Sarah Olney MP: speeches

Speeches

• 11 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Twenty First sitting) · Hansard source

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  The amendment would remove the phrase “or otherwise” in the clause. All I am proposing is for the wording to be consistent with amendment 205 to clause 10, which has just been agreed. It does not specify “or otherwise”, but simply uses the words, “the practitioner dies or through illness is unable or unwilling”. What might “otherwise” incorporate? It indicates that there might be a range of reasons beyond death or illness why the co-ordinating doctor would drop out. In many ways, I am trying to probe what the other reasons might be. If there are no other reasons, and consistent with amendment 205 that we have just agreed, we should drop the phrase “or otherwise”.

• 6 Mar 2025 · Cyber-security: Local Government Resilience · Hansard source

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  The US Defence Secretary, Pete Hegseth, has this week announced the stepping back of US counter-cyber measures against Russia. This incredibly concerning decision by the Americans threatens not only their cyber-security, but our own. The Russian Government have been accused of orchestrating a widespread campaign of interference and disinformation that seeks to undermine the global order. In 2020, the UK Parliament’s Intelligence and Security Committee stated that the Government had underestimated the response required to the Russian threat. Can the Minister tell us what further measures the Government are taking to protect British democracy, and will he commit to publishing the full, unredacted Russia report?

• 6 Mar 2025 · Political Finance Rules · Hansard source

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  I thank the hon. Member for South Dorset (Lloyd Hatton) for his work in securing this important debate, and Members from across the House for their contributions this afternoon. The Liberal Democrats support this motion, which aligns with our long-standing stance on political finance reform and protecting democracy from foreign influence. We have long called for reforms to prevent foreign interference and increase the transparency in political donations. We support strengthening the Electoral Commission by restoring its independence and increasing its enforcement powers, including higher fines for breaches of political finance laws. Our democracy should never be up for sale to foreign billionaires, oligarchs, or hostile states and, as such, we support this motion, which acknowledges some of those risks. The Liberal Democrats will continue to push for strong measures to protect our political and electoral system. We want to take big money out of politics by capping donations to political parties. I am proud that my hon. Friend the Member for Stratford-on-Avon (Manuela Perteghella) presented a Bill in this House to do just that. And we want to enhance regulatory powers to protect British democracy from the unprecedented threat posed by foreign interference and attacks on our democracy. Liberal Democrats will make protecting our democracy a national security priority. We are seeing record levels of disillusionment with the political process, with citizens becoming increasingly disengaged. Research from the Electoral Commission highlights a significant drop in the rate of public confidence in political finance transparency, falling from 37% in 2011 to about 15% today. It has also recently pointed out the threat of foreign influence on social media, highlighting the rise in misinformation and artificial intelligence deepfakes in the run-up to the general election in July last year, as well as new issues arising from the changes to fact checking on popular websites. Public trust in our electoral process was not helped by the disastrous record of the former Conservative Government. It was not just their successive sleaze scandals, which created a crisis of democracy in this country, or their exorbitant voter ID scheme, which disproportionately disenfranchises the young and those from ethnic minority communities, but their shameful decision to weaken the independence of the Electoral Commission, and that is a decision that will go down in ignominy. If we are to strengthen our democratic safeguards, and correspondingly strengthen public trust in our democracy, that has to start with empowering the Electoral Commission. That is why we need to reverse the Conservatives’ changes. We want to strengthen the Electoral Commission by repealing the Government’s power to designate a strategy and policy statement for the commission. The former Conservative Government also failed to take the threat posed by Russia seriously. They were content to allow Russian money to flood into the UK and also to allow Russian money to flow into the coffers of their own party. And the manner in which Boris Johnson let the Russia report sit on his desk was shocking. When that report was finally published, it laid bare the extent to which Russia is a threat, including to our democratic institutions. The report said: “The UK is clearly a target for Russia’s disinformation campaigns and political influence operations and must therefore equip itself to counter such efforts.” It called Russian influence in the UK “the new normal” and said that the Government had underestimated the response required to the Russian threat. We continue to call for the full publication of the unredacted report. The Russian Government have been accused of orchestrating a widespread campaign of interference and disinformation that seeks to undermine the global order. In September 2024, the heads of MI6 and the CIA jointly warned that the international order is under threat in a way not seen since the end of the cold war, accusing Russia of a “reckless campaign of sabotage across Europe”. I hope that the Minister shares my concern that this week United States Defence Secretary Hegseth has announced the stepping back of US counter-cyber measures against Russia. That is an incredibly concerning decision by the Americans, which threatens not only their cyber-security but our own. Will she update the House on what measures the UK is taking to step up our defence of our democratic institutions? We will continue to urge the Government to designate protecting our democracy as a national security priority. Turning to foreign oligarchs, it would be remiss of me not to mention Elon Musk. Let us recall that just weeks before Musk became a US Government official, he suggested that America should liberate the people of Britain and overthrow the UK Government. I hope that other parties will join the Liberal Democrats in unequivocally condemning such remarks. That incident further proves that we urgently need to tighten up political funding. That includes a cap on big donations. We must prevent foreign oligarchs from being able to interfere in our democracy. The Liberal Democrats want to take big money out of politics by capping donations to political parties, and we support the motion. A fair cap will ensure that politics serves our constituents and not big money. Over two thirds of the British public support a cap on political donations. We must deliver the reforms that people are demanding.

