Rebecca Paul MP: speeches

Speeches

• 1 Apr 2025 · Relationship Education in Schools · Hansard source

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  It is a pleasure to serve under your chairmanship, Sir Jeremy. I thank the hon. Member for Epsom and Ewell (Helen Maguire) for securing this important debate on relationship education in schools, as well as for touching on the harrowing stories of violence against women and girls in her constituency. Before I proceed further, I offer my heartfelt condolences to the families, friends, colleagues and pupils of those impacted. In the decade between 2008 to 2018, around three women a week were killed by men in the UK. Shockingly, around one in four women have been raped or sexually assaulted. This shows the gravity of the misogyny in our society faced by women and girls. Although relationship education can only go so far in addressing male violence against women and girls, it plays an important role in educating our young people on what positive and healthy relationships look like and the importance of putting in place clear boundaries. Those skills are vital in navigating relationships, recognising potential abuse, including that of coercive control, and knowing how and when to seek help. Relationship education was made compulsory in all primary and secondary schools in 2020. Although schools are able to determine their own curriculum, they must have regard to the statutory guidance released in 2019. From my experience of looking at some of the school materials used, it seems that focus in relationship education has a tendency to gravitate towards other topics rather than spending the necessary amount of time on propagating positive and respectful relationships between boys and girls and addressing many of the issues raised today. That is something that schools and the Government need to reflect on. An important part of relationship education is teaching young people about the risks and harms of the internet and social media. With damaging online porn available at the touch of a button on smartphones, young men are fed a constant stream of misogynistic content that will change how they view women and girls. While they are able to access hours of degrading and violent content directed at women whenever they like, the relatively small amount of time spent learning the opposite in a classroom cannot hope to offset the harmful influence. That is why the Conservatives have called for a ban on smartphones in schools for under-16s, which would at least go part of the way in promoting children’s wellbeing and protecting them from harmful content on social media during the school day. It is also important to note that, for many young people, the distinction between the online and media world can be blurred, so they need the skills to navigate that safely. We all know that people feel more anonymous online, say things that they would never say face to face and may even present themselves as someone different to who they actually are. On top of this, they are fed a stream of factually incorrect information and unobtainable body images. In accordance with Department for Education guidance, schools should be alive to issues such as everyday sexism, misogyny, homophobia and gender stereotypes, and take positive action to build a culture where those are not tolerated. In spite of this, sexual violence and harassment does, I am afraid to say, take place in schools. It is vital that such behaviours are not tolerated and are never acceptable. Any reports of sexual violence or harassment should be taken seriously, and it must be recognised that girls are much more likely to be victims, with boys the most likely perpetrator. With that being said, it is vital that our boys are not made to feel that this behaviour is inevitable as a result of them being male. Indeed, it is only a minority who behave in this way. When it comes to our boys, we should value their unique attributes and not demonise them or make them feel bad for having masculine traits. These traits are not, in the great majority of cases, toxic. The requirement to deliver RHSE has led to a surge in outside providers making available their resources to schools. Some are good, and some are not so good. The guidance is clear that schools should not, under any circumstances, work with or use materials produced by external agencies that take or promote extreme political positions. Accordingly, schools are required to assess each resource to ensure it is age-appropriate and sensitive to their needs, and should provide examples to parents on request. Parents should be given every opportunity to understand the purpose and content of materials, and it is certainly not appropriate for such materials to be withheld under the guise of copyright restrictions. All parents have a right to know what a school is teaching their child. It was confirmed by the previous Education Secretary in the Conservative Government that materials used in the classroom can be shared, irrespective of copyright restrictions. It should never be forgotten that parents and carers are ultimately responsible for the education of their children, so in most cases teaching in schools should be done with parents, not contrary to them, and in a way that is sympathetic to their values and beliefs. That starts with being transparent about what is being taught. It is also important to note that schools have a legal obligation to be politically impartial when teaching, which means that children must be offered a balanced presentation of opposing views. It seems that many schools have struggled with the impartiality requirement on this specific topic, which drove additional guidance to be released in 2022. I note the reference to a backlash—

• 1 Apr 2025 · Relationship Education in Schools · Hansard source

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  Thank you, Sir Jeremy. I note the reference to a backlash against RHSE lessons due to anti-LGBTQ+ rhetoric, and I want to push back on that. It is not unreasonable for parents to raise their concerns about schools teaching factually incorrect, ideological and damaging content about gender identity. They are right to do so, and it is the responsible thing to do. I agree that the teaching of such harmful concepts as fact has done damage to the important subject of RHSE as a whole. In closing—

• 28 Mar 2025 · Looked After Children (Distance Placements) Bill · Hansard source

