into these brought heavily into these —— | brought heavily into these -- i it brought heavily into these —— i it is tim” , ,, toga ,, 7 n n "to get duncan's view. is normal 7:’ for 2, if if?” 2 7:’ for 2, if if?” how is normi as determined mental capacity, as determined by the mental capacity act, is something which is done every in every hospital 5 in every hospital up 5 in every hospital up and j rther the every doctor down the countrnyvejy doctor every nurse of seniority and every nurse of seniority be able to do that. it require some slight around there's adjustment around us. there's an act, adjustment around us. there's an example, act, adjustment around us. there's an example, that act, adjustment around us. there's an example, that the act, adjustment around us. there's an example, that the more t, for example, that the more serious the decision, the greater the level of capacity needs ineedsto 7needs to that 5.71ng to wwfi'fit is semegne neeésrte have. that is built semegne neeésrte have. that: is built the flied? �*f�*flt'nifi eh? �* the 515555 �*f�*flt'nifi 915 �* the act 5155555 55'15'h55 5155 �* the act and the principles of the act and the things done. of way things are done. forms of training and, would training and ! wauld alag , that to the management extend that ta the management end—of—life, which should be of end—of—life, which should be a part of medical a ndrmat part at medicat and practice. will all die

we will all die eventually, has always been part of thathasalways been. part at and should be. that medicine and we should be. that should be but may need should be generic, but may need adapting. then there be adapting then there vii" be things adapting theh there 1-55".he things which adapting the-h there lei" he things which will adapting theh there lei" he things which will be adapting theh there lei" he th for. which will be adapting theh there lei" he th for people will be adapting theh there lei" he 7th for people tol be ”if this actand in some understand this act and in some take if this act is cases take part if this act is in part of passed in the final part of prescribing drugs patients. prescribing drugs to patients. i think it is much a large number of that a very large number of doctors and nurses may get involved very early involved in very early stages because someone may raise an issue with gp, with issue with her gp, with her nurse, with their consultant, they need to have the basic 7 that. it efieeréfefielfié tfif that fifiefi it to 55555555555 t5f 5555 i£55555 if. to the more detailed that in my require some specific will. reddire some specific — and i think there training. and i think there be a in my view training. and i think there doctors in my view training. and i think there doctors who in my view training. and i think there doctors who are in my view training. and i think there doctors who are happy liew training. and i think there doctors who are happy to w f the f ' the initial 7 f the initial general f have the initial general conversation, once you're happy have the tcr have the atria cta�* red that follows, tcr have the atrdcta�* red that follows, and conversation that follows, and minority of those who be a minority of those who be to go on to take part in happy to go on to take part in the stages. it is very the final stages. it is very important that both the wishes of patient are

thatis that is the central point this, we must start this, w in nust start fri: " this, w in their;tart fri: " of life ff ff ffafmfilef, f f f ff ffafmfilef, that fffff ff ffafmfilef, that is them, f f them, but f them, but we f them, but we must f them, but we must alsofmake for them fladtrwe meet ateomake that for themfladtrwe meet ateomake that the for themflaetrwe meet ateomake that the wishes of sure that the wishes of health around this are both from and through conscience and through choice. i am mindful that there are two groups of here, groups of staff here, staff that will be inthis f in this service if this is passed, but the workforce. at two o'clock the morning when a patient in’the’ mefning when a patient to have in’ the mefhihg when a patient to have a conversation wanted to have a conversation with somebody about that will be with him, or a nurse a care home, �*a nurse in a care home, or a specialist nurse providing care. ca re. we care. we have to cancer care. so we have to about the training and think about the training and support is required for support that is required for them, that around oi’ fff ffofr explaining ffff ffofr feprlaifning where eignpoeting or explaining where go to access more they can go to access more information. it is an important part about the entire wider we to think clearly tar are working in people that are working in such

a about the a service, thinking about the safeguarding of this �*we �* we 5:5 there �*we 5:5 there is ff ffff safeguarding confidentiality, training, confidentiality, particularly mindful that some patients choose not tell patiente ma’ethfiee’ehfit 55 tell �* families patiente ma’ethfiee’ehfit 55 tell �*families about this. how we and we a nd staff do we enable and support staff in managing those kind of around what we thinking ahead around what we need to do in terms of would need to do in terms of undergraduate training, both for doctors, nurses, thinking about curriculum. i for doctors, nurses, thinking about. curriculum. gbgogétitghe curriculum the moment... make nurses health care will be and—healthcare'tearn" in and'health—care'tearn"-'.. in a and—healthcare'team'wfttbe - in a certain - andhealth—care'team'will he in a certain capacity involved in a certain capacity and — involved in a certain capacity andindeed involved in a certain capacity and indeed any from 155ff'lf'5ff5fi 5155 55 ! the 15555555555 5555 55.5 i the levels 155f5i5§ff555 5555 555 i the levels of skills suppose the levels of skills in suppose the levels of skills - in the _ suppose the levels of skills in the current required in the current practice around refusing life—saving treatment and how that might be taken into