• 6 Mar 2025 · Relations with the EU · Hansard source

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  Two weeks ago, I was glad to read reports in The Times that the Government intend to introduce a youth mobility scheme between the UK and the EU. That would be good for our economy, while providing young British people with the opportunity to work and study abroad. That is what the British public want, with new polling showing that more than two thirds of the UK population are in favour of such a scheme, but last week the Home Secretary ruled it out. Will the Minister do the right thing, remove the unnecessary barriers facing young people in the UK and commit to negotiations on an EU-UK youth mobility scheme?

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  We need to consider the possibility that somebody is suffering from a terminal illness as a comorbidity with an eating disorder; they may be suffering from an eating disorder alongside something that can be considered a terminal illness—there are such cases. However, it is not unknown—and Chelsea Roff, an expert on eating disorders, who has given evidence to the Committee both orally and in writing, has uncovered a number of occasions in jurisdictions where assisted dying is already legal—for an eating disorder to be defined as a terminal illness. It is really important that we understand that there remains a risk that an eating disorder could be a terminal illness.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I am grateful for that intervention and, dare I say it, for the one from the right hon. Gentleman. That is the whole point about eating disorders: there is a very fine line to be trod between people who have capacity, people who lack capacity and people who have capacity but who can still be allowed to make an unwise choice, which is obviously a huge risk for people with eating disorders. I find that risk very much magnified in the Bill as it is currently drafted, which is why it is of the utmost importance that it provides specifically for the possibility that somebody is suffering from any kind of mental health illness, and particularly from an eating disorder—but I do not see such a provision at the moment. I heard the arguments that were made when I raised this issue in earlier sittings, and I very much welcome amendment 6, but it deals only with capacity; it does not talk about mental illness. To conclude, amendment 363 is a crucial safeguard that would prevent assisted dying from becoming an unintended route for people suffering from mental health conditions, such as eating disorders, to end their lives prematurely. It would ensure that requests for assisted death are based on genuine, rational decisions, rather than symptoms of a treatable disorder. By aligning with best practice from other jurisdictions and addressing a critical gap in the UK’s current approach, it would strengthen the ethical foundations of the assisted dying Bill and better protect vulnerable individuals.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I believe I repeated several times in my speech that this is not about capacity; it is about mental illness.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  Let me just reply to the hon. Member’s original point. It is so important—and this is why we need the amendment in the Bill—that if there is any doubt at all that someone is suffering from a treatable mental health condition, they are not allowed to proceed with their request for an assisted death until all avenues of treatment for that condition have been explored. Eating disorders are treatable: people can recover and can, in the fullness of time, recover their zest for life. They can move beyond the stage where their decision whether to eat or not is their entire world. They can rediscover their friends, their employment and their education, and they can look forward to a full life again. But it is imperative that while they are in the grip of that eating disorder, they are not offered the option of an assisted death.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  I beg to move amendment 363, in clause 7, page 4, line 7, at end insert— “(ba) is not seeking assistance to end their own life because of an impairment of judgment arising from a mental disorder or other condition,”. This amendment would require that the coordinating doctor is satisfied that a person is not seeking assistance to end their own life due to an impairment of judgement arising from a mental disorder or other condition. It is linked to Amendments 364, 365, 366 and 367.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  Does the hon. Gentleman assert that it is therefore impossible for anybody with a mental illness that might affect their ability to make a decision about an assisted death to be judged to have capacity?

