Baroness Coffey:

Moved by Baroness Coffey

60: Clause 1, page 1, line 21, leave out “8, 10, 11 and 19” and insert “5, 7, 8, 9, 10, 11, 12, 13, 15, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 28, 29 and 30”Member's explanatory statementThis Amendment broadens what activities must be done in England.

I am grateful to the noble Lords, Lord Harper and Lord Empey, for signing this Amendment. I will also speak to my Amendment 65 and consider an amendment put forward by the Shadow front bench.

It is disappointing that the Justice Minister is not in her place on the Front Bench today, because in discussing these amendments I want to consider the important issue of assessing whether someone has capacity. The MoJ is responsible for that, and for several of the other matters I wish to speak on. We are only at Clause 1(3), but this is a key element to consider carefully: where do all these issues have to happen, and do they have to happen face to face?

As the Bill reads currently, it suggests that only the initial request for assistance, the first declaration, the doctor’s assessment and the second doctor’s assessment, and then the second declaration, have to happen while the person making all these requests is in the country. No other part of the Bill, including preliminary discussions and the act itself—all these other things—has to happen in this country; the person does not have to be here.

I think I have made it clear in a series of amendments that I have brought to the Committee that my concern is how this becomes something that is decided not just on paper. There should be real interaction, and I am trying to understand how the Bill will work in practice. That is why I have asked a series of questions on whether or not the terminally ill person making the request has to be in the country. We should get into other aspects, such as whether the panel has to be here.

We had a debate earlier in Committee, during which I made a clumsy attempt to make sure people had to be in this country. As I said, you can be ordinarily resident in more than one country at the same time. I want to continue to focus on this being a person-based process—I do not like using the term “patient-based process”, as I do not consider this to be a health treatment—and a lot of that is about where somebody is and whether there is a face-to-face link.

Recently, in a different policy, the Government rightly want to accelerate and increase substantially the number of face-to-face assessments for consideration of eligibility for sickness benefits. A lot of that was changed during Covid because, frankly, it was not practical to undertake that process. It has been gradually brought back and needs to be accelerated. The thinking alongside that policy is critical to the application of this Bill.

I have interpreted Clause 1(3)(b) as meaning that only

“steps under sections 10 and 11” have to be done by persons in England and Wales, and that is the initial assessment. I put it to the Committee that a lot more of this should be done face to face. As the late James Munby pointed out, it is absolutely right that the panel should be considering this process and looking into this. I am conscious there will be medics here who have perhaps an even greater understanding than I of how the variety of assessments should be done face to face. What happens when people are making a declaration? Are we sure that somebody is not in the room, giving them the eyes so that they will give the right answers? How are we to understand whether coercion can happen or not?

In a documentary undertaken by ITV, the Bill’s promoter, Kim Leadbeater, expressed concerns about what happens in Oregon, where a lot of this is done by video link. I believe she was uncomfortable and would consider adding an amendment to make it clear that consultations with doctors could not be done by video call and should be done in person. That has not been done so far, and no explanation has been given. That is why I have tabled these amendments. They would be a very important way of making sure there are safeguards so that, as we go through this novel process to us— I appreciate it is not novel to the world—we have every confidence that a lot of the safeguards which people are concerned about are going to be appropriately applied.

Last week, a discussion on a group brought forward by the noble Lord, Lord Birt, gave us a picture of how this could look. Indeed, the amendments tabled by the noble and learned Lord, Lord Falconer, have started to touch on aspects of this, such as how a commission can happen. But I can see that, very quickly, especially bearing in mind some of the amendments last week—though I appreciate that the noble and learned Lord did not accept them—a panel could be meeting every day. Right now, it could involve somebody on holiday in Tenerife and somebody else elsewhere meeting on Zoom or Teams or whatever. That could quickly become a routine tick-box exercise. That is the very reason the late Sir James Munby pointed out that this should not be given to judges—what is the point of having a judge if it will be just a tick-box exercise? We need to be careful that we do not end up in that situation.

In Amendment 65, I have suggested specifically what needs to be done face to face: the preliminary discussion, the request—as is in the Bill—and the witness. The witness should be there and it should be face to face. That seems sensible. We have the first and second assessment already there, but I think we could go further. What about the interaction with the independent advocate? Is that going to be done down the phone? These are the serious things which we need to consider. Should the panel meet face to face with the person applying? I appreciate that, in Amendment 320A, the assumption is that it should be face to face, but perhaps with exceptions by a video link. Again, when I initially started observing this at the other end, I thought that this would happen. What seems to have evolved is that a lot of this will be done remotely. The only thing I have not included in Amendment 65 is the actual doctor being there and the assessment happening in this country—although that is not specified in the Bill. Clause 25(3) says that the co-ordinating doctor has to be there in person, although under the following clause that can all be delegated to somebody else.

I do not want to overly labour the point in consideration, but I hope noble Lords will give some thought to how they want to see the Bill work in practice. It may be that people are happy for this all to happen via video and are wondering why we are getting in the way, given that this is about autonomy. However, these would be sensible amendments to consider to make sure that, while no Minister yet has said this is a safe Bill, it is as safe as possible. We need to look at the operation of it. It is certainly the case in other parts of the health system that a lot of this would not be acceptable and would have to be done face to face. It is not a case of overengineering the Bill or leaving it to regulations. We should be clear in Parliament that this is what we are going to do.

I am conscious of Amendment 320A, and I appreciate that my noble friend Lord Evans of Rainow, in Amendment 376, has particularly singled out “in person” for parts of Clause 12. I get that some people may be so terminally ill that perhaps a video link might be used, but that should be exceptional, if we are going to go down that route at all. I look forward to hearing my noble friend explain why that is the case and how it can be administered. With that, I beg to move.

My Lords, I have put my name to some of these amendments. In the spirit of what the Chief Whip said, I will not repeat what the noble Baroness, Lady Coffey, said, but I gently remind the Committee that this Private Member’s Bill is not normal, in so far as most Private Member’s Bills are five, six, seven or eight pages. This one is 51 pages, with 59 clauses. It is a very different animal from what we are used to.

I think the amendments in this group have been tabled because, in many respects, this aspect of the process is deeply disturbing. We are talking about life and death here; we are talking about making assessments of a person who is making an application for an assisted death. Noble Lords will be aware that, on 29 October, in the Select Committee, Professor Martin J Vernon, chair of the British Geriatrics Society’s ethics and law special interest group, said:

“Assessing somebody remotely, digitally, without a face-to-face assessment, particularly if they have complex health and social care needs, is nigh-on impossible”.

I would have thought that, to assess somebody’s state of mind and to have any sense of judging whether they are being coerced or not, one of the most obvious things is to see them in front of you and get the feel for that. How can a psychiatrist judge this?

The other point I would make is about the practicalities. Depending on where someone is in this country, they may or may not have the equipment or the capacity to use it; signals drop off. Inevitably, if somebody is in a frail and unstable condition, there will have to be other people present to operate this. Does that mean that a team from the hospital would have to go out to some remote location—or, even worse, are we doing stuff on the phone? Can you imagine how people would react? “Dial-a-death” would be the sort of way that people would describe it.

I find it exceptionally objectionable that, for somebody in those conditions, the state could effectively provide a service to assist them to kill themselves over the phone. That is what we are talking about here. It is conceivable, I suppose, that there could be special circumstances for trying to assess people remotely but, as with everything else in this Bill, if we had worked this thing out properly, we would have covered a lot of this. I think this part of the Bill is fundamentally unsafe. Assessing somebody’s state of mind and what their settled will is would be difficult for a team to do without seeing them face to face, in the room or in their home. We use video links for legal proceedings, but there is a big difference between somebody who has been held on remand for robbery appearing in court through video and somebody who is seeking assistance to end their life. We are not talking about things in the same sphere of influence or effect at all.

I therefore have to say that I am very unhappy about the proposals in the Bill. I have put my name to some of these amendments and support the comments made by the noble Baroness, Lady Coffey.

My Lords, I will speak to my Amendment 376. It is a pleasure to follow the noble Lord, Lord Empey. Last Friday, like many of your Lordships, I sat here all day and did not say a word. My amendment was in the following group, but sadly we did not get to it. However, there was an excellent discussion, and I want to pay tribute to some of the contributors: my noble friend Lord Deben, the noble Lord, Lord Mawson, and indeed the noble and learned Lord, Lord Falconer.

The noble and learned Lord said something that rang a bell; he referred to studied diligence, and how healthcare professionals and the whole system will study how best to conduct these assessments. When he said “studied diligence”, it reminded me of some experiences that I had as a Member of Parliament in helping people in very distressing circumstances with the healthcare of loved ones and trying to navigate the system. The thing that struck me was studied neglect. Studied neglect is quite difficult to detect, because it is not always obvious.

Many of us in this House have a routine, which is what makes us get up every day, and as you get older, that routine becomes very important. You have a good night’s sleep, you wake up in the morning, you shower, you clean your teeth, you exercise and you go to work, or to functions in the community. You eat well—you eat healthily. You can lead a normal life, as many of us do in this House, but something may happen to you—you may slip, trip and fall, and you may find yourself in hospital. That is when things can go wrong, because you are out of that routine of a good night’s sleep and getting up in the morning. For every week that you lie in bed, you lose 10% of your muscle strength. You do not get up, you do not do your routine, you do not shower and you do not clean your teeth. Things start happening to you, and you can go downhill very quickly.

Those things can happen through daily life—but the thing that really concerns me about this Bill, and the reason why I tabled this particular amendment insisting on face-to-face diagnosis from the healthcare professionals having to make this decision, is based on my experience as an MP. Close family and friends can have a malign influence by slowly but surely—this is why I referred to it as studied neglect—not encouraging a loved one to get out of bed in the morning, so that routine declines. They stop showering in the morning; they do not go for their manicure or pedicure or to get their hair done, and they start to decline. People who we always regard as very smart for their age can decline very quickly. The loved ones around them can engineer that, so that when social workers and healthcare professionals meet those people, it is not obvious what is happening. They are not sleeping properly, not looking after themselves properly and not eating properly, and therefore they decline. Nutrition is very important. You also have medication, and there can be no clear care plan; as one grows older, we take lots more medication, and that medication can be increased when it does not need to be increased or indeed not given at all.