under this act. absolutely ri - ht it - absolutely right it is é absolutely right it is a you're absolutely right it is a completely part of completely normal part of medical wider and medical and wider nursing and other practice, but medical practice consider issues �* consent issues of ca aci . and it and issues of capacity. and it can be says they wa nt want and f ff want and that treatment is could be treatment which is clearly going to be life—saving. a well—known life—saving. a very well—known example is the example of people who arejehovah's people who arelehovah's who not witnesses who choose not to blood products. if they have blood products. if they are heavily, that is are bleeding heavily, that is an that could lead to the an i55ee that 55el5teaette'the’ ” " ’” of their life. end of their life. provided they understand that and fcapacity, capacity, has to bef have eapaeityg that haste leer ,. , . the �* carefully the f f the other f the other which f and the other thing which doctors to do is advice before the have 555515 55555 5555f55555h555 " pee—e —— —— ”w , 5 — operations 555515 55555 5555f55555h555 " pee—e —— —— ”w , 5 — operations or 555515 55555 5555f55555h555 " pee—e —— —— ”w , 5 — operatic or or 555515 55555 5555f55555h555 " pee—e —— —— ”w , 5 — operatic or other 555515 55555 5555f55555h555 " pee—e —— —— ”w , 5 — operatic or other drugs chemotherapy or other drugs which may �* lead to the whiahmayiteel’frlead to the of their also f ff ff flefadffff fffffff ff ff flfefadftfoff ff ff fiefadftefafff leadtoa benefit namely lead to a benefit. explaining to people the risks benefffits, benefits, the and benefits, including the fact that they may lose their life a result of next life as a result of the next is one the high

stage, is one of the high risk during operations, that is a standard part of medical that you do praetiee'that {exude , ~ from the point you as f as people more senior, they mfore senior,fthey to 555 55555 5555" 5555 555555 ' " more experienced it, and be more experienced in it, and as most things, if you as with most things, if you have more better at it. generally get better at it. professor whitty, generally get better at it. professorwhitty, ijust generally get better at it. professc the iitty, i just generally get better at it. professc the definition: ilsf'fttra ctfn - terminal illness is attracting some — terminal illness is attracting some some terminal illness is attracting some _ some are some attentionx—som—e peo-. some attentionx—som—e peon ie a terminal émillness. define a terminalllluessd w- define a terminal illness i you think it ——|ff ffffthlfffeffffcofld improve the bill if we could have — improve the bill if we could have instead a specified list have instead aspeclfieddist i m_ have instead a specified list illnesses would apply of illnesses that would - - 1 this of illnesses that would—applyl - m_ of illnesses that would apply this act. do you think it e! h ie poeeihle'to' come up -- a of ie poeeihle'to'come upw’rtha - of that are �*this- if i'm under this act? if i'm honest, i it be i think it would be extremely difficult. i will why difficelt. 5! witl explain why i is a really because i think it is a really let's take because i think it is a really for let's take because i think it is a really for the let's take because i think it is a really for the great et�*s take because i think it is a really for the great majority cancer. for the great majority of people with the majority of cancers that are

the doctor who is them ff thefmeefllffff inff ff them qefufff infallf 555ina 555555555555 ineli’” ' 5” you have cancer confidence, you have cancer and i to be alive not i expect you'te he alive not make christmas ju55 mahe chime butter , ~ , years je5t malee ghfi5tma5 hut'ter'" ' " ' years to come. so fact many years to come. so't'ne fact have cancer not in a demonstration f a demonstration that f are emonstration that f are going ;tration that f are going to ation that are going to die. that f are going to die. in at f are going to die. in fact, they are going to die. in fact, they are going to die. in fact, the majority not. almost offf 80% of people with breast cancer will be aliee he aliee teh he aliee ten years example. f example. eunfally, f example. eunfally, theref who f who may f who may not have a people who may not have a disease that is to fto a a f to death, f f f to death, but f areff to c diseases are f to c diseases thatf areff f to c diseases thatfarefif interacting in the same person, are it is they are highly frail. it is the one is the not the one disease that is the cause, but the fact of this --a l..-+ 555 5.5.5 .-.a 55:5 h555 he"; the 5.555 “5 th.’5. that 5555 h.�*5 �*5h5 5555 “5 �*5hi5. thatis that is clearly constellation that is clearly reading them a path to reading them on a path to a death at some in the future. exact foreseeable future. exact timings are tricky and wee timinge are tricky and 5555 5' 5 5 5” man to timinge are tricky and 5555 5 5 5 5 555 man to come back to rtiminge are tricky and 5555 5 5 5 5 555 man to come back to that. white manta come hack. tcrthat. i white manta come hack. to that. i think it quite therefore i think it is quite difficult to specify these diseases cause death in diseases will not, these diseases will not, because both potentially be misleading. so, can you 'ust --erhas misleading. so, can you 'ust perhaps ami misleading. so, can you 'ust perhaps talk a i misleading. so, can you 'ust perhaps talk a - bit h perhaps. talk. alittle5hit 5 5 about perhaps. talk. alittle5hit 555 5 about whether perhaps. talk. alittle5hit