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  The hon. Member is absolutely right. The Court of Protection has described eating disorders using language typically reserved for terminal illnesses. It has described an eating disorder as being in “the terminal stage”, talked of “all treatment options” having “been exhausted” and used words such as “incurable”. It is immensely regrettable, but nevertheless the case—even though eating disorders are always treatable—that if a person suffering from an eating disorder is deemed to have capacity and is refusing treatment, there may well be nothing that can be done to stop them choosing that path, which may ultimately lead to their death.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  Will the hon. Gentleman address the point that the requirement to refer for specialist psychiatric support is a requirement in similar legislation in other parts of the world—in Oregon, in California, in the state of Victoria in Australia, and in other jurisdictions that we heard evidence from? It is written into their legislation and provides a crucial extra safeguard, which is separate from the judgment about capacity because it is deemed to be so important.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  Although this is not specified in any of the amendments—which are in the name of my good friend, my hon. Friend the Member for Bath (Wera Hobhouse) —they are very much informed by the work she has done over a number of years as the chair of the eating disorders all-party parliamentary group. This is a subject about which she has a great deal of knowledge, and that is what has prompted this group of amendments, which follow on from the debate we had just before the break. It is important to remember that although amendment 6 —in the name of another good friend, my hon. Friend the Member for St Albans (Daisy Cooper)—talked specifically about people’s capacity, this group of amendments very much returns to a topic I have spoken on at length in previous sittings: how a person’s capacity to request an assisted death might well be impacted if they are suffering from mental health difficulties. Amendment 363 would require a mental health assessment if there is any indication that a person’s judgment may be impaired by a mental disorder or other conditions. We have debated this topic at length— [ Interruption. ] I see the right hon. Member for North West Hampshire nodding, but it is worth returning to the issue, because a principal concern of mine is that we have not yet dealt adequately with this risk in the Bill. We have talked about how the Mental Capacity Act might be applied and about psychosocial interventions, but I am keen to see amendment 363 agreed to, because it would deal with many of the objections raised in those other debates. It is an important safeguard that still needs to be included in the Bill. The Bill has been described as having the strongest safeguards in the world, but it lacks this critical safeguard, which is seen in many similar laws around the world, including Oregon and California, which require that in addition to establishing mental capacity, doctors must ensure that a person’s judgment is not impaired by mental illness. In fact, in the American state of Hawaii, every patient who requests an assisted death is required to see a mental health professional, who can determine whether the patient is capable and appears not to be suffering from under-treatment or non-treatment of depression or other conditions that may interfere with their ability to make an informed decision. It is provided for specifically and clearly in the legislation that governs assisted dying in other jurisdictions that assessments of the state of people’s mental health—and not just their capacity—must be made properly. The absence of any such safeguard in the Bill represents a clear risk. We know that mental health conditions can impair decision making and lead to suicidal ideation, particularly when a person lacks adequate social support. Without this provision, individuals experiencing a treatable mental health crisis may be given life-ending medication instead of the care and treatment that could alleviate their suffering. Professor Allan House made the importance of that clear in his written evidence. He wrote: “Simply checking mental capacity and asking about coercion is not adequate.” He emphasised that National Institute for Health and Care Excellence guidelines in other areas already require a comprehensive psychosocial assessment that explores “thoughts about life not being worth living” and considers “current and recent personal and social circumstances, recent adversities, psychological state beyond merely assessing mental capacity and the presence of severe mental illness.” Professor Louis Appleby, the Government’s adviser on suicide prevention—I have referenced him on many occasions in previous sittings—has also raised concerns that the Bill could undermine suicide prevention efforts. Speaking to The Guardian , he said: “You have a number of potentially remediable risk factors like isolation, for example. Do something about isolation. Depression, treat depression. It should be the offer of supporting people through the remediable elements of a sense of despair.” That highlights why a safeguard is necessary to ensure that individuals receive proper assessment and treatment, if needed, before making an irreversible decision. If a person qualifies for assisted dying but is also experiencing impaired judgment due to a psychiatric condition, how can we be confident that their decision is truly autonomous? Amendment 363 would require the co-ordinating doctor to assess whether a person’s request for assisted dying is influenced by a mental health condition. If there is any concern that impaired judgment due to a mental disorder is a factor, the doctor must refer the individual for a psychiatric assessment. The amendment would explicitly protect individuals with mental health disorders, including eating disorders, from accessing assisted dying when their desire to die is a symptom of their illness rather than a rational decision deriving from a terminal illness. Do not ask me how I know this, but eating disorders really scramble a person’s brain. They leave them entirely incapable of making any kind of rational decision. The lack of nutrition really affects the brain: it has a physical impact that means the brain simply cannot function as it is supposed to. That is a direct cause of a person not ingesting the nutrients they need. When that happens to somebody, their behaviour completely changes: they become anxious, fearful, irrational and aggressive. It is not just that they believe their life is not worth living; the entire span of their life has shrunk down entirely to the question of how they can avoid eating. What is the next meal? What is the next stage in their life when someone is going to try to get them to eat, and how can they avoid that? What tactics can they employ? When a person is in the grip of that kind of eating disorder, if someone comes along and offers them the possibility of an assisted death, there is every chance that they will choose that as a way of avoiding eating. As I say, do not ask me how I know this, but I have seen it, and for me it is beyond comprehension that we could possibly allow young people, and young women in particular, to put themselves in the position where they are being offered an assisted death and no one is taking those extra steps to treat their eating disorders—and eating disorders are always treatable. That is why I want to press the amendment.