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  I am pleased to contribute to this important debate, and I congratulate the hon. Member for Rother Valley (Jake Richards) on bringing the Bill before the House. I commend him for shining a spotlight on an issue that affects some of the most vulnerable children in the country. These children are not simply statistics or case numbers; they are young people who have experienced trauma, instability and, in many cases, loss. It is essential that they get the loving home and the support that they deserve, so that they can flourish. He has brought this issue to the House with compassion and care, and I commend him for doing so. As a serving Surrey county councillor and a former member of the corporate parenting board, this is an issue close to my heart, too. I have seen at first hand many of the challenges and systemic failings that have been talked about. As was set out, local authorities have a duty, so far as reasonably practicable, to ensure that looked-after children are placed in accommodation that meets their needs in the local area, but many local authorities fail to achieve that, and often shockingly high numbers of children are placed out of area. I am sure that the inclusion of the words, “so far as reasonably practicable” was intended to give some leeway to local authorities where needed, and to recognise that sometimes distance placements are in the best interests of the child. However, I am afraid that in far too many cases those words have become a licence for abject failure. Yes, I accept that there are many challenges for local authorities in meeting their duties, including the higher cost of living, which makes it difficult to recruit and retain foster carers; the increased national demand for placements; and even the recent ban on using unregulated accommodation for 16 and 17-year-olds. Those pressures are real, but it is unacceptable that high numbers of looked-after children are being placed in accommodation far away from the communities that they know—far from their schools, their extended family and their support networks. Such placements are often made not because they are seen as the best option for the child, but because there is simply nowhere else to put them. The problem is that it becomes almost normal to send high numbers of children out of area, so it becomes more acceptable. I am here to say that, except in specific cases, it is not acceptable. Local authorities and national Government need to do more to ensure that the sufficiency duty is met. The wellbeing and safety of these vulnerable children depend upon it. The damaging consequences of these long-distance placements are obvious. Children placed miles away are more likely to experience educational disruption, go missing and lose contact with friends, siblings and trusted adults. In some cases, the sense of being cut adrift from everything familiar only deepens an already present feeling of abandonment. It should be noted that these placements are often beyond the local authority boundary, giving rise to myriad further risks. It is self-evident that the system needs further intervention, and I am pleased that any policy decisions taken in the future will build on the major reforms introduced by the previous Conservative Government. Perhaps the most impactful reform in this space was the introduction of the staying put policy in 2014, which allowed young people in foster care to remain with their foster family until the age of 21. That was a transformational step. For the first time, young people in care were offered the stability and ongoing familial support that many of their peers take for granted. It was also the previous Conservative Government who rolled out regional adoption agencies, which are designed to reduce delays in the adoption process and increase the number of children finding permanent, loving homes. Since their introduction, adoption timeliness has improved, and agencies have been better able to match children with prospective parents across wider geographical areas. We also published our strategy and consultation, “Children’s Social Care: Stable Homes, Built on Love”. Our strategy was backed initially by £200 million of additional investment over two years to transform children’s social care, including by delivering a decisive multi-agency child protection system and ensuring that every child has a valued, supported and highly-skilled social worker when needed. Finally, the publication of the independent review of children’s social care in 2022, commissioned by the last Government, was a landmark moment. It provided a comprehensive and honest assessment of the system’s challenges, and offered a road map for reform focused on early intervention, family help and a more relational, less transactional model of care. Those milestones, taken together, demonstrate that we have always taken the needs of looked-after children seriously, and we will continue to work constructively alongside Government Members to improve the support available to these children; I know Government Members have the same overarching objective of transforming life outcomes for these children. I return to the Bill. The ambition of improving the transparency of data about placements of looked-after children is much welcomed. The Bill would place a duty on local authorities to publish such information, making it easier to identify where there are issues, and where local authorities are not performing. We will start to see tangible improvement only when the extent of the issue nationally is