Assisted Dying Bill [HL]

Insert the following new Clause—

“Legal aid

Legal aid shall be available in respect of the application for the consent of
the High Court (Family Division) in accordance with regulations made by
the Secretary of State exerciseable by statutory instrument subject to
annulment in pursuance of a resolution of either House of Parliament.”

Page 1, line 12, after “of” insert “assistance with suicide provided under”

Page 1, line 13, leave out “a registered medical practitioner” and insert “at least two
2registered medical practitioners, with one of whom the person has been registered
for medical care for at least six months immediately prior to making the
declaration at section 1(2)(b) and at least one of whom has diagnosed the terminal
illness and treated the person in relation to that terminal illness,”

Line 2, leave out “registered medical practitioners” and insert “licensed medical
practitioners who are on the General Practice or specialist register”

Page 1, line 13, leave out “a registered medical practitioner” and insert “two
registered medical practitioners independently”

Page 1, line 13, leave out “registered” and insert “licensed”

Page 1, line 13, at end insert “incurable and”

Page 1, line 16, leave out paragraph (b) and insert—

“(b)   as a direct consequence of that terminal illness, is reasonably
expected to die within three months of the date of the declaration at
4section 1(2)(b).”

Line 4, at end insert “in the considered view of two registered medical practitioners
not previously involved in treating the person.”

Page 1, line 16, after “a” insert “direct”

Page 1, line 16, leave out “reasonably”

Page 1, line 17, leave out “months” and insert “weeks”

Page 1, line 18, after “symptoms” insert “and does not delay the progression”

Page 1, line 19, after “can” insert “halt or”

Lord Trefgarne gives notice of his intention to oppose the Question that Clause 2 stand part
of the Bill.

Page 2, line 1, leave out “end their own life” and insert “commit suicide”

Page 2, line 2, leave out from beginning to “in” in line 4 and insert “An application
may be made to the High Court (Family Division) under section 1(2) only if—

(a)   the person has made and signed a declaration that he or she has a
voluntary, clear, settled and informed wish to end his or her own
life”

Page 2, line 2, leave out from “person” to “if” in line 3 and insert “may be provided
with assistance with suicide”

Page 2, line 4, leave out “a declaration” and insert “two declarations dated 14 days
apart”

Page 2, line 5, leave out “a witness (” and insert “two witnesses (who up to that
point must not have been known to each other and”

Page 2, line 5, leave out “witness” and insert “solicitor”

Page 2, line 6, leave out “directly involved in the person’s care or treatment” and
insert “have any personal or social relationship with the person or expect to receive
any benefit directly or indirectly from the person’s death”

Page 2, line 6, after “treatment” insert “or anyone who stands to gain financially or
in any other manner from the death of the person”

Page 2, line 6, after “who” insert “has”

Page 2, line 8, leave out paragraph (b) and insert—

“(b)   that declaration is accompanied by statements from two medical
practitioners, who are qualified as set out in subsection (4) and one
of whom has been the attending doctor with responsibility for that
person’s clinical care for a period of not less than six months
immediately prior to the making of the declaration by the person,
containing a diagnosis and predicted course of that person’s
illness.”

Page 2, line 8, leave out “that declaration has” and insert “those declarations have”

Page 2, line 10, leave out first “the” and insert “a suitably qualified”

Page 2, line 10, leave out “registered” and insert “licensed”

Page 2, line 11, after “doctor”)” insert “after consideration by the attending doctor”

Page 2, line 13, after “another” insert “suitably qualified”

Page 2, line 13, leave out “registered” and insert “licensed”

Page 2, line 13, leave out “independent” and insert “second”

Page 2, line 16, at end insert “nor may either of them countersign a declaration if
they have signed one for anyone during the previous 4 years”

Page 2, line 16, at end insert—

“( )     A registered medical practitioner must not countersign more than the
following number of declarations under this Act—

(a)   when acting as attending doctor, 3 in 12 months; and

(b)   when acting as independent doctor, 6 in 12 months.”

Page 2, line 17, at beginning insert “Neither”

Page 2, line 17, leave out “(but not the independent doctor)”

Page 2, line 17, leave out “but not” and insert “nor”

Page 2, line 18, leave out “registered” and insert “licensed”

Page 2, line 19, at end insert “but shall—

(a)   be in regular clinical practice and hold a current licence to practise
from the General Medical Council and be registered as a general
practitioner or specialist;

(b)   be the doctor with whom the person requesting assistance to end
his or her own life has been registered for medical care for at least
twelve months and who has been personally involved in that
person’s care for at least six months;

(c)   have visited the person at his or her place of residence at least once
in the three months prior to the making of the declaration;

(d)   not be a relative of the person or have any personal or social
relationship with the person making the declaration;

(e)   be able to communicate with the person making the declaration in
the language of that person’s choice, if necessary via an interpreter
who is not a relative of the person;

(f)   not expect to receive any benefit directly or indirectly from the
death of the person;

(g)   have undertaken no other assessment of a request for assistance
with suicide during the preceding one year;

and the attending doctor must present all assessments for appraisal and
revalidation of a licence to practise as registered with the General Medical
Council.”

