Lord Gove (Con)

My Lords, I am introducing six amendments in the name of my noble friend Lord Frost. My noble friend sends his apologies to your Lordships’ House. He is unavoidably detained but hopes to join us during the debate before 6 pm. In his absence, given that these specific amendments relate to the role of neutral advisers and are bracketed along with the debate on independent advocates, I am taking his place. The role of neutral advisers is different from the role of independent advocates, and it is important to draw that distinction. So far, we have been discussing the provision that independent advocates can make to ensure that those living with a series of conditions that may impair their ability to be full participants in the process of deciding on their fate are assisted along the way. It is to the credit of the noble and learned Lord, Lord Falconer, that he has listened to the concerns that have been expressed and has put forward his own amendments, which are there to ensure that people living with disabilities or other conditions can have the support that is believed necessary at that stage in the process. A number of concerns have been expressed by noble Lords about whether the amendment from the noble and learned Lord meets the requirements that have been expressed, but nobody can be in any doubt that he is sincere in his desire to meet those concerns. Neutral advisers relate to a separate part of the process. They relate to Clause 5(6), which states: “A registered medical practitioner who is unwilling or unable to conduct the preliminary discussion mentioned under subsection (3)”— that is the preliminary discussion with someone who may seek an assisted death— “is not required to refer the person to another medical practitioner but must ensure that the person is directed to where they can obtain information and have the preliminary discussion”. This raises a profound concern. The expectation generally would be that the point of contact and the point of authority for anyone seeking this immensely significant procedure would be a qualified medical practitioner with academic expertise and who is bound by the ethical codes of medical practitioners. Quite understandably, there will be many medical practitioners who will not wish in conscience to fulfil that function. We know that, as it happens, not a single royal college endorses the Bill—some are studiedly neutral—but it is undoubtedly the case that there is, at the very least, a substantial minority of medical professionals who do not wish to discharge that function. Who will someone be directed to at that stage? The Bill does not specify that whoever is in receipt of that direction should be appropriately qualified. Indeed, in the original legislation as introduced, it was not intended to be the case that the person was “directed” to where they could obtain information but referred. “Refer” was taken out, not because it was a minor quibble on the part of those who objected to the word but because representative medical organisations, including the GMC and others, said that it is quite wrong to talk about referring. A GP refers you to a consultant when it is in the GP’s view that your medical and health interests are best served by another medical professional. Direction is something else; it is a less authoritative and less safe process. That is why the word is there. In his amendments, the noble Lord, Lord Frost, seeks simply to ensure that those to whom the patients or petitioners are directed are individuals who have the authority, neutrality and detachment to offer unbiased and authoritative advice. It is important that they have not only that expertise but that independence, because a number of the amendments that my noble friend Lord Frost has laid down are there specifically to chart the operation of those providing that advice and to ensure that there is a proper log or register of their operation and the advice given because, as he has pointed out at other times, if we look at other jurisdictions, we can see that sometimes there are some doctors and some figures who become, as it were, the most energetic, determined, implacable advocates of assisted dying and the most generous providers of that service. One of the concerns of my noble friend, which I share, is that some of those to whom individuals are directed will be ideologically committed to a particular end, rather than those governed first and foremost by patient care. There may be appropriate ways in which those who are in receipt of direction can be held to a high ethical code, be required to be independent and be mandated to have certain expertise, but the Bill is silent on what the qualifications or the monitoring mechanism would be. On a previous occasion, I asked the noble and learned Lord whether the provision in the Bill for regulations would allow the future creation of a national assisted death planning or advisory service. The noble and learned Lord said that they might, but that he did not envisage that. We might consider the provision of such a service a terrible step forward, or we might consider it to be a necessary adjunct to the freedoms that the Bill seeks to create, but at the moment we have a gap. We have the promoter of the Bill saying, “I don’t see the need for such a national service. I don’t see the need for any means by which we can govern, control or support the provision of advice”, yet, at the same time, the Bill explicitly states that people will be directed to those who will provide that advice, who are guided by no code of ethics, who are not held to any particular professional standards and who could be advocates for an ideological outcome that is not in the patient’s interest. I would be fascinated to know the noble and learned Lord’s view of the amendments tabled by my noble friend Lord Frost. I know that he will respond with appropriate consideration.