clearly laid out. As is often the way, measurement prompts improvement. Undoubtedly, one of the most consequential aspects of the Bill is the requirement for the Secretary of State to produce a national sufficiency strategy for looked-after children. Local authorities can and should do more to collaborate at regional level to ensure that children are put in placements close to their homes, but the structural challenges faced likely cannot be solved by local government alone. National leadership is essential, and I urge Ministers to look seriously at how best to increase placement capacity where there are shortages, and at how to ensure that the right children end up in the right locations, not just the cheapest locations. That is not to say that local authorities are not at the heart of this challenge—they are—but I know that they find it increasingly difficult. The residential care market is now heavily dominated by private providers, and the cost of placements continues to rise, placing a huge strain on local authority budgets. A shift to a more strategic approach is needed, and I recognise that the hon. Member for Rother Valley has sought to kick-start that shift with the requirement in his Bill for local sufficiency strategies to be published by local authorities in England. At this point, I should acknowledge that for all the justifiable talk today against distance placements, there is a very limited set of circumstances in which they are appropriate and necessary. Some children need specialist provision that simply does not exist locally. Others may need to be placed at a distance to ensure their safety if they have become involved with gangs or are threatened by an abuser. The question is not whether distance placements should be banned—they should not—but how we can get to a point where they are used only when it is truly and demonstrably in the best interests of the child. A key focus is how we recruit, retain and support foster carers, and how we encourage local authorities to invest in local residential provision at a time of such pressure on their budgets. Many of the answers lie in not only legislation but funding, training and leadership, both local and national. I look forward to the Minister’s comments on these important issues. When a child is taken into care, the state becomes their parent. That is not a responsibility to ever be exercised lightly. We must hold ourselves and the systems we put in place to the highest standard—the standard we would expect and demand for our own children. The hon. Member for Rother Valley has brought this Bill forward in precisely that spirit, and I congratulate him once again on doing so. It was truly a pleasure to speak on it.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  It transformed the quality of life of British citizens at a time of mass unemployment and widespread slums, ensuring free healthcare, in the words of Beveridge, from cradle to grave. The provision of healthcare free at the point of delivery was life-changing and life-prolonging. Although it is far from perfect, we have seen time and time again that as a country we can be very proud of the NHS. The National Health Service Act 1946 came into effect on 5 July 1948, as a direct consequence of the Beveridge report. Section 1 of the Act states: “It shall be the duty of the Minister of Health…to promote the establishment in England and Wales of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness”. It was set up to help people to get better and live healthy lives, and to give hope in situations where otherwise there would be despair. It was lifesaving and life-changing. New clause 36 turns all that on its head. Subsection (4) states that: “Regulations under this section may for example provide that specified references in the National Health Service Act 2006 to the health service continued under section 1(1) of that Act include references to commissioned VAD services.” If this new clause passes, the founding principles of the NHS will be monumentally changed to include helping eligible people to commit suicide. That is what it does. I want to be really clear that it is entirely possible to support assisted dying—to want to ensure that a small group of people, whom palliative care cannot help, have that assisted dying option—but not to support this new clause, which forces provision of the service through the same channels as normal healthcare. Assisted dying is not a medical treatment or a healthcare service and accordingly there should be a degree of separation. We should be incredibly cautious about incorporating the service into the NHS. It will forever change the relationship between doctor and patient, breed mistrust and fear, discourage vulnerable groups from seeking the healthcare they need and fundamentally violate the Hippocratic oath. Dr Catherine Day, a senior partner of a large GP practice in Coventry, states: “Trust lies at the heart of the doctor patient relationship. I believe this trust will be shattered if patients consider that their GP…may think that they should end their life and stop being a drain on our NHS.” Siwan Seaman, a palliative care consultant said: “How could a terminally ill patient trust a doctor if they know that the doctor was prescribing medication to the patient in the next bed in a bay or cubicle with the intention of ending their life. Letting these assessments take place alongside other NHS services will irreversibly impact on patients’ trust in healthcare professionals and negatively impact our therapeutic relationship with patients as doctors.”