• 5 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Nineteeth sitting) · Hansard source

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  That is why we need to ensure that people with eating disorders get the treatment they need, instead of being offered an assisted death. That is why we need the amendment.

• 4 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Seventeenth sitting) · Hansard source

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  Would the hon. Gentleman not accept that a terminal illness in itself is a risk factor for an increased risk of suicide, and also that that risk is increased in the first six months following the diagnosis? That is the thinking behind the amendment.

• 4 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Seventeenth sitting) · Hansard source

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  For clarity, if the amendment specified a psychosocial assessment, would the hon. Gentleman be minded to support it?

• 4 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Seventeenth sitting) · Hansard source

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  I will not take up a huge amount of time, because a lot of what I wanted to say has been said in previous sittings, but I return to the issue of people who may request an assisted death who may also be suffering from a mental health condition. Amendment 271 was tabled by the right hon. Member for South West Wiltshire (Dr Murrison), and specifically concerns people who have received their terminal illness diagnosis less than six months ago and whose prognosis is less than 6 months in the future. The amendment specifically addresses the fact that the risk of suicide for people who are suffering from a terminal illness increases when the diagnosis has been made less than six months before. Professor Louis Appleby is a key academic in the area of suicide prevention and advises the Government on it. Research by him and Professor Sleeman found: “Diagnosis of severe conditions was associated with an increased risk of dying by suicide”. In particular, they found: “The increase in risk was more pronounced in the first six months after diagnosis or first treatment.” They concluded that: “A diagnosis of severe physical illness is associated with higher suicide risk. The interaction of physical and mental illness emphasises the importance of collaborative physical and mental health care in these patients.” We talked at length in an earlier sitting about the risk that bringing in an assisted dying law would undermine suicide prevention strategies and efforts to address the issue of suicide. It is important that we return to this issue, and that we look seriously at the amendment in the name of the right hon. Member for South West Wiltshire, because it addresses the specific concern around those people who have had their diagnosis of terminal illness for less than six months and are therefore at a heightened risk of suicide. NICE guidelines say that if someone is at risk of self-harm or suicide, a clinician must ensure that a psychosocial assessment has been carried out either by a mental health specialist or by a trained person in primary care. That should cover the person’s living arrangements, relationships, social support network, mental health disorders, risk factors, safeguarding concerns and so on. Professor Allan House told the Committee in oral evidence that this should be part of the assessment for assisted dying. He said the current assessment only answers the question: “‘Is this person able to make decisions?’…it does not cover the psychological and social assessment.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 165, Q210.] We have discussed at length the lack of the psychosocial assessment in relation to everybody who makes a request for an assisted death, but the amendment seeks to identify those who are at heightened risk of suicide—those who have received their diagnosis of terminal illness within the last six months—and specifically requires psychosocial assessments for those people. Depression is common among those with terminal illness. Dr Price from the Royal College of Psychiatrists told the Committee that among “people nearing the end of life…depression is…at around 20%—much more common than in the general population. We know that depression is strongly associated with a wish to hasten death” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 275, Q359.] and that that wish is significantly alleviated if depression is treated, which is an extremely important point for the Committee to consider. The Pathfinders Neuromuscular Alliance, which is a user-led charity for those with muscle-weakening conditions such as muscular dystrophy, have stated in written evidence: “Pathfinders members have outlined how important it is to ensure psychological assessments are part of the process in order to ensure that the individual is in a position to make an informed decision. One member outlined: ‘I’ve been there, I’ve wanted to die, and I’ve been in the position where I would take that option if it was given to me, but