Page 2, line 19, at end insert—

“( )     The second doctor shall—

(a)   be in regular clinical practice and hold a current licence to practise
from the General Medical Council and be registered as a general
practitioner or specialist;

(b)   not have any personal or social relationship with the person making
the declaration;

(c)   hold such qualification and have such experience in the diagnosis
and management of the person’s terminal illness as the Secretary of
State may prescribe in regulations;

(d)   be able to communicate with the person in the language of the
person’s choice, if necessary via an interpreter who is not a relative
of the person;

(e)   not expect to receive any benefit directly or indirectly from the
death of the person;

(f)   have undertaken no other assessment of a request for assistance
with suicide, either as an attending doctor or as a second doctor, in
the preceding one year;

and the second doctor must present all assessments for appraisal and
revalidation of a licence to practise as registered with the General Medical
Council.”

Page 2, line 19, at end insert—

“( )     The attending doctor and second doctor must be able to communicate with
the person making the declaration in terms which the person understands
and in the language of that person’s choice, if necessary via an interpreter
who is not a relative of the person.”

Page 2, line 20, leave out subsections (3) and (4) and insert—

“(3)     A medical practitioner is qualified to submit a statement as provided in
subsection (1)(b) if he or she—

(a)   holds a current licence to practise from the General Medical
Council, is in regular clinical practice and is registered as a general
practitioner or as a specialist;

(b)   is unrelated by blood, marriage or civil partnership to the person
making the declaration and has no personal or social relationship
with that person;

(c)   expects to receive no benefit, whether directly or indirectly, from
the death of the person making the declaration;

(d)   has submitted no other statement as provided in subsection (1)(b)
in the 12 months immediately preceding the statement; and

(e)   has such experience in the diagnosis and prognosis of terminal
illness as the Secretary of State may specify in regulations.

(4)     Any statement under subsection (1)(b) which is submitted by a medical
practitioner must be declared at appraisal and revalidation of a licence to
practise as registered with the General Medical Council.”

Page 2, line 21, leave out “independent” and insert “second”

Page 2, line 22, after “other” insert—

“( )   ”

Page 2, line 24, after “ill” insert “as defined in section 2”

Page 2, line 25, leave out “end their own life” and insert “commit suicide”

Page 2, line 25, at end insert—

“( )   fully understands the permanence of their own death;”

Page 2, line 26, leave out “end their own life” and insert “commit suicide”

Page 2, line 27, leave out “an” and insert “a fully”

Page 2, line 28, at end insert- “or resulting from a sense of obligation or duty to
others to die”

Page 2, line 28, at end insert—

“( )   must conduct such clinical tests as may be necessary to confirm the
diagnosis of the person’s medical condition and the prognosis of its
outcome;

( )   must examine all relevant information relating to the person’s
request including his or her medical records and the results of any
scans, biopsies, and other clinical tests.”

Page 2, line 28, at end insert—

“( )     In reaching the judgments in subsection (3), the attending and the second
doctor shall—

(a)   separately and independently examine the person requesting
assistance to end his or her own life;

(b)   conduct such clinical tests as may be necessary to confirm the
diagnosis of the person’s medical condition and the prognosis of its
outcome;

(c)   examine all relevant information relating to the person’s request
including his or her medical records and the results of any scans,
biopsies, and other clinical tests;

(d)   consult other healthcare professionals who have been involved in
the person’s care.”

Page 2, line 29, leave out subsection (4) and insert—

“(4)     A person commits an offence if, while acting as the attending doctor or the
independent doctor, he or she countersigns a declaration under subsection
(3), unless he or she is satisfied that the person making that declaration has
been fully informed of the palliative, hospice and other care which is
available to that person.”

Page 2, line 30, leave out “independent” and insert “second”

Page 2, line 31, leave out from “been” to end of line 32 and insert “referred to and
seen by a specialist in palliative care”

Page 2, line 32, at end insert “including the provision of appropriate social care and
support from his or her local authority”

Page 2, line 32, at end insert “by a person professionally competent to do so”

Page 2, line 32, at end insert—

“( )     If the attending doctor or independent doctor has doubt as to a person’s
capacity to make a decision under subsection (3)(b) or (c), before deciding
whether to countersign a declaration made by that person the doctor
must—

(a)   refer the person for assessment by an appropriate specialist; and

(b)   take account of any opinion provided by the appropriate specialist
in respect of that person.”

Page 2, line 32, at end insert—

“( )     In respect of subsection (3), the attending doctor and the independent
doctor must be satisfied that the person is informed of the palliative,
hospice and other care which is appropriate to the person’s age.”

Page 2, line 33, leave out from “on” to end of line 34 and insert “such date as the
High Court (Family Division) may order”

Page 2, line 34, leave out “independent” and insert “second”

Page 2, line 37, leave out subsection (7)

Page 2, line 37, leave out subsection (7) and insert—

“(7)     For the purpose of subsection (1)(b), an attending doctor or independent
doctor is suitably qualified if that doctor holds such qualification or has
such experience, including in respect of the diagnosis and management of
terminal illness, as the Secretary of State may specify in regulations (which
may make different provision for different purposes).”

Page 2, line 40, at end insert—

“( )     In this section “appropriate specialist” means a registered medical
practitioner (other than the attending doctor or independent doctor) who
is registered in the specialty of psychiatry in the Special Register kept by
the General Medical Council.”

Page 2, line 40, at end insert-—

“( )     The attending doctor and the independent doctor must ensure that the
needs of the patient, and not the institutional requirements of the health
service, are paramount throughout the process established by this Act.”

Page 2, line 40, at end insert—

“(8)     The attending doctor and the independent doctor must be able to
communicate with the person making the declaration in the language or
4dialect of that person’s choice, and must be satisfied that they are culturally
attuned to the needs of the person.”