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  I will come on to some of that, and it goes back to my belief that there should be a degree of separation. I think it should be separate from normal healthcare services and there are multiple ways that we could do that. I regret that we are not specifically debating the various different options, with a proposal in front of us detailing exactly how it would work. I am assuming, from the new clause put forward, that the proposal is for this to go through the NHS as healthcare; that is the only assumption I can make based on what is in front of me in this Bill, because there is no other detail to give me any other impression. Sarah Davies, a consultant respiratory physician in north Wales, argues for a separate service so that ordinary NHS care is not associated with assisted dying. She said: “It is already my experience that patients and their families are anxious about limiting treatment when they are dying. Many people believe that symptom control medication, such as those delivered in a syringe-driver to aid symptom control amount to hastening or bringing on death. This perception can hinder the patient’s acceptance of medications which can afford significant alleviation of distressing symptoms.” I have raised my concerns about providing an assisted dying service alongside and in conjunction with day-to-day healthcare many times over the last few weeks. I think it is a massive mistake both for patients and healthcare staff. It blurs the lines of what a treatment is, increases the risk of bad decisions and, as we heard so powerfully from Dr Jamilla Hussain, it will discourage some of the most vulnerable groups from seeking essential healthcare. We have received so much evidence and it is really important that we take it on board, so I will be quoting some in my speech. Dr Green of the BMA said: “It should be set up through a separate service with a degree of separation. We believe that is important for patients, because it would reassure patients who may be anxious about the service that it would not just be part of their normal care… It would reassure doctors, because doctors who did not want to have any part would not feel that it was part of their normal job, whereas the doctors who wanted to go ahead would be assured of having support, emotional support and proper training.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 45, Q32.] In oral evidence, Professor Preston argued for a separate system and pointed to the Swiss example. She said: “In covid, we did research in care homes, and there was real concern about ‘do not resuscitate’ orders and emergency care plans that were blanketed across the care homes. Care home staff were traumatised by that, so there are real issues. We know that there are real issues day to day in how people are treated within the NHS. I think it is unconscious—I do not think people are intending it—but we know that people are treated differently and that different things are done. That is partly why we think a system outside that would protect them, because then you are not within the healthcare team that is treating you and giving you advice about such things”. She went on to talk about the Swiss system, also being adopted in Germany and Austria, which seeks to “protect these people by keeping it one step removed” from normal healthcare. She said: “Most hospitals in Switzerland will not allow assisted dying to occur, because they do not want a lack of trust in their patient group.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 246, Q317.] I therefore support amendment 525, tabled by my hon. Friend the Member for East Wiltshire, which would amend clause 32 in order not to allow the provision of the assisted dying service to be done through the health service. That would ensure that much-needed degree of separation. In light of what the Bill’s promoter has said, I recognise that there are different ways to do that; I am very open to those different ways, but I need to see that degree of separation from normal healthcare. I also support new amendment (a) to new clause 36, also tabled by my hon. Friend, which does the same thing. Let me come to the other amendments in this group. Amendments 537 and 528, tabled by the hon. Members for Shipley and for Richmond Park respectively, are important to debate—we have had some good debate on them this morning—as they raise the different ways of delivering an assisted dying service. I have been listening closely to the points made. Amendment 537 would limit the provision of an assisted death to charities rather than to the NHS, and conversely, amendment 528 would limit provision to public authorities only. I do not have the answer on the best way to do this, and that is why I regret that a royal commission has not been set up to properly investigate and evaluate all the options and recommend the best way forward. Instead, we are here without all the relevant information and expertise available to us, trying to land on the best way to do it. That is not the way to make such an important decision. I can tell the Committee, however, that—like many others, including my hon. Friend the Member for East Wiltshire—I have huge reservations about delivering such a service through the NHS alongside normal healthcare. I agree with much of the evidence that has already been cited: there should be a degree of separation. The BMA said that assisted dying could be part of the NHS, but should be outside existing care pathways and separate in some way: “Our view is that assisted dying should not be part of the standard role of doctors or integrated into existing care pathways—it is not something that a doctor can just add to their usual role… The separate service could take the form of a professional network of specially trained doctors from across the country who have chosen to participate, who come together to receive specialised training, guidance, and both practical and emotional support. They would then provide the service within their own locality—for example, in the patient’s usual hospital, or their home. Or it could be a combination of some specialist centres and an outreach facility.” In its written evidence, the Royal College of General Practitioners also proposed a separate service: “The establishment of a separate service which covered every stage of the process would ensure healthcare professionals of multiple disciplines (including GPs) who wanted to do so could still opt in to provide assisted dying, but this would be arranged through a different pathway.” I agree with both bodies that the service should be separated out in some way. It is now apparent that my hon. Friend the Member for Runnymede and Weybridge (Dr Spencer), whose amendments would have created an assisted dying agency, was on the right track. I regret that the Committee did not explore his ideas in any real detail during our proceedings. We received important written evidence from Robert Twycross, a pioneer of palliative care who sadly died in October, but had given his friend Ariel Dempsey permission to submit it. Dr Dempsey writes: “Twycross recommends a de-medicalized model in which AD is a separate service, delivered outside of healthcare practice. He argues for a standalone Department for Assisted Dying, separate from the NHS. He writes, ‘Data indicate that the primary reason for a persistent desire for AD is to relieve distress over a perceived loss of autonomy and to experience a sense of personal control over the circumstances of their dying. These are not medical reasons. Thus, for patients fulfilling the legal criteria, a separate AD service should be established. Indeed, this would be the best way to prevent a corrosive effect on medical practice generally.’ ‘Given the widespread disquiet felt by doctors, a law with minimal medical involvement would be the most equitable.’ He suggests, ‘One way to achieve this would be for [AD] to be delegated to a stand-alone Department for Assisted Dying, completely separate from the NHS and with its own budget. Victoria almost achieves this with its combination of Care Navigators, mandatory training for participating doctors, and a separate Voluntary Assisted Dying Statewide Pharmacy Service.’ Twycross emphasizes that hospice and palliative care must be a ‘sanctuary’ for patients – ‘an assisted dying free zone. Even in the absence of AD, some people decline referral to palliative care despite unrelieved pain and/or other distressing symptoms because they fear they will be “drugged to death”…This unfounded fear will most likely be enhanced if AD is legalized, particularly if palliative care is involved’ and result in an overall increase in suffering.”