looking back I can see I was depressed and now I’m so glad that I didn’t take that option.’” Currently, the Bill does not require anyone to explore any psychosocial factors in respect of someone’s situation. Although the person can be referred to a psychiatrist under clause 9(3), that only covers a capacity assessment. Again, it only answers the question of whether the person is able to make decisions, and addresses none of the other relevant factors. In Oregon, there is more room to explore those factors—the doctor may refer a patient for counselling if the patient may be suffering from a psychiatric or psychological disorder or depression, causing impaired judgment. On addressing the risk of social pressure and internalised feelings of burden, the British Geriatrics Society warned in its written evidence: “There is an established link between frailty and feeling a burden to others, meaning many older people with treatable clinical frailty may choose an assisted death to avoid burdening their family, which we view as unacceptable.” The Committee has already discussed at length the issue of older people or people with a terminal illness wishing to choose an assisted death motivated by the wish to save their family money. Dr Jerram, Dr Wagland and Dr Davis found that attitudes towards assisted dying changed over time. Patients closest to death were least likely to want assisted dying, suggesting that fear of suffering was the driving cause and that it may lessen as end of life care improves. Psychosocial care is fundamental to good end-of-life care. Committee members and witnesses from other jurisdictions have said that palliative care and assisted dying can complement each other, and that assessment should be part of the picture. Glyn Berry told the Committee about the importance of “the psychosocial aspect of palliative and end-of-life care”. –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 53, Q58.] In its written evidence, the British Association of Social Workers said that “good health care is not just about clinical interventions”, but also about “the wider social context in which a person lives their life…This is particularly pertinent with assisted dying.” That needs to come before the first declaration, because once somebody has signed that declaration, they are already on a pathway. The amendment would provide an opportunity for people’s needs to be met at the first opportunity. In conclusion, I emphasise the importance of a psychosocial intervention, which was stressed by a number of witnesses giving oral evidence to the Committee. We have discussed this issue at length. Earlier amendments have been voted down, but I stress the particular importance of the amendment 271 for that group of people who are in the first months of their diagnosis of a terminal illness and the raised level of risk of suicide that they present.

• 4 Mar 2025 · Terminally Ill Adults (End of Life) Bill (Seventeenth sitting) · Hansard source

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  I beg to move amendment 271, in clause 5, page 3, line 5, at end insert— “(1A) A person may not sign a first declaration within six months of being diagnosed with a condition which meets the requirements of section (2)(1)(a) unless they have received a psychosocial intervention in relation to their diagnosis with that condition. (1B) The Secretary of State may, by regulations, create exceptions to the provisions of subsection (1A). (1C) Regulations under subsection (1B) are subject to the affirmative procedure.” This amendment would create a requirement that the person must have received a psychosocial intervention if a terminal diagnosis was received less than six months ago. The Secretary of State would be given a delegated power to create exceptions to such a requirement with regulations subject to the affirmative procedure.

• 4 Mar 2025 · Iranian State Threats · Hansard source

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  It has been a privilege and an honour to engage with my many Iranian constituents over the years, but I am always filled with horror when they tell me stories not only of what is happening to their family and friends back home in Iran—particularly the oppression still suffered by many women—but of their experiences in this country. I very much welcome the measures that the Minister has outlined, particularly in relation to police training, which I know will make a big difference to my constituents. One issue that those constituents often raise with me, and which is one of the biggest for British-Iranians living in this country, is banking. I very much welcome the Minister’s response to the hon. Member for Kensington and Bayswater (Joe Powell) on money laundering, but British-Iranian residents who have been living here for many years often find that their bank accounts are frozen, which leaves them in considerable financial hardship—some of those banking restrictions are just imposed without discrimination. Will reassurances can the Minister give my constituents about their ability to continue banking without restrictions?