Line 4, at end insert “and religiously”

Page 2, line 40, at end insert—

“(9)     The form in the Schedule must be made available in any language or dialect
requested by the person who is considering making a declaration.”

Page 2, line 40, at end insert—

“(10)    Interpreters and translators who assist under subsection (8) or (9) must
hold a relevant professional qualification.

(11)     The Secretary of State may specify by regulations what is a relevant
professional qualification for the purpose of subsection (10).”

Leave out Clause 3 and insert the following new Clause—

“Powers of the Court

(1)     The Court may make an order under this Act in any case where on the
evidence the Court is satisfied beyond reasonable doubt that—

(a)   the provisions of section 1(2) are satisfied;

(b)   to refuse the order would amount to a breach of Article 3 of the
European Convention on Human Rights; and

(c)   to refuse the order would amount to a breach of Article 8 of the
European Convention on Human Rights.

(2)     In deciding whether subsection (1) is satisfied, the Court shall consider the
rights of the applicant and also the rights of others who may be affected by
the applicant’s suicide.

(3)     The Court may in its discretion allow persons in addition to the applicant
to be heard.”

Lord Trefgarne gives notice of his intention to oppose the Question that Clause 3 stand part
of the Bill.

Insert the following new Clause—

“Capacity of an applicant

For the purposes of this Act, an applicant has capacity commensurate with
a decision to end his or her own life and a clear, settled, informed and
voluntary intention to do so if he or she-—

(a)   is not suffering from any impairment of, or disturbance in, the
functioning of the mind or brain or from any condition which might
cloud or impair his or her judgement;

(b)   is able to communicate clearly an intention to end his or her life;

(c)   has maintained over a reasonable period of time a firm and
unchanging intention to end his or her life;

(d)   is not the subject of influence by, or a sense of obligation or duty to,
others.”

Insert the following new Clause—

“Capacity to make the decision

(1)     Assistance with suicide under this Act shall not be provided to a person
unless and until it has been established that he or she has the capacity to
make the decision to end his or her own life.

(2)     Unless the attending doctor is satisfied that a person requesting assistance
to end his or her own life has the capacity to make such a decision and is
not suffering from any condition, including but not limited to depression,
which might be impairing his or her judgement, the attending doctor shall
refer the person making the request to a psychiatrist for a specialist
assessment of that person’s capacity.

(3)     Where a person making the request is referred for specialist capacity
assessment, the assessment shall be carried out by a psychiatrist who
shall—

(a)   be on the specialist register as a clinical psychiatrist;

(b)   be unconnected either personally or professionally with either the
attending or the second doctor;

(c)   be unconnected, whether professionally, personally or socially,
with the person making the request for assistance to end his or her
own life.

(4)     If both the attending doctor and the psychiatrist are satisfied that the
person making the request has the capacity to make the decision to end his
or her own life and is not suffering from any condition which might impair
that person’s judgement, the attending doctor shall forward the request to
the second doctor.

(5)     Unless the psychiatrist or the second doctor is satisfied that the person
making the request has the capacity to make the decision, the request shall
not proceed further and the person shall be informed.

(6)     Both the attending doctor and the second doctor shall have had
appropriate training in identifying issues of capacity.”

Insert the following new Clause—

“Application for a Court order

(1)     The applicant or his or her authorised representative may apply to the
Family Division of the High Court (“the court”) for an order to permit
assistance with suicide in accordance with the rules of the court and any
practice directions which the court may issue.

(2)     When considering applications under subsection (1), the court shall
appoint an independent medical expert or experts to assist the judge in
determining any medical (including mental health) issues and to consider
medical evidence provided by the applicant and any other party to the
proceedings.

(3)     For the purposes of subsection (2), each appointed independent medical
expert shall prepare and submit to the court a written report detailing his
investigation and evaluation of the evidence provided to him.

(4)     The court must be satisfied that the application is based on a level of
capacity as defined in section (Capacity of an applicant).

(5)     Where an order under this section is granted, the court shall appoint—

(a)   a doctor to prescribe a lethal dosage of drugs for use by the
applicant to end his or her life;

(b)   an independent person to collect the drugs referred to in paragraph
(a) and to oversee the act of assisted suicide in accordance with the
order.”

Insert the following new Clause—

“Independent person’s report

Each report prepared in accordance with section (Application for a Court
order)(3) shall be submitted to the Chief Coroner, who will determine
whether an inquest should be held into the death of the applicant.”

Insert the following new Clause—

“Voluntary request

For the purpose of this Act, a request for assistance with suicide may be
regarded as voluntary if—

(a)   the person seeking such assistance is acting of his or her own free
will and without coercion, pressure or duress from others or from a
sense of obligation or duty to others; and

(b)   the attending doctor and second doctor are satisfied, on the basis of
in-depth discussions with the person making the request and with
others close to him or her, that the request meets the requirements
in paragraph (a).”

Insert the following new Clause—

“Informed request

(1)     For the purposes of this Act, a request for assistance with suicide may be
regarded as fully informed if the person making the request has been made
fully aware of his or her medical condition and its prognosis, of the
consequences of receiving assistance with suicide and of alternatives to
pursuing such a course, including palliative care, hospice and other care.

(2)     If a person making a request for assistance with suicide under this Act has
not previously been referred to a specialist practitioner in palliative care,
the attending doctor shall refer the person for a consultation with such a
specialist, for an explanation of how pain relief can be achieved, for
treatment (where appropriate) and for a report as to the person’s
understanding of his or her terminal situation.”

