Lord Rook (Lab)

My Lords, my Amendment 19 would add a modest but important safeguard to Clause 1 by ensuring that a person seeking an assisted death has been registered with a GP practice in England or Wales for at least 12 months and has had at least two contacts with that practice in that period, whether in person, remotely or through a home visit. These are minimal thresholds. They do not obstruct genuine applicants. They would simply ensure that before someone seeks the assistance of the state in ending their life, there is at least some continuity of care—the importance of which the right revered Prelate the Bishop of Norwich has already stressed this morning. To this end, a real relationship with the primary care system is important and prevents a terminal decision becoming subject only to a paper exercise. The Bill already requires 12 months of ordinary residence, but ordinary residence, as we discussed on the last day in Committee, can be, legally speaking, a somewhat elastic concept. A single GP registration can in practice be little more than having your name down on a list. The Government’s own equality impact assessment notes that access to GP services is uneven, that continuity of care is declining, and that patients in deprived or rural areas often struggle to obtain timely appointments. The independent investigation into the NHS by the noble Lord, Lord Darzi, discovered that more than 1,300 GP practices have closed since 2015, while the average full-time GP now has responsibility for more than 2,200 patients. In such a landscape, it is simply unrealistic to assume that every person approaching the end of life will have a meaningful GP relationship, without a safeguard such as the one I propose in this amendment. This amendment would give the residency requirement real substance. Twelve months of registration and two GP contacts would not create a barrier but would provide a more objective basis for assessing doctors to know that the person has not merely appeared in the system at a moment of crisis. The amendment would also increase the chance that some medical history exists. Notes of previous consultations, indications of distress, relevant family context and prior diagnoses are all crucial in understanding whether a wish to die is stable or situational. This matters because, as we have discussed already and at some length, the Bill places extraordinary weight on two clinicians making difficult judgments about a prognosis, about mental state and about possible coercion. Clause 12 allows them to seek information from the person’s GP, but this safeguard works only if a relationship with that GP actually exists. As a number of noble Lords have mentioned, this House has been served well by the Bill’s own Select Committee. In that, your Lordships heard repeatedly that continuity of care is one of the most reliable protections against misjudging capacity or missing signs of procedure. Dr Michael Mulholland of the RCGP stressed that continuity is not a luxury but central to safe clinical judgment. Professor Katherine Sleeman explained that earlier access to palliative care often changes patients’ perception of their suffering, which again relies on a clinician who knows the patient. Without any medical history or any prior interactions with clinicians, life and death decisions are being made without the proper safeguards. This is not safe for patients, and it is not safe for, or fair to, doctors. We also heard extensive evidence on access difficulties. Caroline Abrahams of Age UK told the Select Committee that the single biggest practical improvement that older people want is simply being able to see their GP. Many cannot. She noted that significant numbers of older people near the end of life have no contact at all with their GP, not because they do not want it but because the system does not provide it. A report cited in the equality impact assessment on the Bill found that two in three older people in Wales struggle even to make suitable appointments. If access to GP care is already fragile, the Bill must not assume a relationship that does not exist. There is also the risk, recognised multiple times already in Committee, of doctor shopping. We see it in pain management, in cosmetic procedures, even in end-of-life discussions. When someone is desperate, frightened or grieving, they will simply go from clinician to clinician until they find the answer that they feel they want and need. Expert witnesses, including psychiatrists and geriatricians, told the Select Committee that major emotional shifts commonly occur around diagnosis, around transitions in care or around family crises. These are precisely the moments when a single assessment by an unfamiliar doctor is most likely to misread a temporary situational wish to die as a settled and autonomous choice. International evidence reinforces the point. Australian states, often cited as models, have tightened their systems after discovering patterns of people travelling to access assisted dying without any real connection to local health services. Canadian doctors regularly highlight the difficulty of assessing capacity and voluntariness when clinicians had no longitudinal knowledge of the patient, contributing to public concern over several high-profile cases. We need not make those mistakes. The DHSC and MoJ impact assessments underline that assisted deaths must be documented and monitored and that clinicians require access to historical records to make safe judgments. But the true quality and veracity of these records relies on real and consistent engagement with a primary care provider. The Select Committee also heard from social workers and safeguarding experts, who emphasised that subtle coercion is almost impossible to detect in a single clinical encounter.