• 4 Mar 2025 · Hong Kong Democracy Activists · Hansard source

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  It is a privilege to represent a substantial community of Hongkongers in Richmond Park. I notice from Hansard that I was last here two months ago to ask the Government about renewed reports of repression against Hongkongers in this country, yet here we are again and nothing has been done to reassure my constituents about their continued safety and security in this country. I was interested in the Minister’s response to the hon. Member for Leeds Central and Headingley (Alex Sobel), who talked about reviewing transnational repression. I urge him to give us some more detail about when we in this House, and my constituents in Richmond Park, can expect to hear more about what the Government plan to do about this.

• 3 Mar 2025 · Finance Bill · Hansard source

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  I will speak in favour of new clause 4, tabled in the name of my hon. Friend the Member for St Albans (Daisy Cooper). The amendment would require the Government to carry out an impact assessment on the changes that the legislation would introduce for small and medium-sized businesses. Small businesses are the backbone of our economy and the heart of our local communities, and they create the jobs that we all rely on. I hear time and again from the small businesses across my constituency that they are struggling to keep up with soaring energy prices, business rates and the costs of exporting. The Chancellor is absolutely right to be focused on economic growth; however, my Liberal Democrat colleagues and I are deeply concerned about the impacts of the changes in the Bill on our high streets, and particularly on those in the hospitality industry, who are very concerned about the impact that duty rises on wine, beer and cider will have. The wellbeing of small businesses acts as an indicator of the health of the economy as a whole. As such, the new clause would be a useful tool to allow us to understand the broader implications of the legislation on our economic prosperity. More broadly, an impact assessment would look at the combined effect on small businesses, both directly and indirectly, of all policies in the Bill to ensure that SMEs remain at the heart of the Government’s economic policy. It is crucial that the necessary tough spending decisions to clear up the mess that the previous Conservative Government left behind do not hit our small local businesses, which are vital to our economy. To encourage growth for our small businesses, the Chancellor should be looking to reduce the burden on businesses through means such as cutting Brexit red tape, securing better trade deals with Europe and entering a customs union. The combination of the cost of hiring staff, the cost of additional red tape and higher business rates will be simply too much for many SMEs to absorb, which is why I urge the Minister to support our new clause and assess the impact of the legislation on local businesses.

• 26 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Fifteenth sitting) · Hansard source