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Ms McVey. I rise to speak on clause stand part and new clause 36, and in support of amendment 525 and amendment (a) to new clause 36, tabled by my hon. Friend the Member for East Wiltshire. This is a really important debate. The NHS is the greatest achievement of any Labour Government, and maybe even of any Government.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  I thank the hon. Member for his intervention. I was quoting written evidence, so I just quoted it, of course, as written. We should be ashamed if what I have set out is where we end up as a result of this Bill. How would it in any way recognise patient autonomy and give them a real choice? Clearly, it would not. We will end up with patients taking an assisted death because there is no alternative to dying well. If as much effort was put into improving palliative care as has been put into legalising assisted dying, a much greater number of people would be given the dignified, comfortable deaths they rightly deserve. It is a travesty that we find ourselves considering the introduction of assisted dying while hospices are on their knees and patients face a postcode lottery when it comes to receiving adequate end-of-life care. Accordingly, I will vote against new clause 36.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting) · Hansard source

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  It is important that there is a degree of separation, but I would say to the hon. Lady that it would have made more sense for her to put forward a proposal that we could evaluate, assess, and identify the upsides and downsides of. It would be much easier for me to then come up with suggestions. It does not make sense to ask me, “What is the solution and how would you do this?”, and for me to lay out the many different ways that this could be done, without having first laid a proposal in front of me.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I rise to speak briefly to amendments 172 and 173, in my name, but amendment 172 will fall if amendment 539 is voted through. The point of amendment 172 is to ensure that the commissioner has adequate data about important events. It turns a “may” into a “must”. It means that the Secretary of State must issue regulations requiring a doctor to notify the chief medical officer, or the commissioner as in all likelihood it will be, of any notifiable event.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I completely agree. That is exactly what the amendment is intended to do. We are trying to prevent advertising of an inappropriate service to inappropriate groups. It makes sense, therefore, to effectively ban advertising. I think most people would agree that it would be distasteful and inappropriate to have adverts for assisted dying everywhere people look. I hope that hon. Members will consider supporting the amendment, even if that is in an amended form.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  It is a pleasure to serve under your chairmanship, Sir Roger. I rise to speak about amendments 518 and 520. As we have said, it is important that we understand what coercion means in a legal sense, and I am really grateful to the hon. Member for Penistone and Stocksbridge for trying to set that out, because it is not an easy task. Like her, I am concerned that defining it in this way may make it harder to prove coercion and may undermine the safeguards in the Bill. Under the amendments, the assessing doctors and the panel are meant to look not just for evidence of coercion but for evidence of intent to induce assisted suicide, and they will have to show that the applicant is requesting assisted suicide against their will. That could make the law powerless against many kinds of behaviour that we want to prohibit. To start with the point about intent, coercion and pressure take many forms, and they do not always involve a clear intent. Amendment (b) to amendment 518 and amendment (b) to amendment 520, in the name of the hon. Member for Lowestoft, very reasonably draw attention to family relationships. On Second Reading, the right hon. Member for Hackney North and Stoke Newington (Ms Abbott) said: “people do not generally write letters to sick relatives urging them to consider assisted suicide and then put those letters on file. Coercion in the family context can be about not what you say but what you do not say—the long, meaningful pause.” —[ Official Report , 29 November 2024; Vol. 757, c. 1030.] But even in more blatant cases, we cannot necessarily prove intent directed towards assisted suicide. Sue Smith, a clinical psychologist, said in written evidence that coercive control often ramps up when the abused partner receives a cancer diagnosis: “The seriousness of the cancer diagnosis may be systematically and actively denied or minimised, claims can be made by the male partner that she is attention seeking, or she is accused of making up the effects of treatment, and can be left isolated and alone when in physical need…a woman learns to doubt her reality and experience, and is extremely isolated. This can lead to heightened anxiety, hopelessness and helplessness, and abject despair, which can lead to a person wishing they were dead.” That could be seen as coercion towards assisted suicide, but in that scenario does the abusive partner demonstrate clear intent? I am not sure the doctor or panel could demonstrate that in that instance, especially as they need to be satisfied only on the balance of probabilities that there is no coercion. If the panel think that there is a 45% chance that there is intent, but no more than that, they have to grant the application. The harrowing story of Ryan Wellings and Kiena Dawes shows that even when coercion can be proved, proving that an abuser intends someone else’s suicide is a completely different matter. After Kiena Dawes took her own life, Wellings was convicted of coercive control and assault. The judge told him: “from May 2020 until her death you abused, assaulted, exploited, controlled and demeaned her. When she died it is clear that she had begun to believe your lies to the effect that she was deranged, physically disgusting, friendless, worthless and an unfit mother. You had persuaded her that she had no one to turn to.” Before her death, Dawes wrote a note saying, “Ryan Wellings killed me.” Although he was convicted on other counts, Wellings was acquitted of manslaughter. That demonstrates that coercive control, even if it is followed by suicide, does not always mean that intent can be demonstrated. It is really tricky. Similarly, people may pressurise a relative without intending to override their will. The barrister Ruth Hughes KC, who has been quoted before, said: “It is surprisingly easy for a relative, whilst completing a variation on ‘the classic asset strip’, to persuade themselves that they are actually acting in their aunt Dorothy’s best interests or in accordance with her wishes”. In other words, someone can pressurise a relative into assisted suicide without intending to. Again, including intent here could actually muddy the waters. I have a similar concern about the phrase “against that other person’s will”. That sounds very straightforward, but in practice it can be much less clear. Part of the effect of coercion is that people lose confidence in their own will and adopt that of others. In written evidence, many frontline workers pointed out that coercion does not always clearly appear as someone acting against their will. Janet Reiss, a specialist doctor in palliative care in Wolverhampton, says patients will not “even necessarily be aware of being coerced”. Dr Jennifer Hardes Dvorak, a senior lecturer at Canterbury Christ Church University