That is why I am using the phrase “studied neglect”, to the “studied diligence” of noble and learned Lord, Lord Falconer. We really have to look very carefully at the malign forces that, I am afraid, are out there in society. They look at granny and, as my noble friend Lord Deben says, the £2 million house sitting there, and can slowly but surely—but still relatively quickly—see the demise of granny and realise those capital assets. That is the reason why I put this amendment forward.

Crucial steps in the assisted dying process should be undertaken with direct, in-person interaction, to increase the likelihood that the individual’s request is truly voluntary, informed and free from coercion. The necessity for direct interaction with a person, particularly through face-to-face contact, is driven by the importance of rigorous safeguards and scrutiny, and of upholding patient autonomy in a process that culminates in an irreversible outcome, called death. I could use many more examples but, in the interests of time, I beg to move this amendment.

My Lords, I will speak to my Amendment 320B and three others in my name in this group. The first clinical gateway in this Bill is the most important moment any of us will ever legislate for: the moment a doctor begins the process that can lead to a life being ended. That gateway must be treated with the utmost care; it should not be reduced to a convenience-driven video call.

My amendment is simple and proportionate: it creates a presumption that the co-ordinating doctor’s first assessment takes place in person, and it asks only that, if the presumption is displaced, the doctor records why an in-person meeting was not possible for medical reasons. That is not micromanagement; it is common sense. It is the minimum standard of human contact that we should expect before opening a pathway that is irreversible.

Why does this matter? First, capacity and voluntariness are relational judgments. Clinicians do not assess capacity from words alone: they read people’s faces; they notice the hesitation; they observe the environment and see who else is present. They pick up the small, telling signs of distress or coercion that a screen can hide: a hand hovering off the camera, a whispered instruction, a look that does not match the words. Remote consultations blunt those senses. If we are serious about preventing coercion, the law should make face to face the default, not the exception.

Secondly, this is a narrow safeguard, not a prohibition. The amendment allows remote assessment where it is genuinely impossible for medical reasons. It recognises that there will be rare cases where a patient is too frail to be seen in person; in those cases, the co-ordinating doctor must set out the reasons. That requirement creates an audit trail and accountability. It deters the normalisation of remote practice for administrative convenience and gives panels, the commissioner and, if necessary, later reviewers, a clear record of why the presumption was set aside.

Thirdly, the evidence is clear: leading geriatricians and psychiatrists have told committees that assessing capacity remotely for complex patients is nigh on impossible. Telemedicine studies and the experience of courts show the limits of video for detecting vulnerability. We should legislate to reflect clinical reality, not hope that guidance will be followed uniformly across hundreds of clinicians and thousands of cases. Some will say that this amendment would delay access or over-engineer the process, but I disagree. A single in-person assessment at the outset is a modest investment of time that dramatically reduces the risk of error. If the system is robust, it will absorb that step without undue delay. If the system cannot, then speed is being prioritised over safety, and that would be a real problem.

Finally on this amendment, will the noble and learned Lord, Lord Falconer of Thoroton, accept that a life-ending pathway should begin with human contact, with a clinician who has seen the person in the flesh—smelled the room, so to speak—and observed the context in which that wish has arisen, or does he prefer a default of pixels on a screen? When the outcome is death, convenience must never trump clinical rigour. I urge the Committee to support my Amendment 320B.

My Amendment 347A would ensure that the second assessment—the final medical safeguard—is conducted in person. The Bill currently allows the independent doctor to assess the patient entirely by video. That is extraordinary for a life-ending decision. Experts told the House of Lords Select Committee that assessing capacity remotely is, as I said, nigh on impossible for complex patients. The subtle signs of confusion, fear, coercion or cognitive impairment are often visible only in person. Remote assessment hides the environment. Who is in the room? Who is influencing the patient? What pressure are they under? Kim Leadbeater MP herself said she was uncomfortable watching Oregon’s remote assessments, describing them as “tick-box”. If the sponsor is uncomfortable with death by Zoom, Parliament should not legislate for it. This amendment of mine is modest, proportionate and essential for safeguarding.

If remote assessments are permitted at all, my Amendment 406A would introduce the bare minimum safeguards: the doctor must verify that the patient is alone and speaking freely. Coercion, as we know, is often silent. Abusers can sit off-camera, and patients are coached. A Michigan prosecutor famously spotted a domestic abuse victim being coerced during a Zoom hearing. If trained lawyers and judges can miss coercion on video, how can a doctor reliably detect it in a single remote consultation? My amendment would not ban remote assessment but simply prevent the most obvious and dangerous form of abuse. Without it, the Bill’s coercion safeguards are meaningless.

My Amendment 415B would ensure that remote assessments are tightly controlled, used only when appropriate and subject to independent oversight. The Bill currently allows remote and even pre-recorded assessments without any statutory framework. A protocol approved by the commissioner would ensure consistency, transparency and accountability. It would prevent remote assessment becoming the default due to NHS pressures or simple convenience. Without this amendment, I suggest, the Bill creates a system where lethal decisions can be made based on pre-recorded video clips. That is indefensible.

In summary, my four amendments form a single, focused package of safeguards to ensure that human judgment, not administrative convenience, governs a life-ending pathway. Amendment 320B would make the first assessment face to face by default—the minimum human contact needed to test capacity and spot coercion. Amendment 347A would extend that presumption to the independent second assessment so that the final clinical check is equally robust. Amendment 406A would require a simple verification when assessments are remote—a recorded confirmation that the patient is alone and speaking freely. Amendment 415B demands a statutory protocol for remote or pre-recorded assessments so that exceptions are tightly controlled and independently verified.

These are modest, proportionate measures. They do not block access where an in-person assessment is genuinely impossible, but they stop convenience becoming the norm when the consequence is irreversible. If this Bill is to be the safest system in the world, will the noble and learned Lord, Lord Falconer of Thoroton, accept these targeted protections so that speed and convenience never replace clinical judgment and human scrutiny? I urge the Committee to support my amendments.

My Lords, I assure the noble Baroness, Lady Coffey, that this issue will never be a routine tick-box exercise. Being in Tenerife rather than Torbay is the choice of the patient. If they want to spend that time there before they return to the UK and die, it is not our choice. Videos allow patients and their families to be together for those assessments. There is no ethical or clinical reason why an assisted dying request, or aspects of care included in the clauses laid out, must be face to face. What matters is capacity, choice and informed consent, not physical proximity.

During Covid, I assessed thousands of patients’ capacity, consent and safeguarding issues remotely, with no evidence of increased coercion or harm. Patients can already refuse life-sustaining treatments such as renal dialysis, have feeding withdrawn or make advanced decisions to remove treatment without face-to-face legal requirements. Face-to-face assessment requirements, as laid out in these amendments, are a policy choice, not a clinical or ethical necessity. What protects patients is careful assessment, independence, documentation and review, not the distance between two chairs.

My Lords, for the reasons given, mainly by the noble Lord, Lord Empey, and despite what the noble Baroness, Lady Gerada, has just said, it seems to me highly desirable that there should be face-to-face contact if such an enormously important decision is being made. I therefore support face-to-face contact at both stages, other than for reasons where it cannot happen.

My Lords, taken together, the amendments in this group highlight the importance of contact with people at the hardest time in their lives—a time when we must be most vulnerable, clinically and personally. This must not be a process in which anyone is made to feel rushed or that can be completed entirely online.

If we are content to enable access to a slick service as quickly as possible, an online service may be acceptable, but if we are to continue to take seriously our duties of suicide prevention, of assessing and meeting unmet need and of safeguarding, the human contact of being face to face is part of that.

During the Select Committee sessions, we heard evidence from the chief executives of Mind and Standing Together Against Domestic Abuse, who said that an online or pre-recorded consultation was not an adequate safeguard to assess a person’s emotional state. This must be especially true in complex cases. I remind your Lordships that prisoners are still eligible under the Bill. As we engage with every group, we must consider how the particular issue might play out in a prison context. All the challenges that we are worried about, including the assessment of unmet need and the presence of an undiagnosed mental disorder, are more difficult in a prison environment. So I would be grateful if the noble and learned Lord, Lord Falconer, could outline whether he thinks in-person assessments should be even more important in a prison context.

My Lords, I added my name in support of the Amendment from the noble Lord, Lord Evans of Rainow, for in-person assessment by the assisting doctor—the first assessment and the second. As has been said, how on earth can any doctor judge the mind—the physical and mental condition—of the person whom he or she may be ticking off to death without being in the room with them, particularly as this doctor may never have treated them in person?

I know that since Covid there has been an increase in remote consultations, but it is still the case that the average number of in-person consultations that a patient has with a doctor is three a year. In the case of consultation for assisted suicide, that such an appointment with the doctor is in person matters, as other noble Lords have said. We have heard a reference to telemedicine from the noble Lord, Lord Blencathra, but let us look at exactly what the British Columbia study reported of telemedicine: it limits the ability to observe non-verbal cues, subtle signs of distress and general context, and it fails to provide the emotional support, human contact and rapport essential to the therapeutic relationship between both parties in what is a shared decision. The study goes on to say that it provides limited evidence on long-term outcomes, especially with regard to hard data on assessment quality or adverse consequences. It goes on to say that ticking boxes rather than doing an in-person examination risks further streamlining to avoid an impact on scarce medical resources.

We know, for instance, from the Liverpool care pathway figures released in 2012 under the Freedom of Information Act, that two-thirds of the trusts had received incentive payments for meeting targets for using the pathway, amounting to around £12 million—that was in 2012. Telemedicine is also inappropriate for some patients: people with learning difficulties, autism, poor communication or verbal skills or mental health illness.