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  I wish to speak briefly to amendment 270, in the name of the right hon. Member for South West Wiltshire, to which I have put my name. It is about the really important issue of assessing suicidal intent as part of the assessment as to whether somebody has capacity to seek an assisted death. It is a really important point. The Bill expressly sets out that the person seeking an assisted death should have “a clear, settled and informed wish to end their own life,”. Amendment 270 seeks to establish that the wish cannot be clear or settled if there is any doubt about whether the person has a suicidal intention instead of seeking an assisted death on the basis that they have a terminal illness. In its current form, the Bill does not require a structured assessment of whether a patient is experiencing remediable suicidal risk factors, such as treatable depression, external pressures or suicidal ideation, before assisted dying is discussed. In the oral evidence, Dr Mulholland said that most people with depression, anxiety and other mental health problems “would have capacity” under the Mental Capacity Act because it would be presumed. It is not necessarily an obstruction to people being referred for anything. It is an important point that someone can have depression and that it can lead them to have suicidal thoughts, but under the Mental Capacity Act they would still be assessed as having capacity to decide that they wanted an assisted death. What is really important is that we have, over some years in this country, developed a suicide prevention strategy. I am sure that every Member in this room has had constituents approach them, as I certainly have, about family members who have committed suicide, where they were able to identify factors that made that suicide preventable. That is why it is so important that the suicide prevention strategy has been developed and continues to be developed, and why leading figures associated with that strategy—and with suicide prevention more widely—are concerned that a Bill for assisted dying may undermine suicide prevention strategies. We should take every care to prevent that in this Bill. The current UK suicide prevention strategy cites early intervention as a priority to implement tangible actions aiming to reduce the risk factors of suicide. In line with that strategy, amendment 270 provides early intervention that aims to identify the symptoms of suicidality in a patient before the initial discussion about assisted dying can take place. At the bare minimum, someone who is severely suicidal will not be allowed to enter into conversations about receiving an assisted death. It is important to reflect that suicidal ideation is not the same as a settled wish to die. Evidence shows that when mental health issues are treated, many patients no longer seek to end their life by suicide. Dr Price, in the oral evidence, said that 20% of terminally ill patients experienced depression, which is strongly associated with the wish to hasten death. When depression is identified and treated, the wish to die often diminishes. It is so important to distinguish and make provision for those people who are experiencing a wish to die as suicidal ideation, as opposed to the “clear, settled and informed wish” specified in the Bill. Research from the Office for National Statistics, King’s College London and the University of Manchester suggests that people diagnosed with a physical terminal illness are at an elevated risk of death by suicide, because of an increase in the psychological distress that can lead to severe depression in many patients, but data from the study shows that it is a more pronounced risk of suicide in the first six months after diagnosis or first treatment and, on average, suicide rates in the first year after a terminal diagnosis were 21.6%. Of course, it is important to reflect on the fact that a diagnosis of a terminal illness can take place some years in advance of the actual prognosis that the person’s death may occur. We are looking at a group of people who are within six months of their death as far as can be established by what is, as we know, uncertain prognosis—yet the incidence of suicide among those with a terminal illness is much more weighted towards those who have just received a diagnosis. These, of course, are not the same group of people; there may well be overlap, but they are definitively not the same. Evidence on the gov.uk website suggests that “over half of men aged 40 to 54 who died by suicide had a physical health condition.” We know that having a physical health condition or any kind of terminal illness has an impact, and that evidence demonstrates the impact that poor physical health has on mental wellbeing. We know that thereDr Louis Appleby, a psychiatrist who leads the national suicide prevention strategy for England and directs the national confidential inquiry into suicide, has expressed concerns that the Bill fundamentally undermines the basis of the suicide prevention strategy. Identifying and diagnosing capacity and mental disorders are easy to put down in writing, but in practice it is much harder for professionals to make a correct judgment straightaway. Where we do not want someone to die, we intervene by offering mental health support, crisis services and what we hope is a comprehensive suicide prevention strategy, but for those who qualify under this Bill, instead of that suite of support, we allow them to progress straight into discussion to end their life. It is really important that we have had a debate today about how the discussion should be initiated and the appropriate way to do that, but what is important about amendment 270 is that it takes into account the specific factor of suicidal ideation. It would mean that whatever the outcome of the decision about how the conversation should be initiated, the possibility that the person wishes to commit suicide is nevertheless taken into account.

• 26 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Fifteenth sitting) · Hansard source

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  That is absolutely right. I think it becomes quite challenging for medical professionals when they are presented with a patient who expresses a wish to die: is this a suicidal intent or is it a clear, settled and informed wish to end their life under the provisions of the Bill? That is why it is really, really important that the possibility of suicidal intent is ruled out, as set out in amendment 270, which I support.

• 26 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Fourteenth sitting) · Hansard source