Insert the following new Clause—

“Commensurate capacity

(1)     For the purposes of this Act, section 1(2) of the Mental Capacity Act 2005
(whereby a person shall be presumed to have capacity unless it is
established that he or she does not) shall not apply.

(2)     Assistance with suicide under this Act shall not be provided to a person
unless and until it has been established that he or she has a level of capacity
commensurate with a decision to end his or her own life.

(3)     If the attending doctor is satisfied that a person requesting assistance to end
his or her own life has capacity commensurate with such a decision, he or
she shall refer the person making the request to a specialist in psychiatry
who should offer two assessments, spaced at least 28 days apart—

(a)   for assessment to confirm that the person is not suffering from a
mental disorder, including but not limited to depression, which
might be impairing his or her judgment, and

(b)   for assessment to confirm that the person has a level of capacity
commensurate with a decision to end his or her own life.

(4)     If the attending doctor has any reservations concerning the presence of the
required level of capacity, he or she shall not consider the request further
and shall so inform the person making the request.

(5)     For the purpose of subsection (3), a specialist in psychiatry shall be—

(a)   registered as a specialist in psychiatry with and hold a current
licence to practice from the General Medical Council;

(b)   trained in assessment of decision-making capacity in persons with
complex illness;

(c)   approved under section 12(2) of the Mental Health Act 1983;

and shall report any involvement in assessment of requests for assistance
with suicide at revalidation and re-licensing appraisals.”

Insert the following new Clause—

“Clear and settled intention

For the purposes of this Act, a person requesting assistance with suicide
may be regarded as having a clear and settled intention to end his or her
own life if—

(a)   an Advance Declaration in the form of Schedule (Form of Advance
Declaration) has been made by the person making the request and
witnessed and countersigned by a solicitor at least twelve months
before the making of the request and remains in force at the time the
request is made; and

(b)   the attending doctor and the second doctor are satisfied, on the
basis of in-depth discussions with the person making the request
and with others close to him or her, that the person has a clear and
settled intention to end his or her own life.”

Insert the following new Clause—

“Consideration by the High Court

(1)     The High Court (“court”) shall make no order in favour of assisting the
death of a person making a declaration under section 3 unless it is satisfied
beyond reasonable doubt that that person has a clear, voluntary, settled
and informed wish to end his or her life and has the capacity to make the
decision to end his or her life.

(2)     In considering whether a person has a clear, voluntary, settled and
informed wish to end his or her life and has the capacity to make the
decision to end his or her own life, the court may have regard to such
matters as it deems appropriate which shall include but are not limited to—

(a)   any submissions made by the person making the declaration, or by
a lawyer or other representative carrying a duty of the utmost good
faith to that person;

(b)   the evidence of such medical practitioners as have submitted
statements containing a diagnosis and predicted course of that
person’s terminal illness;

(c)   the evidence of specialists qualified in the assessment of mental
capacity;

(d)   the evidence of specialists in the management of terminal illness;

(e)   the evidence of persons who have known the person making the
declaration over a reasonable period of time and are familiar with
his or her character and personality or with any personal, domestic
or social situations or considerations (or both) which may have a
bearing on the request;

(f)   the evidence of interested parties whose intervention the court
considers likely to be of assistance in reaching a decision.

(3)     If the court is satisfied that the requirements of subsection (1) have been
met, it shall make an order authorising prescription of the drugs necessary
to enable the person to end his or her own life, and may appoint another
person to deliver those drugs under the terms set out in section 4.”

Page 2, line 42, leave out subsections (1) to (3) and insert—

“(1)     Where the court has made an order authorising the prescription of drugs to
enable a person to end his or her own life, such drugs shall be made
available to that person only if he or she has requested them for use.

(2)     If such a request for use has been made, the person appointed for the
purpose by the court shall obtain the required drugs and convey them to
the person who has requested them for use.

(3)     The drugs may be delivered to the person who has requested them for use
if—

(a)   a minimum of 14 days has elapsed from the date on which the court
made the order;

(b)   the person requesting the drugs for use has confirmed that he or she
has not revoked and does not wish to revoke his or her declaration;

(c)   the person appointed by the court is satisfied that the person who
has requested the drugs for use continues to meet the criteria on the
basis of which the court has made the order.

(4)     If the person appointed by the court is not satisfied that the person who has
requested the drugs for use continues to meet the criteria on the basis of
which the court has made the order, he or she must so inform the person
requesting the drugs for use and remove the drugs for safe keeping.”

Page 2, line 42, leave out from beginning to “to” in line 43, and insert “The High
Court (Family Division) shall appoint a person to prescribe medicines to enable a
person whose request for assistance with suicide has been approved”

Page 2, line 42, at beginning insert “Only”

Page 2, line 43, leave out “medicines” and insert “a lethal dosage of drugs”

Page 2, line 43, at end insert—

“( )     Within 24 hours of prescribing the medicines referred to in subsection (1),
the attending doctor must register, with the General Medical Council, the
name of the person for whom the drugs have been prescribed, the quantity
and doses of the drugs prescribed, his or her advice on how the drugs
should be taken and sign a binding statement that he has observed all the
requirements of this Act.”

Page 2, line 44, leave out “medicines” and insert “lethal dosage of drugs”

Page 2, line 46, leave out paragraphs (a) and (b) and insert “by the attending
doctor—

“( )   if it has been requested by the person for whom they have been
prescribed”

Page 2, line 46, leave out from “the” to second “has” in line 5 on page 3, and insert
“person appointed by the Court;

(b)   after the person appointed by the Court has confirmed that the
person whose request for assistance with suicide has been
approved”

Page 2, line 46, leave out from “doctor” to end of line 4 on page 3

Page 3, line 2, leave out “registered” and insert “licensed”

Page 3, line 5, leave out “assisting health professional” and insert “attending
doctor”

Page 3, line 6, at end insert—

“( )   if the person is able to communicate his or her wishes clearly;”

Page 3, line 7, after “days” insert “and no more than 28 days”

Page 3, line 8, leave out “person’s declaration” and insert “applicant’s request was
approved and”

Page 3, line 8, at end insert—

“( )   if the person retains the capacity to make the decision to end his or
her own life.”

Page 3, line 8, at end insert—

“( )     Before releasing a lethal dosage of drugs to the person for whom it has been
prescribed, the attending doctor shall confirm that—

(a)   the person’s medical condition has not changed in a way that could
call into question the diagnosis and prognosis made by the
attending and second doctors;

(b)   the person retains capacity commensurate with the decision to end
his or her own life;

(c)   the person continues to have a clear and settled intention to end his
or her own life and has reached that decision of his or her own free
will and without pressure, coercion or duress from others or from a
sense of duty or obligation to others;

(d)   the person is able to communicate his or her wishes clearly.”

Page 3, line 9, leave out subsection (3)

Page 3, line 13, leave out “a medicine” and insert “any lethal dosage of drugs”

Page 3, line 13, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 13, leave out “for a person”

Page 3, line 14, leave out “subsection (1)” and insert “this section”

Page 3, line 14, leave out “an assisting health professional” and insert “a person
appointed by the court”

Page 3, line 14, leave out “assisting health professional” and insert “attending
doctor”

Page 3, line 15, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 15, leave out “medicine” and insert “dosage of drugs”

Page 3, line 15, leave out “that person” and insert “the person who has requested it”

Page 3, line 15, leave out “that person” and insert “the person whose request for
assistance with suicide has been approved”

Page 3, line 15, at end insert “in the presence of that person”

Page 3, line 16, at beginning insert “if necessary”

Page 3, line 17, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 17, leave out “medicine” and insert “dosage of drugs”

Page 3, line 17, leave out “medicine” and insert “lethal dosage of drugs in the
presence of that person”

Page 3, line 17, after “medicine” insert “by whatever route is normally used for
ingestion of food”

Page 3, line 17, at end insert—

“( )   supply medication, such as an anti-emetic dosage, in order to
facilitate absorption of the drugs;”

Page 3, line 18, leave out paragraph (c)

Page 3, leave out lines 18 to 20

Page 3, line 19, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 20, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 20, at end insert “at a time not less than 6 hours after the completion of
preparations as set out in paragraphs (a) to (c).”

Page 3, line 21, leave out “an assisting health professional” and insert “the person
appointed by the court or any other person”

Page 3, line 21, leave out “an assisting health professional” and insert “the person
appointed by the Court”

Page 3, line 21, leave out “assisting health professional” and insert “attending
doctor”

Page 3, leave out line 22 and insert “the lethal dosage of drugs to the person who
has requested it or to assist that person to self-administer the dosage of drugs other
than as provided in subsection (4)”

Page 3, line 22, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 22, at end insert—

“( )     The self-administration of the drug must be carried out in—

(a)   the home or usual place of residence of that person, or

(b)   if that is not possible, a hospital vested in the Secretary of State for
the purposes of his functions under the National Health Service Act
2006 or in a hospital vested in a Primary Care Trust or a National
Health Service trust or an NHS foundation trust or in a place
approved for the purposes of this section by the Secretary of State.”

Page 3, line 23, leave out “assisting health professional” and insert “attending
doctor”

Page 3, line 23, leave out “assisting health professional” and insert “person
appointed by the Court”

Page 3, line 25, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 25, leave out “medicine” and insert “drugs”

Page 3, line 26, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 26, leave out “medicine” and insert “drugs”

Page 3, leave out lines 27 to 29

Page 3, line 27, leave out “assisting health professional” and insert “attending
doctor”

Page 3, line 27, leave out “assisting health professional” and insert “person
appointed by the Court”

Page 3, line 28, leave out “the assisting health professional” and insert “he or she”

Page 3, line 28, leave out “assisting health professional” and insert “attending
doctor”

Page 3, line 28, leave out “assisting health professional” and insert “person
appointed by the Court”

Page 3, line 28, leave out “in close proximity to, but not”

Page 3, line 30, leave out “may” and insert “shall”

Page 3, line 31, leave out “medicines” and insert “lethal dosage of drugs”

Page 3, line 31, leave out “medicines” and insert “drugs”

Page 3, line 33, leave out “such medicines” and insert “lethal dosages of drugs”

Page 3, line 33, leave out “medicines” and insert “drugs”

Page 3, line 34, at end insert—

“( )   the competencies which the assisting health professional must have
and how they will be developed, assessed, safeguarded, taught and
audited.”