I conclude by asking whether the noble and learned Lord, the promoter of the Bill, disagrees with Professor Mumtaz Patel, President of the Royal College of Physicians, that face to face assessment really matters? She says:

“Face-to-face assessment is really important and then the wider decision-making has to be done as a team, through shared decision-making and with somebody who knows the patient well. It goes back to the continuity”.

Does the noble and learned Lord acknowledge the evidence of the “off camera” abuse example from the US state of Michigan? The noble Baroness, Lady Coffey, mentioned the difficulty of detecting abuse online at the very outset of the debate. In Michigan, a prosecutor noticed a domestic abuse victim being coerced off camera during a Zoom hearing. I hope the noble and learned Lord can reply to some of those points.

My Lords, I wonder whether the House will listen to the point made by the noble Baroness, Lady Gerada, which is that she is probably the only person in the House—and certainly the only person who has spoken this morning—who has had practical experience of assessing people. She spoke very well about the issues which have been raised this morning in relation to the Covid epidemic, saying that, “There was not a clinical or ethical necessity to see people face to face to make proper judgments”. I really want the House to accept that someone with that practical experience should be listened to.

I will make one other short point, which is that I am again surprised, frankly, by the number of people who have spoken this morning who, without, as it were, even mentioning the question of the circumstances of those who are terminally ill and are asking for assistance, talk so much about administrative procedures, the way in which a network might be formed, or the way in which technology could be used. Frankly, I would like to hear a little more from everybody who contributes about the circumstances and problems of those who are actually seeking assisted dying and who may well be those who, frankly, for one reason or another—because they are physically in a way that they cannot do it, or they are perhaps geographically remote or have other circumstances which prevent them being able to access a face-to-face agreement or a face-to-face assessment—none the less very much want an assisted death for their terminal illness. Their concerns should be the ones we primarily consider.

My Lords, the noble Baroness, Lady Jay, just asked us to consider the circumstances of those who are seeking an assisted death, but I would like to give a salutary lesson—I am sorry to disagree with the noble Baroness, Lady Gerada.

My father was taken ill during the Covid pandemic. He did not have a smartphone and was not able to have an in-person consultation. He had jaundice. The message he came away with from speaking to a doctor on the telephone—the doctor had never met him—was, “It’s pancreatic cancer”. My father then spent weeks saying goodbye to all his relatives and friends. By the time relevant tests had been done, it was shown that he did not have pancreatic cancer.

That demonstrates one of the flaws of doing something remotely, which is: what are the messages? The doctors are not getting the cues and the patient is not necessarily hearing what the doctor is saying. I am sure that the doctor did not say, “Mr Smith, you have pancreatic cancer”—clearly, they could not have said that—but that was the message that my father heard. I therefore very strongly support the amendments in the name of the noble Lord, Lord Evans of Rainow, and two of the amendments from the noble Lord, Lord Blencathra.

However, I want to express one serious reservation about Amendment 406A from the noble Lord, Lord Blencathra. If the discussion has to be taken by video conference, it might not be appropriate to say that in every circumstance the only person who should be on that call is the patient. We all know that, when you go to the doctors, even if you are there in person, you have capacity, you are a rational person and you do not have any cognitive difficulties, you do not hear everything. Sometimes, if it is a difficult diagnosis, you do not take everything on board. For some people who are told that they have a terminal diagnosis and understand that that is the case—unlike in the false case of my late father, who did not have a terminal condition at that stage—we know what their settled will is. There are several people in your Lordships’ House who have what their settled will is very clearly on record, in the public domain. But there will be other people with whom the doctor has never spoken before, so they cannot know whether it is somebody’s settled will in a way that the legislation requires.

If, then, there has to be a video conversation, or indeed an in-person conversation, it might be appropriate for there to be an independent advocate or somebody else who would support that person and could say, “The doctor did not really say that, you know”. We need to think about real-life cases. Yes, we need to understand from the medical profession, and it needs to be from the perspective of somebody with a terminal diagnosis, but we also need to understand the reality for ordinary people who do not have the advantages of the internet or the accessibility that Members of your Lordships’ House have.

My Lords, I will speak on face-to-face consultation; my Amendment 483 on this is in a later group.

During the Covid-19 pandemic, it was briefly made possible for the making of a will to be witnessed by videolink rather than in person. This change could have been made permanent, but instead the Government decided that the videolink provision should cease from January 2024. The law is now again that the witness must have a clear line of sight of the person making the will. Are these precautions any less important when assessing whether someone truly wants an assisted death and is not being coerced than when establishing what should happen to their assets afterwards?

My Lords, the noble Baroness, Lady Keeley, has already alluded to the issue of wills, so I will not go to that, but there is another legal precedent, Devon Partnership NHS Trust v the Secretary of State for Health and Social Care in 2021, when the High Court ruled that under the Mental Health Act, the phrases “personally seen” and “personally examined” require the clinician and approved mental health professional to be physically present with the patient for detention assessments. Following that, NHS England reviewed its guidance. That underscores the legal and clinical importance of physical co-present evaluation when decisions carry high consequence.

Secondly, during Covid I chaired the National Mental Capacity Forum and ran fast-track online seminars for those who were doing remote assessments because of the problem of people in care homes. It was a very difficult time and that was a public health necessity. Since then, some remote consultations have certainly continued, as we have already heard. However, the qualitative studies of remote mental health care during the pandemic found that a lack of face-to-face contact compromised risk assessment and therapeutic insight.

Systemic reviews have noted significant difficulty establishing a therapeutic relationship, identifying risk, and with challenges in picking up non-verbal communication and building rapport coming through as recurrent themes. They caution how remote assessments can be less effective in capturing complex, subtle behaviours, non-verbal distress, agitation and contextual pressures, which are crucial in determining voluntariness and in detecting distress or coercion. Clinicians and carers have reported that non-verbal cues were often unavailable or obscured in remote interactions, particularly telephone consultations but also by video. Even when remote assessments were used only to triage risk, delaying face-to-face evaluation, the effects slowed down accurate identification of deteriorating conditions.

Importantly, family members and carers who might normally contribute to a fuller understanding—the noble Baroness, Lady Smith, has pointed this out already—are less able to participate meaningfully in remote consultations, hindering in particular the detection of contextual pressures or risk factors. Also, in remote assessments, the clinician cannot tell whether there is another person in the room standing out of sight behind the camera.

For such an important decision, face-to-face assessments should occur by default. The assessing professional must visit the patient, ensuring that the patient is comfortable and has all their personal needs met before embarking on any type of interview to hear from them. If speech is lost, a prior recording could be made and played in the presence of the person, with the professional watching for non-verbal cues to confirm, or otherwise, the veracity of the recording and to detect any coercive influences.

Face-to-face, physically co-present assessments that are not mediated by technology should probably be the norm in the Bill. Where there is a remote assessment, a recording of it should be required, as that will be essential for auditing and quality control, as well as in the event of any legal challenge later. This group of amendments should be considered together and reworked and we should come back to them on Report.

My Lords, it is essential that, as we debate this group of amendments, we keep in mind the fact that the systems that we are creating are for people in the last six months of their lives. We must balance the demands that we place on them at this very vulnerable time with what really matters to them during that time. We should stop talking about microprocess and start really thinking about the individual. In her evidence to the House of Lords inquiry in November, Dr Jessica Young said that

“a system that is too onerous creates stress among the people it aims to serve”.

We must not create a system that is too complex and too protracted for someone who is at the end of their life to deal with.

We have made incredible progress in recent years on facilitating video consultations. That came on hugely in the pandemic. Are we not in danger of taking a retrograde step with these amendments? I fear in particular that we in this House must be careful about standing in the way of technological process. Reading some of these amendments, I wonder whether people might want to add in that we write with feather quills and ink, because it seems that that is what this is really about.

Amendment 65 would mandate a whole range of steps beyond clinical assessments to be undertaken face to face. It also seems to disapply the flexibility provided in the Bill with regards to the person meeting the panel. Is it the intention of this amendment that a person who cannot travel to appointments, whether physically or because of the risk of infection, must be denied a choice over how they die? These amendments will affect hugely those who live in rural areas and far from their GP, let alone a hospital with a relevant specialist. They will affect those whose immune systems have been compromised as a result of extensive chemotherapy and those whose mobility is affected by their terminal illness and who find it impossible to travel. Are we not at risk of denying access to these people when such challenges are not unusual, given the nature of what they are experiencing with their terminal illness? Is it the intention that someone who is, for practical medical reasons, unable to meet the independent advocate or the panel, but is able and willing to do so via video link, will immediately be ineligible even if they fulfil all the other criteria? It is difficult to see a basis on which that can be justified.

Will the noble Baroness give way?

I am coming to the end of my speech; I do not think I have to take an Intervention, so I would like to finish my point.

It seems to me that this is about making the choice of an assisted death difficult or impossible. We need to think carefully about the checks that we are putting in place for people in the last six months of their lives. We need to make sure that the system really will work for them.

My Lords, we should thank the noble Baronesses, Lady Gerada and Lady Pidgeon, for raising important counters to a lot of these contributions, because it is important that we do not fetishise face-to-face communication as infallible. It offers no guarantee that comprehension happens, that people listen and that there is no misunderstanding. We should know that because we sit face to face in this Committee every Friday and goodness knows it has not guaranteed much of that.

I have put my name to several of the amendments in this group because, despite what the noble Baroness, Lady Pidgeon, just said about how we must make this as easy as possible for people with six months to live, the Bill’s sponsors have rightly built the need for eligibility into the Bill. You cannot just wander in and say, “I’ve got six months to live, get rid of me”; you have to pass the eligibility assessment. We are trying to work out whether face to face as the default would be a better way of guaranteeing that there is no abuse, which is reasonable.