- about whether you further 5555 555 5 any further 5555 5-5�* 5 - any difficulties with perceive any difficulties with having — perceive any difficulties with having a _ perceive any difficulties with having a definition of terminal illness— having a definition of terminal illness within this act? e do you think --oin to profession are going to interpret 35st profession are going to interpret _ em 5555555555. em extremes, and most people are at the extremes, it is very at the extremee'. itieeery 555 5 5 55 5 �*what at the extremee'. itieeery 555 5 5 55 5 �* what is at the extremee'. itieeery 555 5 5 55 5 �*what is going at, ths sxtrsmssg 455455”; ”w ' f "f " �*what is going to happen. peoble 3 a, :,,% e peoble {cu ”is? peoble fou say for most people you can say with that, barring with confidence that, barring some accident like some extra accident like hit by a car on the getting hit by a car on the way out, you will be fine in a year, t'f�*e'f have year, even though you have heart disease or cancer at the other extreme, are ”eole who there are people who are clearly dying and will die next néxfth nextztwo £74777 days. the next two or three days. there is virtually nothing that that what will change that reality. what talking about in this act we're talking about in this act j, ,, stages. but is a point between stages. but definitely reach a people definitely reach a point where there is now to be 77 7 7 7 |77thirfk7 77 77 77 7 7forl77thirfk7 77 77 77 7 7forl7thi77bill77 77 77 importantly for this bill and slide towards reversible sheets-teases a7 7 7 7 of reversible sliae—tawares arr 7 . 7 of death —— reversible slise—tslvares a7 7 . 7

of death —— iireversible. that 7 7 that there is a accepting that there is a around that. i am isa is a general public and there is a general public and of public acceptance, members of public acceptance, is not a science, this is not a precise science, this is not a precise science, this a central view. this is not a precise science, this a centralview. in this is a central view. in academic around some will die thisrsemepeeple will die earlier than they some die significantly later. some nificantly later. some people ly later. some people will ter. some people will certainly and some people will certainly die a little bit later. the die a little bit later. but the central view is usually reasonably accurate, that rsassnabls asssrats; that now rsassnabls asssratst that now on rsasahabla attaratat that now on a pointer someone is now on a pointer pathway from which there not pathwayfrem whishthereis net a return. athway hem whieh therets - a going to a return. thank you. thank you — going to a return. thank you. thank you i coming - going to a return. thank you. i thank you i coming - giving thank you for coming and giving evidence this morning, i would like to pick a bit more around coercion up a bit more arebndsaercian capacity because think and capacity rbecaase i think, are two important these are two important points in terms of the would ; to know a more 7 7 the work 7 777the777wo7rk7ti71at 7 777the77wo7rkti717at and about the work that doctors and do in terms of nurses do in terms of checking for coercion and assessing capacity when patients are 2:7: 7 really important making really important decisions and at the