Page 3, line 34, at end insert—

“(d)   what information must be supplied to the coroner and to the
General Medical Council after a person has committed suicide as
permitted by this Act”

Page 3, line 35, leave out “an assisting health professional” and insert “the person
appointed by the Court”

Page 3, line 35, leave out “assisting health professional” and insert “attending
doctor”

Page 3, line 37, leave out “only”

Page 3, line 37, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 37, leave out “medicine” and insert “drugs”

Page 3, line 37, after “section” insert “only”

Page 3, line 40, leave out “medicine” and insert “lethal dosage of drugs”

Page 3, line 40, leave out “medicine” and insert “drugs”

Page 4, line 1, leave out subsection (10)

Leave out Clause 4 and insert the following new Clause—

“Assistance with suicide

(1)     Any lethal dosage of drugs prescribed under section (Application for a Court
order)(5)(a) shall be delivered only by the independent person appointed by
the court, only to the person for whom it is prescribed and only after its
delivery has been requested by the applicant and after the applicant has
confirmed in writing that he or she has not revoked and does not wish to
revoke his or her intention to die.

(2)     In respect of a lethal dosage of drugs which has been prescribed under this
Act, the independent person appointed by the court may, if necessary,
prepare that lethal dosage for self-administration by the applicant but shall
not otherwise assist the applicant to ingest it.

(3)     If the applicant is unable to ingest the prescribed lethal dosage of drugs
orally, the court may appoint a doctor or nurse to prepare a medical device
which will enable the applicant to administer the dosage to himself or
herself by another route.

(4)     The independent person appointed by the court shall not take any action or
permit others to take any action to administer the prescribed lethal dosage
of drugs to the applicant.

(5)     The independent person appointed by the court shall remain with the
applicant until the applicant has—

(a)   self-administered the lethal dosage of drugs and died, or

(b)   decided not to self-administer the lethal dosage of drugs,

and for the purpose of this subsection the independent person appointed
by the court is to be regarded as remaining with the applicant if he or she
is in the same room as the applicant.

(6)     The Secretary of State may by regulations specify—

(a)   the drugs and lethal dosages of them which may be prescribed to
give effect to an order under this Act,

(b)   the form and manner in which such prescriptions are to be issued
and drugs supplied, and

(c)   the manner and conditions under which such drugs are to be
dispensed, stored, transported, used and destroyed.

(7)     Regulations under subsection (6) shall provide that an independent person
appointed by the court shall—

(a)   deliver any lethal dosage of drugs prescribed under this Act to the
person for whom it has been prescribed immediately before its
intended use; and

(b)   in the event that the person decides not to self-administer the lethal
dosage of drugs immediately remove it from that person and, as
soon as reasonably practicable, return it to the pharmacy from
which it was dispensed.

(8)     Regulations under subsection (7) may—

(a)   make different provision for different purposes; and

(b)   include consequential, incidental, supplementary or transitional
provisions.”

Lord Trefgarne gives notice of his intention to oppose the Question that Clause 4 stand part
of the Bill.

Insert the following new Clause—

“Reporting

(1)     Immediately following the death of a person who has received assistance
with suicide under this Act, the attending doctor shall report the death to
the coroner and submit a report to the relevant authority.

(2)     A report under subsection (1) shall include—

(a)   the declaration made by the person requesting assistance with
suicide;

(b)   the reports of any persons who assessed the request for assistance
with suicide;

(c)   an account of any discussions which the attending and second
doctors have had with the person requesting assistance with
suicide and with others close to that person; and

(d)   an account of the assistance with suicide which was given.”

Insert the following new Clause—

“Rejected requests

(1)     No requests by a person for assistance with suicide under this Act may be
considered within six months of the date of the rejection of a previous
request by that person.

(2)     Any rejected request for assistance with suicide shall be noted on the
medical file of the person making the request along with a statement of
why the request was rejected.”

Page 4, line 5, after “person” insert “or establishment”

Page 4, line 7, after “person” insert “or establishment”

Page 4, line 7, after “conscientious” insert “or other”

Page 4, line 7, leave out “objection” and insert “or other objection, or to refer an
applicant to another person”

Page 4, line 7, at end insert “nor may any recognised health body or organisation
which operates in the field of health or social care (or both) take into account a
doctor’s refusal to participate in self-administered suicide, when making any
determination about the employment, promotion, appointment or career of that
doctor.”

Page 4, line 7, at end insert—-

“( )     A doctor or other healthcare professional who refuses for whatever reason
to participate in assessing a request for assistance with suicide under this
Act, or in prescribing or supplying a lethal dose of drugs to a person who
qualifies under this Act for assistance with suicide, shall be under no
obligation to refer the person making the request to another doctor for that
purpose.”

Lord Trefgarne gives notice of his intention to oppose the Question that Clause 5 stand part
of the Bill.

Insert the following new Clause—

“Hospices and registered residential care homes

(1)     The operator of a hospice or registered residential care home may register,
in respect of that hospice or registered residential care home, a
conscientious objection to the provisions of this Act with the Care Quality
Commission.

(2)     A person who is resident in a hospice or registered residential care home
may not be prevented from requesting assistance to end his or her own life,
or from receiving such assistance under the provisions of this Act, unless
he or she was informed in writing of a registered conscientious objection
operating within that hospice or registered residential care home before he
or she became resident there.

(3)     A person who has made a valid declaration under section 3 before
becoming resident at a hospice or registered residential care home must
inform the manager of that hospice or registered residential care home
before moving in, but he or she shall not be prevented from becoming
resident by reason of that declaration unless that hospice or registered
residential care home has previously registered a conscientious objection
under subsection (1).

(4)     Where a person who is resident in a hospice or registered residential care
home makes a valid declaration under section 3, that declaration shall
remain confidential between the person and his or her medical
professionals except—

(a)   insofar as the person chooses to disclose it, and

(b)   that the manager of the hospice or registered residential care home
must be informed immediately.”