I remember the ITV documentary referenced by the noble Baroness, Lady Coffey, in which I heard the Bill’s sponsor in the other place, Kim Leadbeater, admit that she was uncomfortable with what has been labelled “death by Zoom”—the model that she was watching in Oregon. Despite what the noble Baroness, Lady Gerada, said, it was actually Kim Leadbeater who rightly noted that it looked too much like a tick-box exercise. We need to be wary of anything that goes in that direction, but, because this is what I saw in that documentary, I expected a basic requirement in the Bill for face-to-face assessment, except in exceptional circumstances. So I ask the noble and learned Lord, Lord Falconer, to respond on why the Bill still permits so many encounters with doctors, including the panel, to be conducted remotely, meaning that somebody may access assisted death without having seen a doctor face to face. One might pause on that, at least.

Despite the virtues of telemedicine, of which there are many—we can all see the reasons why, on occasion, it is important, just as we all use Zoom for meetings and so on—this is a question of whether it is superior and whether it can be relied on. The noble Baroness, Lady Smith of Newnham, gave a vivid example in response to the contribution from the noble Baroness, Lady Jay, in which she said, “At least the noble Baroness, Lady Gerada, knows what it is like to be the doctor doing the consultation”. Well, some of us know what it is like to be the patient on the other end of it. To be honest, it is not always a case of “trust the expert” and all that, because there absolutely may be crossed wires, hanging around, frustration and all sorts of things going wrong.

Professor Martin Vernon, who chairs the ethics and law special interest group at the British Geriatrics Society, said:

“Assessing somebody remotely, digitally, without a face-to-face assessment, particularly if they have complex health and social care needs, is nigh-on impossible”.

There is something in that, too, which we should consider. Non-face-to-face Zoom or phone encounters are particularly challenging for certain groups, such as people with communication difficulties. The noble Baroness, Lady Nicholson, reminded us of the issues for people with hearing difficulties in our debate on a previous group. We all know that there are difficulties of language.

Of course, older people are likely to make up the Majority of those being assessed for assisted dying. Without wanting to caricature oldies as being technically illiterate—although there is a smidgen of truth there—there is something else to consider. Older people sometimes present their best selves on the phone. They put on their best voice. There is nothing wrong with that, but they chat away as though everything is fine and, even on Zoom, they sit there looking their best.

However, when you see them face to face—I am not now talking about a doctor assessing them—they are dishevelled, pale and frail. Something else happens. Because the assisted dying decision involves highly emotional and existential issues, purely remote assessments potentially undermine the relational aspects of care that will help ensure that decisions are well considered and autonomously made. We have to think about those direct, personal interactions. The noble Baroness, Lady Jay, is right: these are the last six months of your life—allegedly; that is what you have been told. People are vulnerable, distressed and not quite sure. All these amendments are suggesting is that it would possibly be better to see the doctor. If you cannot get there, that is all fine, nobody is being inhumane; but the doctor sees you and assesses what is going on. It is a necessary if not sufficient way of establishing the eligibility criteria.

Finally, the noble Lord, Lord Empey, talked about how this might be appropriate for online legal proceedings. I am sure that the noble and learned Lord is aware of the evidence on the use of video links in court proceedings and trials. In Transform Justice’s survey of court users, 70% of respondents said that it was difficult to recognise whether someone who was on video had a disability, while 74% believed that those who had no legal representation were disadvantaged by appearing on video; in other words, the vulnerable always suffer in those instances.

The report similarly found that there were significant issues in assessing evidence and character. We can learn from other areas, but the main thing is that the default should be face to face. That should be in the Bill. I agree with Kim Leadbeater on that one—that is a headline. I do not understand why, Kim Leadbeater having noted that, it is not in the Bill. There should be exceptions if people are too ill, too far away or having a ball in Tenerife for their last six months. Yes, we get all that, but the default point is: face to face, where possible, as much as possible.

My Lords, if we are to have remote assessments, it is very important that we have an exception for one group of people who might be seeking assisted dying: those who require the services of a public service interpreter. Elsewhere in the Bill, the provision of interpreters is acknowledged and provided for. This is one situation where face-to-face consultations are essential. During Covid, there was a huge rise in remote interpreting in the criminal justice system. A number of studies, including a very robust piece of research by the Magistrates’ Association, showed that there were problems with remote interpreting, for reasons ranging from dodgy technology to missed cues because of missed body language.

In these circumstances, more than anything else, a face-to-face consultation or assessment is right and appropriate, where the services of a public service interpreter are needed for the benefit of the person seeking help.

My Lords, that provision is in the Bill, if the noble Baroness would just look. I am afraid that I cannot put my finger on the actual Clause, but the assessing doctor is required to provide interpreters where necessary.

My Lords, I have added my name to Amendment 65 in this group, but will first respond briefly to what the noble Baroness, Lady Gerada, said about remote consultations. This is the core of what we are discussing today. It is not just the doctor who needs to be able to see and understand. The patient needs to be able to see, understand and interact with the doctor.

During Covid, my brother tried for six months to see his doctor. There were regular telephone calls. On each occasion, he was told that his symptoms were resulting from cardiac problems and other problems that he had had, and that all he needed to do was take painkillers. When he finally presented to A&E six months later, he had stage 4 lung cancer and bone cancer. Remote consultations do not always protect. Because this is a matter of life and death, because this is a situation in which someone is seeking death, we need to be very sure of what we are doing.

Face-to-face consultations are not required by the Bill. There has been a lot of talk about how the person may not be alone in the room and the various interactions that may occur outside the vision of the consulting doctor at the time. I fully accept that patients may be reluctant to travel, for a variety of reasons, but that is not the only criterion to be considered. The noble Baroness, Lady Fox, referred to the Transform Justice report on how video links endanger communication in court trials, with 70% of respondents finding it difficult to understand whether someone on a video had a disability. That is a basic starting point. The inability to observe things such as non-verbal cues is also a major problem with virtual consultations.

It may be argued that coercion is a criminal offence under the Bill, but any prosecution could come too late for the person who is being coerced into seeking assisted dying. Our duty as legislators is to provide safeguards to prevent that happening where possible, and therefore to ensure face-to-face consultations on every occasion on which those are possible.

I note the intention of Amendment 320A, tabled by the noble Lord, Lord Wolfson of Tredegar:

“The first assessment must be undertaken in person, except in circumstances where this is not reasonably practicable when it may be conducted by a live video and audio link”.

The test of reasonable practicability may be too uncertain. What might make a face-to-face diagnosis not reasonably practicable? The doctor lives a long way away. There is a Tube strike so the patient cannot travel because of that. The doctor cannot travel because of that. They would be able to travel the next day, but that would then disrupt the doctor’s existing diary—he may have appointments with other patients seeking assisted death. Some more specific test is required to prevent a failure to ensure that in all but the most exceptional circumstances, the meeting must be face-to-face. I have not tabled a further amendment on this because we have the opportunity to discuss the issue today.

The noble Baroness, Lady Coffey, talked about assessments taking place in the UK. The significance of these is that they then enable the regulatory regimes of the various professions to operate effectively. They enable proper consideration, and investigation where necessary, to enable recourse to civil law where necessary, so criminal law offences would apply to the actions in question. Also, the designation of the lethal drugs to be used to kill and the regulations governing their prescribing, dispensing, transporting, storage, handling, et cetera, are all subject to secondary legislation powers. We need controls in place within the jurisdiction before the system can operate safely. The duty to issue codes of practice relating to the operation and integrity of the Act—capacity assessment, coercion, et cetera—is again conferred on the Secretary of State or the Welsh Ministers. The process must operate in England and Wales.

When a person makes an altruistic kidney donation, all the staff repeatedly ask the person face to face, before they go into surgery, what they are doing and whether they understand the consequences. All the consultations which precede the donations are done face to face for obvious reasons. If those requirements exist to ensure that a person is acting without coercion and in full understanding of what they are doing when they undergo the surgery, surely it would be essential that a person who is contemplating ending their own life with assistance is protected by carefully conducted, professional, face-to-face consultations, which can be arranged in a location in the UK which is convenient for the patient but which should never be conducted on video.

We really need absolute clarity as to how these processes must operate. Can the noble and learned Lord, Lord Falconer, explain how doctors and the panels could operate safely without seeing the patient? The psychiatrists have said that they cannot assess capacity remotely. The limitations of remote assessment in the justice and healthcare system are well-known. How is the panel to verify matters if it does not see the patient, at least in most cases? Can the noble and learned Lord explain what safeguards exist to stop the panel becoming, as Sir Nicholas Mostyn said, a “symbolic rubber stamp”?

Sir James Munby also pointed out that the impact assessment expects the panel to meet for three hours per case. He said that will put pressure on the panel to conclude the first listed case in time so it can move on to the second case. If ever there is a tribunal which should be under no pressure of time, surely it is a tribunal dealing with matters of life and death.

Amendment 65 provides a list of activities which would take place face to face. I have no difficulty in supporting this amendment, because the situations that are provided for in those subsections are of fundamental importance. After the Bill’s sponsor in the Commons, Kim Leadbeater MP, witnessed the tick-box online assessment in Oregon, she told ITV, as others have said, that the assessment should be in person, face to face. The Bill still permits exactly those “Death by Zoom” assessments.

In the absence of amendments such as these, how can the Minister ensure that Parliament is discharging its most important responsibilities to the people of this country? If he does not accept the need for these amendments, will the noble and learned Lord, Lord Falconer, introduce amendments to address the very serious problems which have been identified in this group?

My Lords, I declare an interest as the chair of one of the medical royal college’s trusts. I want to speak to this group of amendments, taking into account the medical profession. I entirely agree, and I am sure that the vast Majority of doctors will also entirely agree, that it is better to have face-to-face consultations in these circumstances. However, nearly all those who have spoken in favour of face-to-face consultations have admitted or agreed that there will be exceptions, and there will be quite a lot of exceptions. We have to remember that many people who are terminally ill are bed-bound; they are not able to get up and go to a face-to-face consultation, even if it is quite near to where they live. The vast majority of doctors would want to discuss with their patients whether a face-to-face appointment is acceptable, possible and desirable and, if not, to have an online consultation with them. That seems to me the right approach.