specialising in medical law, states that the Bill “does not consider how people internalise feelings of coercion and…act on this.” If someone has internalised a feeling that they would be better off dead, that may be their will, even if we hope we could change it. Anni Donaldson, a domestic abuse expert at the University of Strathclyde, said: “Decades of work examining the impact of coercive and controlling behaviour has shown that ‘coercive control’ is not merely persuasion, but a complete change in the perspective of the victim so that she truly believes that she is worthless, a burden to her partner or wider family, and would not be missed should she die…Women are regularly humiliated, demeaned, and told they would be ‘better off dead’, or, that they are a ‘useless mother’, or that the children would be better off without them. This abuse erodes women’s confidence, autonomy, and self-esteem. Cut off from support, women often come to believe these lies, fearing reprisals from their partner if they report the abuse, many choose to tell no one. This long term, relentless, dehumanising process can result in a woman believing that she is ‘disposable’.” Similarly, the writer and campaigner Sarah Ditum warns that the Bill may not protect “the patient who, through lengthy cruelty and coercion from a partner or carer, becomes genuinely convinced that she (or sometimes he) is a burden who would be better off dead. Such a person may even refuse treatment, causing a curable disease to become terminal and placing them within the purview of the bill.” So we might not believe that assisted suicide is in someone’s best interests, but there is no best interest test in the Bill or the amendments—just a reference to the person’s will. If a victim of coercive control truly believes they ought to die, it is not clear how the doctor or the panel can refuse their application, unless coercion can actually be proved, and proving it is not always easy, as we have just discussed. My hon. Friend the Member for East Wiltshire has tabled amendments to remove the phrase “against that other person’s will”. Obviously, that is all academic now, as we are not pressing the amendment to a vote, but I would support doing that, because that phrase does more to narrow the definition than anything else. On another point, amendments 518 and 520 refer to pressure and coercion from organisations. I do not know exactly what the hon. Member for Penistone and Stocksbridge has in mind with that. I guess an example might be the cases we have heard about in other jurisdictions where a health insurer or provider tells someone that they cannot fund a treatment but can fund assisted dying options. It could be that the hon. Lady had other things in mind there. That would possibly count as pressure under some circumstances, but it would be very hard to show that there was intent on the part of the organisation. It is not clear that the amendments help us to identify and avoid coercion and pressure in that sense. Before I finish, I would like to point out something else that might be missing from the amendments: it is my favourite topic, the question of undue influence—my apologies to the Justice Minister, because I know we have gone over it a few times.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I thank my right hon. Friend for that point. He is absolutely right that we can learn from what other jurisdictions have done, leverage that and create an amendment or new clause that works for what we are trying to achieve, and know that it will target the advertising that we seek to target.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  It would be reassuring if that were the case because such data can be very useful. By making sure we get into the routine of providing it, it is there if we ever need it. Amendment 173 provides that any regulations under the clause must be made under the affirmative rather than the negative statutory instrument procedure. In the interests of using our time well, I will not repeat the arguments that were made last week on this. However, if amendment 539 is accepted, the Bill will again defer a lot to ministerial powers and non-binding guidance and codes of practice. Under the negative procedure, Parliament is reduced to watching rather than properly participating in the decision-making process.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I think we would be talking about an advert via electronic form, marketing a particular service. We would have to go back to the meaning of “advert” to answer that. Obviously, there are broader ways of advertising on social media and so on, which I also seek to prevent with the amendment. That is why banning the advertising of such services is so important, so that a pro-suicide message is not inadvertently delivered to millions of people who assisted dying is not appropriate for. We have to recognise that there are vulnerable people out there who could be influenced by it. It is my view that conversations about assisted dying should happen in person, between the relevant doctor and the patient; they should not be prompted by a TV ad or something seen on a bus. Ads should not be coming up on someone’s Facebook feed every time they log on. I hope Committee members will support this common-sense amendment. I think that for it to be properly effective, it needs to be expanded to also cover clinics or other organisations advertising assisted dying services more broadly. I very much welcome the opportunity to work with Ministers and the Bill’s sponsor to get this right, if the Committee is disposed to supporting such an amendment.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I thank the hon. Lady for that clarification of the information she has been given. We have gone over the question of undue influence a few times. I promise I will not talk about it for much longer, but it is relevant, which is why I keep raising it. In a judgment that my hon. Friend the Member for Solihull West and Shirley has previously mentioned, Lord Nicholls said that undue influence includes two things. The first is “overt acts of improper pressure or coercion”. The second is a kind of influence that “arises out of a relationship between two persons where one has acquired over another a measure of influence, or ascendancy, of which the ascendant person then takes unfair advantage...The influence one person has over another provides scope for misuse without any specific overt acts of persuasion. The relationship between two individuals may be such that, without more, one of them is disposed to agree a course of action proposed by the other.” That definition suggests something broader than what is described in amendments 518 and 520, but I take the point that the hon. Member for Penistone and Stocksbridge has just clarified. The amendments suggest that somebody will actively interfere with someone else’s “decision-making autonomy” and have an intention to induce them to do something. But Lord Nicolls’s definition of undue influence is much less dramatic; it just identifies a relationship where one person’s view holds a lot of sway. For the last time—I promise—I would be grateful for the Minister’s view on that. I am sure she will talk through that point and advise on the clarification the hon. Lady has just given. In conclusion, the amendments are completely well intended. It is helpful that the hon. Lady tabled them and that we have had this debate, and I am grateful to her for that. However, I am inclined to think that they would narrow the definition too much. My preference would be to remain with what we have, subject to the points I have raised many times on undue influence.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  Will the hon. Lady give way?