Page 4, line 12, leave out “” and insert “”

Lord Trefgarne gives notice of his intention to oppose the Question that Clause 6 stand part
of the Bill.

Page 4, line 16, at beginning insert “Subject to section (Capacity of an applicant),”

Page 4, line 18, after “died” insert “solely”

Page 4, line 18, after “assistance” insert “with suicide”

Page 4, line 19, at end insert—

“( )     Nothing in subsection (1) shall be taken to limit the powers of a coroner to
investigate a death where there are reasonable grounds to suspect that the
death has occurred in contravention of the provisions of this Act.”

Page 4, line 22, leave out from beginning to end of line 8 on page 5 and insert—

Page 4, line 22, leave out “” and insert “”

Page 4, line 26, after “assistance” insert “with suicide”

Page 4, line 26, leave out “Assisted Dying” and insert “Suicide Act 1961
(Amendment)”

Page 4, line 26, leave out “Assisted Dying” and insert “Assistance with Suicide”

Page 4, line 38, leave out “Assisted Dying” and insert “Assistance with Suicide”

[Withdraw]

Page 4, line 42, leave out second “death” and insert “suicide”

Page 4, line 42, after second “death” insert “arising from the self-administration of
medicines supplied under the Assisted Dying Act 2015”

Lord Trefgarne gives notice of his intention to oppose the Question that Clause 7 stand part
of the Bill.

Page 5, line 10, leave out “may” and insert “shall”

Page 5, line 13, leave out from “life” to end of line 21 and insert “has capacity
commensurate with the decision to end his or her own life and is making a decision
to end his or her own life which is fully informed and free from pressure, coercion
or duress from others or from a sense of obligation to others, and”

Page 5, line 13, at end insert—

“( )   assessing whether the person is making a decision to end his
or her own life which is fully informed and free from
pressure, coercion or duress, or a sense of obligation or duty
to others;”

Page 5, line 14, leave out “to make” and insert “commensurate with making”

Page 5, line 15, at end insert—

“  assessing whether the person understands the permanence
of their own death;”

Page 5, line 15, at end insert—

“  assessing the extent to which a person has requested an end
to their life independently of the influence of others and
with a full understanding and knowledge of what that
means;”

Page 5, line 20, after “them” insert “, including the provision of appropriate social
care and support from their local authority,”

Page 5, line 20, after “them” insert “, including specialist palliative care and pain
and symptom control,”

Page 5, line 21, after “life” insert “including the effect on others close to them”

Page 5, line 21, after “life;” insert—

Page 5, line 25, at end insert—

“(3)     A code does not come into operation until the Secretary of State by order so
provides.

(4)     The power conferred by subsection (3) is exercisable by statutory
instrument.

(5)     An order bringing a code into operation may not be made unless a draft of
the order has been laid before, and approved by, a resolution of each House
of Parliament.

(6)     When a draft order is laid, the code to which it relates must also be laid.

(7)     A person performing any function under this Act must have regard to any
relevant provision of a code and failure to do so shall not of itself render a
person liable to any criminal or civil proceedings but may be taken into
account in any proceedings.”

Page 5, line 25, at end insert—

“( )     Any such codes of practice shall preserve and be consistent with the
provisions specified in this Act governing the assessment of requests for
assistance with suicide.”

The above-named Lords give notice of their intention to oppose the Question that Clause 8
stand part of the Bill.

Page 5, line 30, after “authority” insert “, including the appropriate police
authority,”

Page 5, line 42, leave out paragraph (b)

Page 6, line 3, leave out paragraph (b)

Page 6, line 6, leave out from “state;” to end of line 7

Leave out Clause 9 and insert the following new Clause—

“Monitoring and scrutiny

(1)     The Secretary of State shall appoint a scrutiny commission (“the
commission”) and not more than seven subordinate commissions, each
covering a specified region of England and Wales, to receive and examine
reports from attending doctors and to determine whether the requirements
of this Act have been observed.

(2)     The Secretary of State shall bear in mind, when selecting members of the
commission and of its subordinate commissions, the existence of strongly-
held opinions both for and against the principle of legalised assisted
suicide and shall make appointments which he or she considers conducive
to achieving impartial and objective examination of the facts and to
bringing an appropriate level of challenge to the scrutiny of reports of
assistance with suicide.

(3)     Members of the commission and of its subordinate commissions shall serve
for a maximum of five years.

(4)     It shall be the role of the regional commissions to examine reports from
doctors who have assisted suicides under this Act, to reach conclusions as
to whether the terms of the Act have been faithfully observed and to
forward those conclusions to the commission in order to—

(a)   enable the commission to oversee how reports from doctors are
being examined and judgements on them made and thereby to
ensure consistency across all regions in the way that such reports
are handled;

(b)   provide a factual basis for the preparation by the commission of
annual reports on the operation of this Act to the Secretary of State;

(c)   enable the commission to provide advice to the Secretary of State on
the operation of the Act.

(5)     If the relevant regional commission is satisfied, having considered a report
of assistance with suicide from an attending doctor, that the requirements
of this Act have been fully met, it shall so inform the doctor concerned.

(6)     If the relevant regional commission has reservations over any aspect of an
attending doctor’s report of assistance with suicide, it shall seek further
information from the doctor concerned, either in writing or in person, in
order to reach a final judgement.

(7)     If the relevant regional commission is not satisfied that the requirements of
this Act have been complied with in their totality, it shall so inform the
doctor concerned and forward the case, with all the documentation
available, to the Crown Prosecution Service and to the General Medical
Council.”