Moreover, I really wonder whether we should be putting in the Bill a Clause that would constrain doctors in a way that I think is unacceptable. We must accept that the vast majority of doctors will go into this work with utter commitment to doing the best possible job they can. I find it a bit disconcerting that there is constant reference to a tick-box approach; you can have a tick-box approach face-to-face, or you can have a tick box approach in a consultation online. It does not seem to me a relevant and important point to make. I suggest that, rather than putting this in the Bill, given that I am sure that there is a very strong case for face-to-face consultations normally, it should instead be part of a code of practice for the medical profession that will certainly have to be developed if and when this Bill is enacted.

My Lords, we are discussing one of the most important decisions that any individual might make in their lives. It is important for the individual and for the state. I think that it is appropriate to ask that the critical meetings with the medical practitioners should be face-to-face, because that allows a degree of intimacy and nuance which, frankly, the world of Teams, however valuable it is, does not. There are three doctors involved in the process set out in the Bill and, at the very least, for the second doctor who is going to co-ordinate the process, it is reasonable to require that that meeting be face to face.

My Lords, very briefly, I support the Amendment that is calling for face-to-face consultations to take place, rather than only in exceptional cases. I want to reflect on why this matters. We know from other jurisdictions that many of these assessments are being done online. It is a really important question for us to consider whether we would want that in our country—and if not, it should be in the Bill. In addition, my comments are informed by the evidence that we were presented with in the Select Committee and drawn from my experience of meeting a number of elderly constituents over the course of nearly a decade as a Member of Parliament.

I reflect particularly on the women I met in their 70s, 80s and 90s who shared their experiences of domestic abuse. This conversation and these amendments matter because this legislation does not happen in a vacuum. The Labour Government today are rightly concerned with addressing the public health emergency of violence against women and girls in our country and has an important landmark mission and goal of halving violence against women and girls over the next decades. The NHS is playing its part and enhancing its efforts in tackling and violence against women and girls, focusing particularly on early identification. There is a lot of other very important work going on via training and investment, and I commend the work of many colleagues who are dealing with this on a daily basis. It was the experts that told us that to identify coercion, undue influence and pressure, doctors and other professionals need to look at someone’s body language. It is not just the words we say, how we say them, the volume or the tone—it is our non-verbal cues and what our body says. It is what we do not say that often shares an important message.

I listened very carefully to the counterchallenge of noble Lords so far. I do not think there is anything to stop the Bill from stipulating that, in exceptional circumstances, the doctors, or the independent advocates or panel members can visit an individual. But I would much rather that we had legislation that supports the Government’s important aim to reduce violence against women and girls, rather than something that will exacerbate the very serious problem that we know that too many women in our country face, particularly at their most vulnerable moments, which includes the end of life.

Can the noble Baroness recall that last week she told the House that 23% of six-months-to-live diagnoses turned out to be wrong and that people lived longer? Does that not make the whole position of face-to-face diagnosis much more important when doctors so often get it wrong?

My Lords, technology has gone a long way to helping disabled people to lead inclusive and integrated lives in British society, and I generally support the use of it. But for many of us who worked on the coronavirus legislation, where we had to make very quick decisions, the speed with which we went online made it seem as if, as a society, we had moved decades forward from having to meet only in person. Even your Lordships’ Chamber managed to meet and vote online. But that comes with a set of challenges.

We have to look at what happened during Covid and the huge increase in domestic abuse. It was not just because we did not have to ask people to turn their cameras on. It was deemed that would be upsetting, so we could not see if somebody had been domestically abused. The impact of increasing domestic abuse was also because there was more recording. Even when you look at the technology that we have in your Lordships’ Chamber, it is not foolproof. I was on a call yesterday in my office. The system crashed twice, and the people I was speaking to on Teams did not even realise and carried on talking. We have to think very carefully about how we would use technology.

Age UK said that about 2.4 million older people do not have access to technology in this country and just under 2 million do not have a mobile phone, let alone a smartphone, so if we are going to do this, we need to think carefully about what other provisions will be in place. I agree with the noble Baroness, Lady Berger; why can the panel not go and visit the individual? I think there is something about being in their own home. The noble Baroness, Lady Pidgeon, raised rural areas. What if people do not have the technology? What will be put in place to ensure that there is a suitable online option?

I am quoting from evidence that was given. The noble Baroness, Lady Pidgeon, mentioned Dr Young’s evidence and I understand that she has a PhD in sociology. I have been contacted by Professor Charlotte Wilson-Jones, a professor of psychology, education and innovation. She is incredibly worried about moving to online assessments as a given. This is an individual who has high-level training in both palliative care and psychiatry. She said to me that, without being in the room, it is very difficult to understand what is going on behind the camera. She has worked with a significant number of terminally ill people and has looked at mental illness and capacity assessments. She said to me that this takes time; it cannot necessarily be done in a single appointment. Then you add in layers of communication and difficulties in talking, which make it very difficult to do a proper assessment.

The Bill requires doctors, but it could be a newly qualified doctor who does not have experience in these matters and may not have a postgrad in psychology. Carrying out a role that consultant psychiatrists say is hard to do would throw up another set of challenges. Dr Mumtaz Patel, from the Royal College of Physicians, talked about how important that connection is.

I looked at a study on the impact of Covid on 11 of the jurisdictions where assisted suicide is legal. It found that, in each of those, telemedicine had pushed the boundaries and rules were blurred. In some cases, rules were broken because it had become much quicker to do an assessment. We have not got on to how people are going to be paid or whether there is going to be remuneration, and to the appointment of those individuals, but my concern with telemedicine or doing this by video is that it would incentivise people to push through the assessments and do them quickly.

As other noble Lords have raised, the honourable Member for Spen Valley, Kim Leadbeater, said she was uncomfortable with the Oregon model. Where the noble Baroness, Lady Blackstone, and I probably do agree is that none of this should be a tick-box exercise, but my concern with doing it online is that it would become that. Does the noble and learned Lord agree with Kim Leadbeater’s concerns over this becoming a tick-box exercise? I know that he cannot speak for her, so I am going to write to her, but I would like to understand why she did not amend the Bill to include this after saying that she felt really uncomfortable with it.

Like the noble Baroness, Lady Fox, I have had online assessments; during Covid, I had a breast exam online to see whether I needed a mammogram. I would argue that that was relatively easy. Having to Sharpie under my arms to show where the lumps were is slightly different from someone assessing whether people could take drugs—“poison”, as the noble and learned Lord said last week—to end their lives.

I have another example to show why I have a real worry about this process. My husband was unwell and we had an online assessment. The doctor said that my husband had an ear infection, but it is only because I am probably quite a “difficult” expert patient that I pushed back quite hard and explained that he was permanently on antibiotics and was already taking the antibiotics that would have been prescribed for an ear infection. I gave the amounts that he was taking and I kept being told that it was an ear infection. I pushed back and pushed back. He had had a stroke. Without me forcing the issue and getting him to hospital, I am not sure he would be with me now.

My final point is another question to the noble and learned Lord, which I would be grateful to him for answering. I do not want to assume his answer, but I expect him to say that the criminal law is there to punish coercion. However, surely our job is to prevent coercion, not to put someone through the court system when coercion is suspected or spotted. Will the noble and learned Lord, either in the Bill or by answering today, explain how coercion will be prevented and how we can make sure that people do not, unwittingly or through force, choose to end their lives when it is not what they want?

My Lords, I want to make two points about whether these consultations should be face to face. First, I remind the Committee of the General Medical Council’s remote consultation diagram, which is in the GMC guidance. It is not absolutist about whether doctors should see patients remotely or face to face, but it sets out guidance. It starts:

“Remote consultations may be appropriate when… The patient’s clinical need or treatment request is straightforward”.

We are not talking about straightforward clinical needs or treatment requests here. The other side of the diagram says:

“Face to face consultations may be preferrable when… The patient has complex clinical needs or is requesting higher risk treatments”.

As I have said previously, and it is historic, I was a lay member of the General Medical Council for 10 years and I was involved in helping to draft GMC guidance as well as dealing with conduct and health cases. It is unimaginable to me that the General Medical Council would create guidance in which it accepted the proposal that, save from the most exceptional circumstances based on the clearest evidence, such consultations should be done remotely.

Secondly, the medical profession is not the only group of people who have to give important advice to their patients, clients or customers. Like a few other Members of your Lordships’ House here, I have often had to give advice to people in critical situations when they faced spending possibly the rest of their lives in custody. I recall one case when, in the middle of a longish murder trial, the client asked to see me to ask a very simple question, “How do you think it’s going, sir?” The answer had to be robust and realistic, and it was very difficult. It changed the whole course of the case, which came to a quick end shortly afterwards. The result was a minor advantage to the client: he did not spend the rest of his life in prison, just a substantial proportion of it, but that was very important to him.

I would say to your Lordships that it is quite difficult to see a doctor these days, unless you go to a private doctor. Even if you have seen a doctor, it is quite difficult to see the same one twice. There are remote hearings in the legal profession in certain circumstances, but for the sort of important decisions that I have been describing, it is unthinkable—to us, the professional lawyers who do these cases—that such consultations should not be face to face. That is a qualitative analysis based on two examples, but I hope your Lordships found it convincing.

My Lords, I can be truly short here and it is further to a point made by the noble Baroness, Lady Grey-Thompson. Many of us are concerned about subtle pressure and coercion. It will not appear in all cases, but it will in some and these are legitimate concerns. If this is online, doctors are unlikely to know whether there is someone else present in the room or whether the door is open for someone to listen, nod and encourage the applicant—if I can call the person that—to make their request. If at least one of the panel is present in the room, they would be able to see and counter that. It is really important that there is at least one of those people, preferably the panel, in order to prevent that. That is an important safeguard and, if it is done online, such things could be missed. My recollection is that, in Canada, there have been instances where people, including coroners, have raised legitimate questions afterwards.