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  I apologise for arriving late; thank you for calling me to speak anyway, Mr Dowd. I rise to speak in favour of amendment 50, which stands in the name of the hon. Member for Runnymede and Weybridge (Dr Spencer) and to which I have also put my name. I am conscious that we have been through many of the arguments about the Mental Capacity Act today and at an earlier sitting, but I am keen to press the amendment to a vote, because I think it would address some of the issues that have arisen. The point of dispute appears to be whether the Mental Capacity Act, as it is currently operated for all the purposes for which it is used—I have no doubt that it is a very effective piece of legislation that is widely used and understood by clinicians everywhere, as the hon. Member for Stroud says—is the appropriate measure and tool to use for the Bill. This decision that people are embarking on is like no other, so I think it right and proper to consider whether the Act is the appropriate way to measure whether people are able to make it. It is useful to reflect on the experience of the hon. Member for Runnymede and Weybridge, who drafted the amendment. I am conscious of the comments that the hon. Member for Ipswich made yesterday about poorly drafted amendments. My understanding is that the hon. Member for Runnymede and Weybridge has extensive expertise in the area; he is an expert in mental capacity assessment, and I dare say that if he were in the room he would have many useful and interesting things to say. That is why I think his amendment bears greater weight, to the extent that one Member’s amendment should be regarded as any better than another’s. Key to the Mental Capacity Act is the capacity test, which is about the ability to understand, retain, use and weigh the relevant information. The amendment attempts to address what it means to make an informed decision. Dr Annabel Price, who gave oral evidence to the Committee in her role with the Royal College of Psychiatrists, said that people planning to make the decision of seeking an assisted death “would need to be able to understand the impact of the substance they are taking and what the likely positives and negatives of that are…The informed consent process is different from a refusal of treatment, and the informed consent process feeds into the capacity assessment.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 30 January 2025; c. 277, Q361.] The point, which has come up in previous debates, is whether an informed decision to refuse treatment can be regarded as the same as an informed decision to end one’s life. My personal view is that the two things are quite different, and that a different standard of capacity should therefore be brought to bear on the decision. I support amendment 50 because it sets out in detail how the Mental Capacity Act should be used specifically in relation to this decision. As I said in an intervention on the hon. Member for Stroud, it would not change the Act or tamper in any way with how it is currently used; it would merely specify the particular ways in which it should be used in relation to the decision. I hear what the hon. Member said about doctors’ use of the Act, as well as what the chief medical officer said. I am also conscious of what the hon. Member for Bexleyheath and Crayford has said about the variety of experience that he has, as a parent, with professionals’ understanding of the Act. That came across in a lot of the oral evidence. As the hon. Member for East Wiltshire said, the chief medical officer himself had to clarify the remarks that he made to the Committee in oral evidence. The chief medical officer implied that there were different ways of applying the Act depending on the decision to be made, but there are not—that was a very clear clarification. That implies that there is a difference in the way doctors approach the use of the Act. We cannot have a difference of approach when it comes to a decision of such momentous importance as the decision whether someone has the capacity to choose to end their life. The amendment reflects the fact that there is value in attempting to standardise how the Mental Capacity Act should be used in relation to the decision. That is why we should agree to it: it is important that Members of this House make a clear statement in the Bill about what we expect doctors to do as they approach an assessment of capacity. We should specify the minimum understanding of capacity to choose an assisted death, which includes an understanding of the likely process of all treatment options, including non-treatment and prognostic uncertainty. In her evidence, Dr Rachel Clarke said: “I would not be the first person to make the observation that sometimes doctors can be very pleased with their own abilities at a particular practice, and that practice might be having a conversation where you are assessing someone’s capacity.” –– [ Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 80, Q103.] Doctors have different assessments of their own ability to assess capacity. That is why a standardised approach, as set out in amendment 50, is so important. I stress how important it is that Parliament be the place where the standards for what MPs expect as an assessment of mental capacity are set. We should be the ones to determine them, rather than leaving them to the vagaries of individual clinicians. The assessment of capacity and the explanation of treatment options to the person considering an assisted death need to include the extent of prognostic certainty about their illness or condition. We spoke yesterday about the difficulty of knowing whether someone has six or 12 months left to live, and of knowing the extent to which they are going to deteriorate. We also covered in detail the relevant and available care and treatment, including palliative care, hospice care or other care. That needs to be part of the conversation about somebody’s capacity to make the decision. Amendment 50 states that “a decision to proceed under this Act does not prevent or make unavailable any care and treatment provision that would normally be provided.” It would therefore be clear that somebody had assessed the full range of their options. The amendment makes clear a fundamental issue that I do not think is otherwise covered by the Mental Capacity Act, or at least not to this level of specificity, which is that “the person’s decision to proceed…must be theirs alone and not bound or directed by the views or decisions of others.” We have talked about the importance of that issue in relation to the Bill as a whole, but it would be valuable to include it in the clause as a specific requirement for assessing somebody’s capability. Doubts have been expressed across the Committee about whether the Bill goes far enough in assessing the extent to which somebody might be under duress or coercion. Putting such a provision in the Bill, as part of the capacity assessment, would be an important and essential safeguard. Once someone has made the decision to seek an assisted death, is the doctor or assessing person confident that the person could unmake the decision or change their mind at any stage?

• 26 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Fourteenth sitting) · Hansard source

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  I want to pick up on a point that the hon. Member made before the previous intervention about the rights of the doctors themselves. This is an important point that we do not consider enough. We talk a lot about the rights of the patient, quite rightly, but this Bill will provide the means by which another person can get involved in someone’s death. It is really important that the legislation protects the rights of that person—the doctor involved—as well. Does he agree that providing greater clarity about the standard required to assess capacity will help the doctor to protect their own rights, perhaps in response to legal challenge from families, and that it is important that we consider the rights of the doctor as well as the patient?