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I am sorry to backtrack slightly, but I want to clarify that the Isle of Man is a Crown dependency and not part of the UK.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I beg to move, That the clause be read a Second time. The new clause would make the advertising of services by a co-ordinating and/or independent doctor by a person in the course of a business an offence with a sentence of up to two years in prison or a fine or both. As we have discussed previously, we will likely see private provision of assisted dying services, if the Bill is approved. That will create a potentially lucrative opportunity for private businesses, particularly if provision on the NHS is not consistent across the country or is overwhelmed. “Advertising” means the techniques used to bring attention to a product or service with the aim of presenting it as something a potential customer might need or want. The overarching aim of advertising by a business is to ultimately sell more of a product or service. We must keep that overarching reason in mind when considering the amendment. It would be incredibly inappropriate for such services to be advertised on billboards, public transport or daytime telly, targeting those who may be approaching the end of their life, with ads run repeatedly along with those for stairlifts and life insurance. Such advertising could also undermine our national suicide prevention strategy by normalising suicide in certain situations. It becomes much harder to say to people that suicide is not the answer if we are content to say that it is in certain situations. I can only imagine some of the difficult conversations that could be generated from an advert seen by a young girl or boy already battling with suicidal thoughts. How does a parent or guardian explain why suicide is not right for them? Imagine the potential impact on men, too. As we all know, suicide is a leading cause of death in men in this country. In 2022, for males between the ages of 20 and 34, one in four deaths was categorised as “intentional self-harm” or “event of undetermined intent”. That is a shocking statistic. That is why banning the advertising of such services is so important.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I rise to support new clause 34, which clarifies that assisted dying is not a medical treatment—not only because of the principle behind it, which I have talked a lot about already, but because of the unintended results. We need to recognise that many laws, rules and regulations have been written using the word “treatment” that never envisaged assisted dying being included. Every bit of law that refers to when treatment can be given, with or even without consent, such as section 63 of the Mental Health Act 1983, will become a potential problem if assisted dying is technically viewed as a medical treatment. New clause 34 is therefore essential to protect the meaning and integrity of the current law and to protect patients in future. In written evidence, Professor David Jones points out that there are dangerous consequences to classifying death as a medical treatment. As a general principle, he observes: “If an effective medical treatment cannot be self-administered orally then other routes should be considered, including those administered by a healthcare professional.” We can immediately see the problem that will arise if assisted dying is a treatment. The view that such a treatment can be administered by a healthcare professional suddenly moves us into euthanasia territory, which is clearly not the intention of the Bill. Professor Jones goes on to say: “If a treatment effectively reduces distressing symptoms in one category of patient (adults at the end of life), then it should be considered for treating other categories of patient”. If we substitute the word “treatment” with “assisted dying”, we get a wholly unacceptable approach that could open the way to offering assisted dying to under-18s, as in Belgium, or to people whose psychological suffering is unbearable, as we have seen in Belgium and the Netherlands with the euthanasia of people with mental health conditions. Finally, Professor Jones says: “Where a patient does not have capacity to consent to medical treatment then doctors should provide whatever treatment is ‘of overall benefit’ to the patient.” If we substitute the same words, we can see that once again it leaves us with a big issue. The Bill already has requirements relating to capacity, age and physical illness, and a requirement for self-administration, but the point is that by classifying assisted dying as a medical treatment we are making those requirements less stable and introducing the potential for conflict within the existing law. We are inviting future Parliaments to question why they are there in the first place. Why arbitrarily restrict this medical treatment when we do not restrict other treatments in the same way? If we do not rule out assisted dying as a medical treatment, we are potentially opening the Bill up for challenge by the courts when assisted dying treatment is limited to certain groups. That is one reason why the Association for Palliative Medicine has explicitly backed the principle represented in the new clause. It has said in written evidence that defining death as treatment would be “contrary to all prior medical practice and public expectation, and laden with risks of unintended consequences.” The Bill may look set in stone, but the law can easily be amended in future, for instance by amending a major health Bill. What we decide in this Committee could have major consequences in a few years’ time. I urge that we future-proof the Bill now by explicitly declaring in it that assisted dying is not a medical treatment, so that the issues I have set out will not arise at any point.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I would not choose to have this specific definition in the Bill. There may well be another definition that I would be more comfortable with, so I cannot rule that out. However, I completely agree with the hon. Lady that this has been a helpful debate, and I really appreciate her tabling the amendments so that we could have it.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  I thank everyone for all the very constructive points they made. I completely agree with the points raised; I think some work is needed, but I am pleased that the hon. Member for Spen Valley and other Committee members are willing to work with me and the tabling Member—my hon. Friend the Member for West Worcestershire—to get this measure into a place where it does what we want it to do, without capturing things that we do not want it to capture. I completely take the point on the concern about emails; that is not what we want to capture.