My Lords, I want to pick up on two points made in this debate. First, if I heard the noble Baroness, Lady Gerada, correctly, when she advocated online meetings, she said that there is no distinction between whether the person requesting permission is in Torbay or Tenerife. That is a profoundly important legal point, which I hope the noble and learned Lord will cover in his summing up. If a person was in an online meeting in a foreign jurisdiction and it subsequently transpired that there was coercion—noble Lords have given several examples of how that could happen—from a foreign citizen, assuming the patient returned to the UK to carry out their wish to be assisted to die, what would be the legal position in the criminal law?

My second point relates to what the noble Baroness, Lady Berger, said about home assessments. I do not have the impact assessment to hand, but I recall that the number of people likely to seek assisted dying is not enormously large, running, say, to many thousands per year. Therefore, if only 10% of people were unable to have face-to-face consultations, surely the impact assessment should cover that small minority of people and the costs and practicalities of them requiring home assessments.

My Lords, I support the amendments in this group, especially the one from my noble friend Lord Evans. I was not going to speak but I was moved by what the noble Baroness, Lady Smith, said about her father.

I am not a Luddite. My mother passed away in July 2023 from brain cancer, and this debate has reminded me of the Zoom call we had to look at the next stage of her treatment. I was here in London; my sister was with my mother in Liverpool, where she was lying in bed unable to speak. The nurse who was looking at the next stage of treatment for her was in Margate, had never met my mother, and was asking questions for over an hour to which mother could not reply. I have listened to this whole debate, and if we cannot put face-to-face consultation in the Bill, we are doing a great injustice to many people.

My Lords, earlier in the debate, the noble Baroness, Lady Jay of Paddington, intervened to say that she could not understand why, having talked so much, we had not actually talked about terminal illness. If the noble Baroness remains in her place, she will be here for the fifth group of amendments, on terminal illness, and there will certainly be a lot of discussion then of that issue. In fact, if we were speaking to that group of amendments now, we would be told by the Whip to address instead the amendments before us.

In the light of my experience as a Minister, dealing with the general public from another side, I gently say to the noble Baroness, who was advocating for online assessments, that, if they are so perfect, why are so many mistakes made? Should we just dismiss those mistakes?

The sponsor and supporters of the Bill argue that it offers the safest system in the world and is deeply patient centred. Yet they defend provisions that allow doctors and panels never to see the person who is about to take a decision with life-and-death implications. When that decision is taken, there is no return: they are ushered from time into eternity.

We are considering a virtual assessment scheme without proper face-to-face consultation. What discussions about this scheme have been held, and with whom? What does it actually mean? Surely, remote assessment undermines protection from coercion, which is often very subtle and carefully crafted. The abuser could be sitting in that very room—but not visible—listening to the conversation. Coercion is very difficult to detect at the best of times. Serious mistakes have been made in the past. No panel should be called upon to grant the stamp of approval to someone availing themselves of assisted suicide without seeing that person. If assessing capacity remotely is impossible for professional psychiatrists, what makes it okay for these panels?

Surely, parliamentarians must not fail in their duty to protect the public. It is wrong to suggest that this issue should be left to guidance or secondary legislation, rather than primary legislation. This is not simply someone filling in technical details; it is the pathway to a death sentence.

It is right to repeat that in the other place, the Bill’s sponsor, Kim Leadbeater, admitted that the death-by-Zoom model witnessed in Oregon made her uncomfortable and looked like a tick-box exercise. If that is what she thinks, yet nothing was done to stop such an exercise, why should it be acceptable to us simply to let the Bill pass? The Bill should require that the first and second assessments and panel interview be conducted face to face. If the Bill’s sponsor is uncomfortable with death by Zoom, why should we simply rubberstamp it?

If the noble and learned Lord thinks that this is a patient-centred Bill, can he tell us why the doctor never has to see the patient or look them in the eye properly to assess all the issues that have seemingly brought them to the decision to seek assisted suicide? There can be many facets to that decision. Surely, the whole purpose of the assessment process is to be preventive.

When assessing, for example, the mental capacity of the person, the noble and learned Lord suggests that the Mental Capacity Act is tried and tested. Yet expert evidence from Professor Martin Vernon says that assessing capacity remotely, especially for a person with mental needs, is “nigh-on impossible”. He is a professor; I suggest that he too has some experience in this field. In his oral evidence to the Select Committee on 29 October, he said:

“Assessing somebody remotely … without a face-to-face assessment, particularly if they have complex health and social care needs, is nigh-on impossible”.

Do we dismiss the professor’s statement? Sir James Munby said that without hearing from and questioning the patient in person, a psychiatrist cannot be professionally satisfied of capacity. Is he too dismissed?

I believe the noble and learned Lord, Lord Falconer, contends that face-to-face assessment is possibly overengineering the process, but does he really consider that seeing a patient face to face before prescribing lethal drugs is overengineering? Must it not be proven beyond any reasonable doubt—as a learned lawyer, he will know that phrase—that a patient is not being coerced into making this decision?

Amendment 65 has my full-hearted support. It

“provides for advice, declarations and other matters to only be undertaken face to face with the terminally ill person seeking to take their own life with assistance”.

It has been suggested that that may not possible, because the doctor and the person may not meet face to face. I come from a period of life when, if the patient was not able to go to the doctor, the doctor used to go to the patient. Surely that is not asking too much, especially when we are talking about the end of life.

The noble Lord, Lord Wolfson, has Amendment 320A to Clause 10, to add at line 31:

“The first assessment must be undertaken in person, except in circumstances where this is not reasonably practicable when it may be conducted by a live video and audio link”.

The National Health Service is under extreme pressure and remote appointments are becoming the norm because of the demand for efficiency. My honest fear is that “reasonably practicable” will become “administratively convenient”. Surely the grave danger here is putting efficiency over the safety of the extremely vulnerable in our society.

If a registered medical practitioner conducts a preliminary discussion, they surely must explain and discuss the person’s diagnosis, prognosis, available treatment and palliative care options, and surely that person must understand what has been said.

My Lords, I will briefly follow on from the noble Lord on the issue of overengineering. I had great sympathy with the words of the noble Baroness, Lady Blackstone, and I suspect that there is widespread support in the Committee that face-to-face consultations should, in general practice and in the norm, be what happens in these circumstances. We get into great difficulty when we micro-legislate to cover every single circumstance that might occur. A code of practice is a more reasonable and flexible document to deal with this. The noble Lord shakes his head, but he just spoke about the dangers of having anyone else in the room in a consultation because of the possibility of coercion, yet the noble Baroness, Lady Smith, spoke potently about how important it was for there to be a family member, or support, or someone who could hear.

I was not speaking against someone being in the room. I am speaking about someone being in the room whenever it is on Zoom or on camera and not in person, because you do not know whether the person in the room is privately and secretly coercing that person.

I understand that the noble Lord was talking about a subset of consultations, but this is my point: I think he accepted that there might, in any process, be exceptional circumstances where a consultation was not in person. I am just saying that, even in that narrow subset, there might be a reason for another person to be in the room. I am not talking about that specific point; I am trying, in general, to suggest that we should try to lay down some principles but not try to overengineer and cover every possible circumstance.

My Lords, like the noble Baroness, Lady Hayman, I will respond to the noble Baroness, Lady Blackstone. She seemed to express a kind of common-sense view that of course we all agree that it is much better to have face-to-face interviews, and we have heard all sorts of evidence today from the medical profession and the legal profession about how that is much better. The noble Baroness thinks there should be a code of practice. I agree, but surely that code of practice should be about where there are exceptions. It would be much safer to have a Bill in which it is specified that interviews should be face to face, except for certain exceptions laid out in a code of practice. Surely it should be that way around in order that we have as safe a Bill as possible.

My Lords, the noble and right reverend Lord makes a really valid point about codes of practice. Codes of practice sometimes are not statutory, so it would need to be a statutory code. Apart from all that, we also know that codes of practice become outdated. In another area of my expertise, a statutory code of practice was agreed in 2011. Although it is unlawful today, it has still not been withdrawn by the Government.

My Lords, it is far easier to develop a code of practice over time and change it in the context of changes in the environment. It is much more difficult to change a law by statute, which means it has to be brought back into both Houses of Parliament, so I do not really think that the point the noble Baroness just made is valid.

My Lords, having listened to this debate, I am struck that there seems to be a fair bit of consensus. Thinking back to the arrangement of business discussion we had about the pace before this debate, I have listened to the number of people who quoted Kim Leadbeater and her uncomfortableness about making these decisions on Zoom. It strikes me that if she had followed through on that uncomfortableness and put into the Bill a clear presumption that these decisions should be taken face to face, with some exceptions that I will elaborate on in a minute, we would not have needed this debate and we would be moving at a faster pace. There is perhaps a lesson there for the noble and learned Lord: if more cognisance had been taken about some of these concerns at an earlier stage, we would have moved at a faster pace.

The only reason why these amendments exists, why we have debated them and why the noble Lord, Lord Birt, referenced how important a decision this is to get right is that this issue has not already been addressed. I will just leave that there as a possible reason why there are as many amendments as there are to this lengthy Bill and why the debate is necessary: it is because it has not already been done. I will leave that for noble Lords to think about.

I have one note of question. We are all quoting Kim Leadbeater and how she felt about the Oregon example, but, in fact, it may be that she was not talking about the issue of videolinking but about assessments that were done solely on the basis of paperwork. I think we need to find out exactly what Kim Leadbeater was saying before we jump to conclusions about whether the promoters of this Bill have been neglectful in the way that they have dealt with that issue.

The noble Baroness makes a very good point which illustrates the importance of being able to ask people questions directly rather than hearing reports of what they have said or seeing it on a video call. That is the importance of in-person conversation and the ability to ask questions and hear answers so that you know what people actually think. I think the noble Baroness has illustrated and evidenced my point extraordinarily well, and I am grateful for her Intervention.

