greater latitude for patients to understand their choice, and at the pace they need. This Bill, as the sponsors have made very clear, is about autonomy. People’s autonomy in decision-making depends on having the information they need, and in any format that they require, as they drive their information-gathering process themselves, outside of the intricacies of the relationship with clinicians. The power imbalance between the doctor or senior nurse and the patient can be a distorting influence. This amendment is designed to give the patient agency in how they learn about an assisted death. Amendment 42 would require that the person in question is fully informed. Having an assisted death is a hugely consequential choice for someone to make. Their understanding of the drugs they will take, how the process works and the consequences for self and others is crucial. I am concerned the Bill does not include enough details about the process through which this can happen. The Bill discusses but provides very few details about how this service is to be provided and funded. It feels like a black hole in the Bill. The Delegated Powers and Regulatory Reform Committee noted: “One might expect the integration of the assisted dying system with the NHS to involve a substantial degree of new regulation but the powers contain next to no indication of the shape or substance of the regulatory regime that is intended for VAD services. Instead, they give Ministers almost unlimited powers to legislate in that area by statutory instrument”. It goes on to say in the report—I should declare that I am a member of that committee—that Clauses 41 and 42 “are skeleton provision because they are ‘so insubstantial that the real operation of the Act … would be entirely by the regulations or orders made under it’”. The committee recommended that the delegated powers in Clauses 41 and 42 be removed from the Bill, and, if alternative delegated powers in relation to the services are introduced, that “they are appropriately justified, include sufficient detail and statement of principle to understand the intended regulatory system, are limited to what is necessary to meet their objectives, and are subject to the affirmative procedure”. In a similar way, there are glaring gaps in the Bill. Clause 5, on “Preliminary discussions with registered medical practitioners”, specifies in subsection (6) that a doctor “who is unwilling or unable to conduct the preliminary discussion … must ensure that the person is directed to where they can obtain information and have the preliminary discussion”. Nothing more is said, though, about who may provide that information, what their qualifications are and whether there is any government or regulatory oversight of those providing such information; nor does the Bill address the need for a trusted and neutral source of information. Whether it is a register, an agency or a local assisted dying service, all get to the heart of legislating in this way. None of the detail seems to have been worked through. If this is to be a private service, the regulation envisaged in the Bill is entirely inadequate. If this is to be an NHS service, is it to be fully integrated or a separate service? How we do this on the NHS does not seem clear at all.