• 25 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting) · Hansard source

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  Given the spirit of it, I feel like we should. That does not prevent me from tabling it on Report—so yes, I will press it to a vote. Question put, That the clause be read a Second time.

• 19 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-seventh sitting) · Hansard source

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  My apologies, Mr Dowd, but it is a technical point. I think the Minister understands what I am asking.

• 19 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-seventh sitting) · Hansard source

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  I appreciate that, Mr Dowd, which is why I was elaborating—I wanted to make sure that everyone understood the nature of the question without having seen the letter. In order to summarise, following your instruction, I refer to the letter.

• 19 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty-seventh sitting) · Hansard source

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  I rise to speak briefly on clause stand part. As I noted a few weeks back—it feels a long time ago—when we debated amendment 82, the clause leaves the law in a strange position. I hope that we will now have the opportunity to explore that and make sure that we are comfortable with the position and have identified whether any changes are needed. Section 2(1) of the Suicide Act 1961 criminalises both assisting and encouraging suicide: “A person (‘D’) commits an offence if— (a) D does an act capable of encouraging or assisting the suicide or attempted suicide of another person, and (b) D’s act was intended to encourage or assist suicide or an attempt at suicide.” It is a single offence, but can be committed in two ways: either through assistance or through encouragement. Clause 24(3), both as drafted and as amended by amendment 505, would make an exception from criminal liability under the Suicide Act, but in respect only of assistance, not of encouragement. It would cover: “(a) providing assistance to a person to end their own life in accordance with the Terminally Ill Adults (End of Life) Act 2025, or performing any other function under that Act in accordance with that Act, or (b) assisting a person seeking to end their own life in accordance with that Act, in connection with the doing of anything under that Act.” In other words, it is strictly limited to assisting suicide. It only covers the actions in the Bill around conducting the preliminary discussion, assessing the applicant, giving the applicant the approved substance and so on. What happens to the other half of section 2 of the Suicide Act: the offence of encouraging suicide? I will not rehash the debates that we had over amendment 82, but I must point out that as that amendment was rejected, the law does not dovetail. Encouragement would still be very much an offence under the Suicide Act, as it has not been excepted under the Bill. Because my amendment was not agreed to, we will have the absurd situation in which somebody can commit the crime of actively encouraging someone to take their own life, yet that will not be looked for or taken into account when assessing someone’s eligibility for an assisted death. On the flipside, there is a very real risk for families and friends of loved ones who could inadvertently overstep the mark and move from support of a loved one to encouragement. It does not take much imagination to realise that that could lead to accusations and potentially even to prosecution if the law is not sorted and clarified at this stage. We already know how difficult it has been for family members who want to accompany loved ones to Dignitas but fear that they could face prosecution; the hon. Member for Spen Valley has made that point so eloquently. No one wants that, so it is important that we ensure that the Bill does not create a similar situation in which someone could be unfairly prosecuted for encouragement, which is still very much a crime under the Suicide Act.