At the beginning of this, the noble Baroness, Lady Gerada, referred to medical assessments. She is right in saying that many of them can be done very well remotely. I think that is excellent. I am a great supporter of technology. We do not all believe in quills and pens, and I do not think the noble Baroness, Lady Pidgeon, was entirely suggesting that we were. She might want to reflect on that remark and whether it was entirely well-intentioned, given what the Chief Whip said to us about treating everyone with courtesy and respect. I support the use of technology where it is appropriate.

The problem here is that the noble Baroness, Lady Gerada, said that we can all rest assured that doctors would never view this as a routine exercise. The problem is that in other jurisdictions there is quite a lot of evidence that they do. While it is true, as the noble Baroness, Lady Blackstone, said, that the vast Majority of doctors will approach this in absolutely the right way, I am afraid not all doctors are perfect. There was an example yesterday of a paediatrician at Great Ormond Street who had an appalling record. We have to make sure that the law makes sure that patients are properly protected in all cases, not just in the vast majority of them. Where I disagree with her slightly is that this is a policy decision, not a medical decision. Whether assessments should be face to face, either in every case or that the presumption should be that they are, is a policy decision, rightly for Parliament, not for clinicians. It should be informed by listening to clinicians, but it should also be informed by listening to evidence from the patient experience, so ably set out by the noble Baronesses, Lady Smith and Lady Berger.

The noble and learned Baroness, Lady Butler-Sloss, gave her own testimony that she has had to make decisions in these cases, and I was very struck by her view that we should certainly have a presumption that these decisions should be taken face to face. I was very struck by listening to her on previous occasions. Her experience on these matters carries a lot of weight. I also listened very carefully to the noble Lord, Lord Carlile, when he set out the GMC’s advice. Decisions for patients with a terminal illness about a course of action that will lead to the end of their life seem to me to fall squarely within the set of cases where you would want a face-to-face appointment, but equally I felt there was good counsel for us and challenge from the noble Baronesses, Lady Jay, Lady Pidgeon and Lady Blackstone, to think of the patient, the person who has the terminal illness who wants a decision. They were right to challenge us on that.

That is why I think, if we look at the balance of amendments in this group, they are very helpful because they set out a span of choices for your Lordships, from saying that every decision has to be taken in person, which I think would be wrong for the reasons that the three noble Baronesses set out, that you have to look at the patient’s views, but equally, I think the present wording is too loose and does not set out a presumption that they should be face to face. I would be very grateful to hear the view of the noble and learned Lord, Lord Falconer, on where he thinks he is likely to settle because that will be helpful for all of us when thinking about whether we have to table further amendments. It seems to be a presumption that it is face to face, but with a very limited set of circumstances where it can be not face to face. But we should not accept the presumption in a patient-centred model that the patient always has to go and see the panel or the doctors. It should absolutely be, particularly because so many people in these circumstances are going to be in poor health, that we think of a system that makes sure that when it comes to the panel at least one member of the panel, the independent person, is physically present.

That is important. These amendments touch on two parts of Clause 17. The first is subsection (6), which states:

“The duty under subsection (4)(b) to hear from the person to whom the referral relates does not apply if the panel is of the opinion that there are exceptional circumstances which justify not hearing from that person”.

That means there are circumstances where the panel does not have to hear from the person at all: not by videolink, not in person, not by pre-recorded video, not at all. That was confirmed to me when the noble and learned Lord, Lord Falconer, and I were doing a media programme—I think it was “The Week in Westminster”—where I challenged him on this. He confirmed that there were circumstances in which a decision could be taken for someone to seek assisted suicide and the panel would never have to see them at all. I do not think that is right.

The other subsection these amendments touch on is subsection (5), which states:

“Where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material”.

That was inserted in the House of Commons by a Back-Bench Amendment. It was not very well debated. The fact that it is pre-recorded means that it gets rid of any opportunity for questioning or challenge. The problem I have with the language there is that it says “medical reasons”, it does not say “medical reasons pertaining to the patient”. This is my last point—

We are forgetting that we can use the telephone in this circumstance. It is not even that you would have sight of the person, but you could have a pre-recorded telephone call.

I am grateful for that. The final point I want to make is that we had experience during the pandemic of too many vulnerable people, people with learning disabilities, having “do not resuscitate” notices put on them by doctors. I do not want to see a system where, if we had a similar circumstance again, these sorts of decisions would be taken remotely at speed. We know from our deliberations in this House, and it is my experience in the other place, that there is no substitute for doing these things face to face where you can challenge people, ask questions, put people under that challenge and get good answers to make good decisions.

I commend this group of amendments to your Lordships, and I look forward to hearing the response of the noble and learned Lord, Lord Falconer.

I would like to provide a brief clarification on the back of what the noble Lord, Lord Harper, said about the points raised by Ms Leadbeater’s comments about feeling uncomfortable. It came from a report on ITVX on 6 March 2025. An assessment was taking place with Dr Jess Kaan. I believe family members were there, and then she asked the patient’s family to leave the room so that she could privately ask the patient whether it was a settled wish. The patient said yes, it was. I quote directly from the ITV website:

“For Kim Leadbeater, the virtual consultations did not make for comfortable viewing—she says it has made her think about adding an Amendment to make clear that consultations with doctors cannot be done via video call and that they should be done in person”.

My Lords, in the interests of time I do not propose to summarise the many points and questions that have been raised in this debate. However, I wish to speak briefly to Amendment 320A in the name of my noble friend Lord Wolfson. The amendment seeks to set the presumption that the first assessment by the co-ordinating doctor

“must be undertaken in person, except in circumstances where this is not reasonably practicable”.

It is plain from everything that we have heard in the debate that the first assessment is a pivotal moment in the process set out in the Bill. It is the point at which a co-ordinating doctor must satisfy themselves not only of the diagnosis and prognosis but of the patient’s capacity and will and, crucially, the absence of coercion or pressure, as set out in Clause 10. These are human judgments that depend not simply on what a patient says but on the way that they say it, on physical cues and on the broader context in which the conversation takes place.

I listened carefully to the noble Baroness, Lady Finlay, in particular, as I did to other noble Lords, and an in-person assessment undoubtedly allows a clinician to observe matters that may not be apparent on a screen—for example, who else is present in the room, whether the individual appears comfortable speaking freely or whether there are signs, however subtle, of hesitation or external influence. At the same time, I suggest that we need to be patient-focused as well as doctor-focused, which is why my noble friend’s amendment seeks to recognise practical realities. There will surely, from time to time, be circumstances, perhaps in late-stage illness when a person may be in acute distress, where an in-person assessment is genuinely not possible. The reasons for that could be several, but in those cases we need to ask ourselves whether a live video and audio link would be preferable to a delay, or even a complete exclusion from the process.

I emphasise that the amendment is a probing one. If we decide that provision should be made for certain cases then that would surely be a classic area for guidance or codes of practice, but the key test in every instance would be what is reasonable in the circumstances. My noble friend wants to be clear that this amendment is about setting the right default for arguably the most consequential clinical judgment in the entire scheme of the Bill, while preserving professional discretion in response to the needs of the patient where circumstances require flexibility.

I have deliberately spoken in general terms when talking about what might not be reasonably practicable. The question is really the one posed by the noble Baroness, Lady Hayman: how rigid do we wish the Bill to be in prescribing how the system should work? I hope the noble and learned Lord, Lord Falconer, could set out his vision of how this mechanism will work in practice and how he will ensure that the safeguards that we all want to see can still be maintained if an in-person assessment is not possible.

My Lords, I am grateful to all noble Lords for their contributions to this debate. As ever, I will limit my comments to amendments on which the Government have major legal, technical or operational workability concerns.

First, I draw the attention of the Committee to operational workability concerns about Amendments 60 and 65. Under Amendment 60, professionals delivering the service would be responsible for checking whether the person was in England or Wales on multiple occasions before carrying out their duties, even if it had been confirmed that the person was ordinarily resident in England or Wales. That would place a significant burden on professionals delivering an assisted dying service.

Amendment 65, also tabled by the noble Baroness, Lady Coffey, would require certain steps under the Bill to be carried out face to face. If accepted, the amendment could have workability impacts on the Bill. For example, it could introduce internal inconsistency with Clause 17(5), which provides that:

“Where the panel considers it appropriate for medical reasons, it may make 45 provision for the use of pre-recorded audio or video material for the purposes of” carrying out its duties. Requiring all steps in the Bill to be carried out face to face could also give rise to legal challenge on the basis of Article 14 when read with Article 8 of the ECHR. For example, excluding people who may have difficulties meeting face to face from accessing assisted dying may amount to indirect discrimination on the basis of disability or age, as certain groups may find it more difficult to meet face to face. Any differential treatment would need to be objectively and reasonably justified to be lawful.

On Amendment 376, tabled by the noble Lord, Lord Evans, the stated aim is to require that assessments by the co-ordinating doctor, an independent doctor, are carried out in person, not remotely. It is possible that requiring an in-person assessment could have some workability risks, given that there are some circumstances in which it is not possible for an in-person assessment to take place.

I make no comment on other amendments in this group. As noble Lords are aware, the amendments have not had technical drafting support from officials. Further revision and corresponding amendments would therefore need to provide consistent and coherent terminology throughout the Bill.

In reference to Amendment 60, if I picked the Minister up correctly, she said that establishing where an individual was in the world would put a burden on the medical people involved. Surely if they are in touch with them, they can at least ask them where they are.

I understand the point, but it is about verifying that.

My Lords, I express my gratitude to everyone who has taken part in the debate. I make special mention of the noble Baroness, Lady Smith of Newnham, and the noble Lord, Lord Polak, who spoke about the death of their father and mother. Like everyone else, I am grateful for what may have been something that was quite difficult to contribute to the debate. I hope I have not left out anyone else out who has done that.

These amendments fall effectively into two categories. The first is the England and Wales category—what do you have to be in England and Wales to do?—and, secondly, and separately, in what circumstances is a face-to-face meeting between either the patient and the doctors or the patient and the panel required?

I will deal first with the position of England and Wales, raised by Amendment 60, from the noble Baroness, Lady Coffey. Currently, under the provisions of the Bill, the first declaration made by the patient, the second declaration made by the patient, the first assessment of the patient, the second assessment of the patient and assistance being given to the patient all have to take place in England and Wales. There was a range of other things that the noble Baroness wished to take place while the patient was in England and Wales—for example, switching from one doctor to another, which is a process. For my part, I think the Bill has broadly got right when you have to be in England and Wales. Having listened carefully to what the noble Baroness has said, I am not minded to suggest an amendment in relation to that, and I note that it was not picked up as an issue by other people.

The face-to-face issues were much more what the Committee, if I may say so, was interested in through the course of this debate. The effect of the debate has been, in effect, to identify four possibilities. First, Amendment 65 wants each of the occasions, namely the two doctors and the panel, to always involve a face-to-face meeting. Secondly, there should be a face-to-face meeting unless there are—I use this phrase without intending to pick up all the amendments—exceptional circumstances or practicability issues. Thirdly, the third amendment from the noble Lord, Lord Blencathra, which he referred to, is that there should be, to use his language, a “statutory protocol” defining where there can be remote meetings, accepting that the norm is face to face. Fourthly, we could simply rely on the existing provisions of the Bill, which is that codes of practice can be issued by the Minister under the various provisions of the Bill saying when face to face is appropriate and when it is not.

The testimony—that is what it felt like—given of cases where remote has gone wrong have enormous power and I think we are all aware of circumstances where face to face will lead to much greater and better communication. The other side of the coin, which was referred to by the noble Baronesses, Lady Pidgeon and Lady Hayman, my noble friends Lady Jay and Lady Blackstone and the noble Earl, Lord Howe, is that there will be circumstances where, if you insist on face to face, you are, in effect, excluding some people from this right when they should have it. There are arguments on both sides.

I come away with the strongest possible feeling that the Committee thinks that face to face where possible is best but that there will be circumstances where it is not appropriate. That brings me to my third and fourth possibilities. It is wrong and dangerous to try to use a phrase such as “reasonably practicable” or “exceptional”; more is required and guidance should be given. This is not a criticism—it is a congratulation—but I do not think the words “statutory protocol” are right, but I get from what the noble Lord, Lord Blencathra, is saying that he wants something that has the force of regulations or something similar that says, “This is what we have in mind”. Whether that is a code of practice or a statutory protocol, I am not sure. I am sure it is not what is called a protocol, but it might be something quite like that. I think the right course for me is to go away and bring back something that satisfies the Committee that there will be something—a statutory protocol or a code of guidance—that indicates when face to face is appropriate or should be the norm, but gives the circumstances where it would not be, because I get the sense of anxiety about that. I hope, in the light of that approach, noble Lords will feel able to withdraw or not to press their amendments.

I cannot quite understand why the noble and learned Lord is so unwilling to have in the Bill that the presumption should be face to face, with exceptions written into a protocol? Why is he objecting to having it that way round?

As a lawyer, going for a presumption is wrong. I think the right thing to do is say something such as the norm is face to face, but there could be circumstances in which you may not do that. You should give maximum flexibility.

Can I just illustrate, perhaps, to the noble and learned Lord why people are so nervous? In the Commons, at Second Reading and for much of the Committee stage, MPs were told that the panel would have to speak to the patient. Amendments were tabled subsequently—the ones I talked about—which then allowed the panel to accept pre-recorded video and waive hearing from the applicant entirely in those undefined exceptional circumstances. I absolutely accept the argument against a blanket position, but if there was a rebuttable presumption that it should be face to face and some circumstances were set out, which could be developed with case law, from listening to the debate, it seems that that would command widespread support from the Committee and would deal both with people’s concerns and, rightly, the patient-centred approach that the three noble Baronesses set out for noble Lords.

In relation to the noble Lord’s point about the imposition of subsection (6), the Bill currently says that the panel

“must (subject to subsection (6)) hear from, and may question, the person to whom the referral relates”,

so it has to question the person, though not necessarily in person. Subsection (6), which he referred to, says:

“The duty … to hear from the person … does not apply if the panel is of the opinion that there are exceptional circumstances which justify not hearing from that person”.

That was added during Committee, because a Member of the Committee described the circumstances of his own mother, I think. That is why it happened. But I will note what the noble Lord says. I do not think I will go for a presumption, but I hear what he says.

The noble and learned Lord talked about questioning; this is important, because I think he slightly misspoke. Subsection (5) says:

“Where the panel considers it appropriate for medical reasons, it may make provision for the use of pre-recorded audio or video material”.

The problem with that is that you lose any ability to ask questions, which is critical. That was added afterwards—after people had heard these concerns—and it went backwards. Will the noble and learned Lord reflect on that? If he is going to table an Amendment, I ask him to make sure that it reflects the debate that he has heard this morning in your Lordships’ Committee.

Obviously, you cannot ask questions under subsection (6), so it is exactly the same point. The point being made in subsections (5) and (6) is that the panel recognises that there are circumstances in which questioning is not possible. I do not know what additional point the noble Lord was making.

I am grateful to the noble and learned Lord. I acknowledge that he has accepted that something else needs to be added to the Bill, possibly along the lines that I was suggesting. That comes on top of the dozen new clauses that he is already planning to add to the Bill, so I ask him to help me understand something. If the noble and learned Lord is therefore admitting that the Bill is fundamentally flawed, to a greater or lesser extent, and that it needs to be amended, how on earth can he reconcile that with what he said a couple of days ago? He said that he would seek to drive the Bill through, unamended from the House of Commons—the Bill that is so fundamentally flawed that he is now trying to move amendments to correct it. That said, I am grateful for his concession this morning.

I would not look a gift horse in the mouth if I were the noble Lord. First, I do not regard accepting amendments in Committee of the House of Lords as indicating that a Bill is fundamentally flawed; I regard it as listening and making appropriate changes. Secondly, in relation to the question of the Parliament Act, the last thing I want is for this to happen through the Parliament Act. I want this House to do the job that it is supposed to do, which is do scrutiny and then send it back to the Commons.

In the debate on 8 January 2026, I gave in detail the reasons why I thought we were not going about it properly, and I thought that the House agreed with me when it said that we needed to move quicker. The problem is not that everybody does not have good ideas; the problem is that it is taking not just far too long but disproportionately long. My experience of the Lords is that we can do this, and we can do it much quicker than we are doing it and there still be quality. That was the point I made on 8 January and that I understood the House to have accepted.

My Lords, if I remember it correctly, the Motion that the noble and learned Lord put before the House on 8 January was a Motion that more time was required, not that the House needed to race through the Bill and proceed more quickly. The Motion did not say that we needed to move more quickly; it said that we needed more time. That is what the House agreed to.

The Motion said that more time should be given so that we could complete the stages of the Bill so that it would have sufficient time to get back to the Commons. I was particularly impressed during that debate by what my friend, the noble and learned Baroness, Lady Butler-Sloss, said—that we have to “get through” this. We are not getting through it.

My Lords, the noble and learned Lord has made the point that I was making. We were saying—we agreed and did not vote against him—that more time was required. But the discussion earlier this morning was about the fact that the House must not rush this, because that we are talking about life and death, and in particular the life and death of very vulnerable and marginalised people who are living in poverty and all those things. These things require the kind of consideration which has occurred this morning, as reflected in the noble and learned Lord’s response.

I understand the noble and learned Lord’s comments about “reasonably practicable” in relation to this group of amendments. But the Bill actually has “reasonably practicable” written many times—in Clauses 10, 11, 16, 18, 47 and 50—in relation to the length of time a doctor should take to write a written report. I have amendments to shorten that length of time. I am interested in why the noble and learned Lord does not think—I am sure he is going to say that we will discuss this when we get on to those groupings—that “reasonably practicable” is not suitable in this situation, but is suitable in situations such as the length of time it takes doctors to write a report?

That is a very valid point in relation to this particular Amendment. The reason I think some sort of regulatory process from the Secretary of State—a code of practice or something similar—is better is that you can give much more detail and many more examples. You should not be relying on just a particular two-word legal test.

My Lords, this has been quite a revealing debate in many ways. In trying to go with the spirit of getting on with the Bill, I could have easily broken that group into just consideration about what should be physically in the country and what should be face to face. However, I thought bringing that debate together could have been, and has been, of benefit to your Lordships.

One thing that has come up, and the noble and learned Lord has recognised, is that the concept of face to face being largely default has been well received. There have been a few other issues, though. In her contribution, the noble Baroness, Lady Pidgeon, gave a series of examples where, I have been informed by barristers, it would be required for clinicians to conduct home visits.

I was particularly struck by several speeches: I am not going to repeat them all. The noble Baroness, Lady Keeley, spoke about something as straightforward as a will, and certainly the legal protections are there.

Going forward to Report, I am clear that I believe that a lot of the operation and activities of these panels should happen in this country, rather than the psychiatrist, the KC or whoever being abroad in Tenerife—never mind anybody else. I think it is not sufficient to rely simply on statutory guidance. I gave the example last week when we talked about Montgomery: the GMC only changed their guidance, as was referred to, five years after the legal ruling. It did not happen straight away. The other thing about statutory guidance is that it does not have to come to Parliament; it is simply what the Minister can put out. For me, there are deficiencies in that approach, although I understand the flexibility. The whole point is that—

Whether it has to come to Parliament depends on the provisions, does it not?

As it stands, there seems to be a variety around the Bill on whether or not there is that 40-day pre-laying. It just seems to vary. Standard legislation would not require it, unless Parliament or the Government inserted that specifically into the Bill.

Overall, there is still a lot to be discussed. I would like to seek a meeting with the Minister on the response that somehow Article 8 is engaged, linked to Article 14 and how Amendments 60 and 65 in particular are not operable in that regard. With that, I beg leave to withdraw Amendment 60.

Amendment 60 withdrawn.

Amendments 61 to 65 not moved.

Sitting suspended. Committee to begin again not before 1.44 pm.