of life, but also may be in end of life, but also may be in other contexts as well. i mean, we refer to the mental capacity act in the bill, the mental capacity act a big of act in the bill, the mental capacity act but big of act in the bill, the mental capacity act but i'm of act in the bill, the mental capacity act but i'm very of 52-7 77 onlya slight7 77 to lya slight7 77 to it a slight7 to it in ;light7 77 to itin the|t7 do 7776715; {her}; 7 7 7thin7k7 {sag anything 7 7 7thin7k7 {sag anything we" you think there's anything we could add to the bill that coularaedte the bill that maybe improve the would maybe improve the of that to robustness of that reference to mental what does it = -:= like now 7 like now and is think could you think could add? when michael duncan, the —7= bitand 7 bitandi 7777bi7t7an7d7l7will777 77 77 77 7 7bi7t7an7d7l7will7take77 77 77 7 7bi7t7an7d7l7will7take7the 7 77 second. in terms of looking for si . ns of second. in terms of looking for signs of- all _ second. in terms of looking for signs of - all of - second. in terms of looking for signs of- all of our - e—-— 5 clinical staff nursing staff, clinical staff have — nursing staff, clinical staff have safeguarding training. nursing staff, clinical staff have safegu�* looks training. nursing staff, clinical staff have safegu�* looks at ining. nursing staff, clinical staff have safegu�* looks at things nursing staff, clinical staff have are agu�* looks at things nursing staff, clinical staff have are people (s at things nursing staff, clinical staff have are people being... gs nursing staff, clinical staff have are people being... under 2:27: financial coercion, for example, or �*forms of that trainin- is abuse. that training is already in - has _ abuse. that training is already in has extensive in place and has extensive across _ in place and has extensive across the nhs, across social ie m care. if the bill is passed, we - need _ care. if the bill is passed, we - need to— care. if the bill is passed, we need to at, do =,, will aged; that relation mltbaasbtbinntathnfiane that relation to ffi.7.sfi,77 7777—7777 77_. si-ns 77_- si-ns of s--ottin the -otential signs of spotting the potential signs of in this space as well.

spotting the potential signs of given 1 this space as well. spotting the potential signs of given that; space as well. spotting the potential signs of given that mechanism ell. spotting the potential signs of given that mechanism is. 7 7—7 7 77777777 already in place, i think that would — already in place, i think that would be _ already in place, i think that would be an extension, so it is raster that taster that i 7 also mindful about, given 77 7 -77 7—77 7 77—7 7 77 77777 we have health and care, across health and care, the lime — across health and care, the lime - if— across health and care, the time if this act is time between, if this act is passed _ time between, if this act is passed and it is sufficient that we enable everybody receive that it is sufficient that we enable everybody —— live that it is sufficient that we enable everybody —— additional 7; s—————, a 7 —= a 77 of stren--thenin the asa i as a i was bill, as a practitioner, i was that of relieved that the decision of this bill, if it stays in this'bilt.’ if it stays in this was to stick this'bilt; if it stays in this was to stick with the act. for the mental capacity act. for two reasons. first of which reasons. the first of which is this is used up and down the country and nurses country by doctors and nurses every they know it, they . . it. . it. as 7 7 it.7 as you it 7 7 itis 7 it isa 7 7 it is a piece7 7 it is a piece7of 7 . it7 7 it 7is it is one 7 it 7is one that legislation, it is one that have three in multiple7 times. you six or doctors, does person capacity? in this bersen have sabasitvlln7—777 7 , , , all get almost all cases, you'll get six or seven cases six or seven identical cases because people used to

because people are used to it. also been using it. it has also been tested in the courts. this has as far supreme gone as far as the supreme court and the sort of 7777inevit7a7bl7y77 in 7in the 7 7in the legislation the7re were in the legislation there have been clarified by senior hats bssn slaritiad'bgaanibr " ' ' therefore meaning it judges. therefore meaning it . practitioners me feels to practitioners like me 7 of robust and feels to practitioners like me 7 of r legislation. predictable legislation. within it is very important that it, it is very important that there are some situations we there are some sitbatiens we— ———— 7 7 77 need to there are some sitbatiens we7 7777 7 —7 77 need to call for will need to call for assistance. additional assistance. for if someone has 7 me7ntal 7777777men7tal77i717e7alth77777 existing mental health would probably conditisngysb—wsa'a prsbably to ask additionally from a is as psychiatrist, is as interfering the that with the derisrmthathas been to the taken to the point that somebody loses capacity for this my own view this very decision, my own view that starting this is sensible 7 sensible thing to do. that not 7 not mean there cannot for 77fo7r7777 7a7dd7it7io7nal7 arguments for some additional around it, buti arguments for some additional around it, but i cannot again, asa immediately... again, as a jobbing doctor, see once where this is to make a i think this is going to make a big difference. it is the fact bigzdifference. it is the7fact there is a very that there is a very established bit of well used

