Baroness O'Loan (CB)

My Lords, I have put my name to Amendments 171, 171A, 173, 174 and 174A in this group. The group deals with obligations placed on a registered medical practitioner conducting a preliminary discussion to ensure that it will be possible for the patient to communicate well with the doctor, to hear and understand what is being said, to respond and, in so doing, to be understood. The Bill provides for adjustments for language and literacy barriers, including the use of interpreters. In Amendment 171, so articulately presented by the noble Baroness, Lady Nicholson, she rightly seeks to add provision for hearing and visual impairments. By Amendment 171A, the noble Baroness also seeks to ensure that provision is made for cultural, religious and sex-based factors. This covers a wide range of situations, perhaps the simplest of which might be the reluctance of a woman to speak through a male interpreter in a discussion that might include matters of great sensitivity. Similarly, men may be uncomfortable or even distressed by having such conversations with a woman. Religious considerations may also be profoundly important to the person having the discussion. Many religions seek to deter suicide. This has to be taken into account, particularly to ensure that the person understands exactly what they are agreeing to and the consequences of taking whatever lethal drug is prescribed. By Amendment 174A, the noble Baroness, Lady Nicholson, seeks to introduce an advocate with particular characteristics: having safeguarding experience in relation to cultural and religious issues and being of the same sex as the person contemplating asking for assisted suicide. Those are both profoundly important, as they will facilitate trust in the advocate and hence trust in the process. Similarly, there are those who use sign language—a matter covered by Amendment 172 in the name of the noble Baroness, Lady Grey-Thompson. Of course, under the British Sign Language Act 2022, which was sponsored by the former MP Rosie Cooper, British Sign Language is now an official language of England, Scotland and Wales. I would mention that Rosie Cooper MP was the child of two profoundly deaf parents. She described to me the last days of her father, who was dying at an advanced age with many complications. The problem was that it was not possible for a sign language interpreter to be there when they needed to talk to him and Rosie was finding that she had to go in so often to try to make sure that her father was safe and understood the discussions and what was being put to him. This is a profoundly important matter. In addition, Amendment 173 would provide for those who are blind or partially sighted being able to use amanuenses or Braille. It is not appropriate—though it does happen—for children to be used as interpreters when their parents or family members are sick. The noble Baroness, Lady Berridge, has referred to that. As one who dealt with complaints in a northern health trust, I received complaints about children being used at the age of 10 or 11 to discuss their parents’—particularly their mothers’ —intimate medical conditions, something that was entirely inappropriate for children. I suggest that, if it is inappropriate for children to be involved in that kind of discussion, it is equally inappropriate for a child to be involved in the discussion of matters of life and death. Therefore, I support the noble Baroness, Lady Berridge, in her amendment to preclude the use of children as interpreters. I support all these amendments and those of the noble Baroness, Lady Grey-Thompson. Her Amendments 322 and 322A would require a version of any report to be provided in a person’s preferred language or in an accessible format of their choice. Amendment 406 seeks to assure compliance with that requirement by requiring a record to be kept of the communication affecting any patient. In a country in which there are almost 1 million people with learning difficulties and in which more than 100 languages are spoken—many of those languages do not contain words that are present in the English language, such as “safeguarding” or even “suicide”, and, in many cultures, there are difficulties in discussing suicide—any discussion about whether a person wants to be prescribed and take lethal drugs that will end their life must be conducted with the utmost rigour, to ensure that those making this final decision are under no pressure and will have a full and complete understanding of what is being proposed and what consequences, including any complications, there may be. Will the noble and learned Lord, Lord Falconer, now support these amendments to make the requirements cover needs beyond language and literature? Surely that is proportionate to the seriousness of the communications in this Bill. Does the noble and learned Lord accept that his earlier amendment to lessen the duty on doctors to ensure effective communication has increased concern in the House and that these specific amendments are necessary? The noble and learned Lord’s use of the words “take all reasonable steps”, to which my noble friend Lady Hollins has just referred, implies that there are steps that can be taken to ensure effective communication but are perceived to be too much effort or disproportionate. In discussing whether to take your own life, aided by the state, crystal-clear communication is essential. What must be required is “all necessary steps”, and those steps must explicitly provide for the categories of people referred to in this group.