The above-named Lords give notice of their intention to oppose the Question that Clause 9
stand part of the Bill.

Insert the following new Clause—

“Insurance

No policy of insurance which has been in force for 12 months on the date
of a person’s death shall be invalidated by reason of that person having
been assisted to commit suicide in accordance with this Act.”

Page 6, line 11, leave out “3” and insert “1(2)(b)”

Page 6, line 12, leave out “3” and insert “1(2)(b)”

Page 6, line 13, at end insert—

“( )   gives or promises to give any benefit in connection with a request
for assistance with suicide and with the intention of influencing the
outcome of that request;

( )   accepts any benefit or promise of benefit in return for giving or
arranging a desired outcome to a request for assistance with
suicide; or

( )   does not notify the attending doctor if he or she has reason to
believe that a person who has made a declaration seeking assistance
with suicide under this Act wishes to revoke the said declaration
and is unable to do so or is being prevented, from whatever cause,
from doing so.”

Page 6, line 15, leave out “3” and insert “1(2)(b)”

Lord Trefgarne gives notice of his intention to oppose the Question that Clause 10 stand
part of the Bill.

Insert the following new Clause—

“Duty to disclose information

(1)     Subsection (2) applies to any person who, based upon information
obtained in connection with the performance of any function under this
Act, has reasonable grounds to suspect that another person—

(a)   has committed an offence under section 10; or

(b)   is guilty of any wrongdoing in connection with this Act.

(2)     A person must, as soon as is reasonably practicable, disclose that suspicion
and the information upon which it is based to the appropriate authority.

(3)     In this section “appropriate authority” means—

(a)   the police;

(b)   a senior coroner; or

(c)   the regulatory body for any profession to which section 60(2) of the
Health Act 1999 (regulation of health professions, social workers,
other care workers etc.) applies.”

Lord Trefgarne gives notice of his intention to oppose the Question that Clause 11 stand
part of the Bill.

Page 6, leave out lines 35 and 36

The above-named Lords give notice of their intention to oppose the Question that Clause 12
stand part of the Bill.

Page 7, line 6, leave out “Assisted Dying” and insert “Assistance with Suicide”

Page 7, line 6, leave out “Assisted Dying” and insert “Suicide Act 1961
(Amendment)”

Page 7, line 7, leave out subsections (2) to (4) and insert—

“( )     This Act shall come into force on 1 January 2016.”

Page 7, line 14, leave out subsection (4) and insert—

“(4)     This Act shall, subject to the following provisions of this section, expire at
the end of the period of five years beginning on the day that the provisions
in subsection (3) come into force.

(4A)    The Secretary of State may, by regulations made by statutory instrument,
provide that this Act shall not expire in accordance with this section but
shall continue in force—

(a)   indefinitely, or

(b)   for a specified period.

(4B)    A statutory instrument containing regulations under subsection (4A) may
not be made unless a draft has been laid before, and approved by a
resolution of, each House of Parliament.”

Page 7, line 17, after “to” insert “Wales,”

Lord Trefgarne gives notice of his intention to oppose the Question that Clause 13 stand
part of the Bill.

Page 8, line 3, leave out “” and insert “”

Page 8, line 7, leave out “months” and insert “weeks”

Page 8, line 10, at end insert “which is appropriate to my age”

Page 8, line 10, at end insert “I have also been informed about the provision of
social care and support which is available to me from my local authority.”

Page 8, line 11, after “information” insert “and having made an Advance
Declaration on [date]”

Page 8, line 13, leave out “medicines” and insert “a lethal dosage of drugs”

Page 9, line 2, leave out “and Wales”

Page 9, line 2, at end insert—

Page 9, line 3, leave out from “and” to end of line 4 and insert “is expected by me
to die as a result of that terminal illness within six weeks of the date of his or her
making this declaration;”

Page 9, leave out lines 5 to 9 and insert—

Page 9, line 8, at beginning insert “fully”

Page 9, line 9, at end insert “including the provision of appropriate social care and
support from his or her local authority”

Page 9, line 9, at end insert “and is appropriate to [his/her] age”

Page 9, line 12, leave out “ Independent ” and insert “ Second ”

Page 9, line 14, leave out “and Wales”

Page 9, line 14, at end insert—

Page 9, line 15, leave out from “and” to end of line 16 and insert “is expected by me
to die as a result of that terminal illness within six weeks of the date of his or her
making this declaration;”

Page 9, leave out lines 17 to 21 and insert—

Page 9, line 19, leave out “an” and insert “a fully”

Page 9, line 21, at end insert “including the provision of appropriate social care and
support from his or her local authority”

Page 9, line 21, at end insert “and is appropriate to [his/her] age”

Leave out the Schedule and insert the following new Schedule—

Lord Trefgarne gives notice of his intention to oppose the Question that the Schedule be the
Schedule to the Bill.

Insert the following new Schedule—

“SCHEDULE

FORM OF ADVANCE DECLARATION

Name of Declarant:

Date of Birth:

Address:

Signed:

Date:

Witnessed by:

Signed:

Name:

Address:

Date:”

Line 1, leave out from beginning to “; and” in line 2 and insert “Amend the Suicide
Act 1961 to make it lawful to provide specified means to end their own lives to
terminally ill persons who so request and so meet specified conditions”

Line 1, leave out from “ill” to “and” in line 2 and insert “to apply to the High Court
of Justice for assistance with suicide if they consider that in the absence of such
assistance their rights under Schedule 1 to the Human Rights Act 1998 would be
breached;”