and well recognised legislation this is founded 1 this is founded - and to that this is founded on. and to that this is founded on. and to that point. _ that this is founded on. and to that point. in _ that this is founded on. and to that point, in terms _ that this is founded on. and to that point, in terms of- that this is founded on. and to that point, in terms of those i that point, in terms of those conversations where people are issgsersatibhswhere pebble are decisions, it is not uncommon that you would additionaladvice other professionals such from other professionals such as possibly asa as a social other professionals if he as other professionals if he felt there was a need to so? felt there was a need to do so? the further you up in felt there was a need to do so? the fl seriousness up in he, felt there was a need to do so? the fl seriousness of in he, felt there was a need to do so? the fl seriousness of the 7, of the seriousness of the decision, the more you would do declsmn themere you nea'd de for example, if you are thatl far eeam’p’le ify’au are a finger that was setting a finger that was broken, will not wait until setting a finger that was b psychiatrist/ill not wait until setting a finger that was b psychiatrist ill not wait until setting a finger that was b psychiatrist i said : wait until setting a finger that was b psychiatrist i said you t until setting a finger that was b psychiatrist i said you can til a psychiatrist i said you can that. within reason, you do that. within reason, you and do that. within reason, you and do it. if you're doing open surgery, those kind of things, you be much more moving forward 777 movin7g7forward7if777 7 77 539in7g7f1>7rw57rd7if§8u 7 77 there 17g7f1>7rw57rd7if7§8u t7he7r7e is7f7orward7if7you t7he7r7e is7fo7rwa7rd7if7yn7 but think there is uncertainty. but be clear, for of people, is very majority of people, it is very clear they have or do not have clear they haveror donet have there is a capacity. there is a relatively small number, important number capacity. there is a relatively sr the number, important number capacity. there is a relatively sr the middle, important number capacity. there is a relatively sr the middle where rtant number capacity. there is a relatively sr the middle where that number capacity. there is a relatively sr the middle where that less |ber in the middle where that less clear additionalviews, slsar’a’na�*aaaitianal views. if this lear’a’na�*aaaitianal views. if this question

particularly if this question mental are relevant. are r7eleva nt. the are relevant. the fact issues arereleva nt. the fact the mental condition not mean in itself does not mean not somebody does not have capacity, but it does have to be taken into account. do they have for this have capacity for this decision at this point time? which is at this point in time? which is how the act lacks. bill bee-e this“ as; out that you be —= into force 7 into force within two brought into force within two years. if intention is to years. if the intention is to provide assisted dying through the nhs, candy nhs be ready in the nhs, candy’nhs be ready in to deliver time to deliver service equitably and safely, and what 27:7 �*for it to do so? 'for it to do so? as was in covid, the 77777777ih77co7vi7d7,77t77he77 7 77li7k7e 77 7 77777777in7co7vi7d7,7the likeany seen in (sovid. the nhs'lke am 7 7 7 77 77 7 can seen in (sovid. the nhs'lke am 77 7 77 77 77 7 can very fast if service can move very fast if there is a for in there is a need for speed. in case, most people see the key in society would see the key thing is to get this right. so, 7 iwould 7t7his gegsonally, i would rather this not running was not running against a timeline. you not timelinee veuwere not wanted on forever then to drag on forever because then you have uncertainty for youjjave uncertainty for but certainly i

7 7 and 7 7 and would and would both thinie buncan eneleeuls be“ to your seems a reasonable 7 point, point, but 7 point, but some things ta ke take longer than that —— dealing with 7 and 7 groups, minority and other groups, for we need get all 7ri7g7ht.a7nd77777777 7 77 77777777ri7g7ht.a7nd7at7 7 77 7ri7g7ht.a7nd7at7le7ast7 7 77 right. and at least at pass” 7 77 7777 77 7 pass, get 77 7 77 7 7pass7,g7etit77 7 7 pass, get it7 7 clo7se7 first pass, get it as close to good as we can do so. good as we can possibly do se7 this good as we can possibly do so this why i hope good as we can possibly do so some is why i hope good as we can possibly do so some is the hy i hope good as we can possibly do so some is the more )pe issues done via legislation, may when we 7 when7 we7fir7st7 7777 7 7 when7 we7fir7st7sea7rt7 7 7 when7 we7fir7st7sea7rt7using 7 find when we first start using it, there are some things we not 7 not considered at 7 we need to beginning, therefore we need to go back and improve on because just had not thought -m is true inevitably for bits 7 bits of 7 bits of 7 but many bits of legislation, but is particularly important go7 7,7 77 9° 7 my go 7 my first here. i go back to my first the central person comment, the central person here is a person, an average in their last six here is a person, an average i of 1eir last six here is a person, an average i of life. ast six here is a person, an average i of life. what( here is a person, an average i of life. what we do not months of life. what we do not is a system which very want is a system which is very difficult for them difficult for thern tonayigate they spend �* entire last

so they spend their entire last six months of 1730 00: