Tonia Antoniazzi (Gower) (Lab) I beg to move, That this House has
considered e-petition 604383, relating to assisted dying. It is a
pleasure to serve under your chairmanship, Sir Roger. Assisted
dying is an emotive issue that I have thought about long and hard.
I was grateful to the Petitions Committee and also to the creator
of the petition, Sarah Wootton, for arranging a meeting with some
of the families who have been through traumatic and
upsetting...Request free trial
(Gower) (Lab)
I beg to move,
That this House has considered e-petition 604383, relating to
assisted dying.
It is a pleasure to serve under your chairmanship, Sir Roger.
Assisted dying is an emotive issue that I have thought about long
and hard. I was grateful to the Petitions Committee and also to
the creator of the petition, Sarah Wootton, for arranging a
meeting with some of the families who have been through traumatic
and upsetting experiences. I was really pleased to have the
opportunity to speak to Liz Carr, who has long campaigned against
the introduction of assisted dying. Both meetings were very
emotional, but I was able to get a much better understanding of
the situation by having those important conversations, so I am
extremely grateful to Emma from the Petitions Committee for
organising them.
My role today is to present this petition on behalf of the
Committee, but I hope that I will be able to represent fairly the
views of those I met. It was a real honour last week to meet the
families who are here today in the room. Hearing their stories
was emotional and informative. They spoke with dignity about
their loved ones’ final days and weeks, and I am glad to see them
here today. I hope that when making interventions in this debate
Members will be mindful that this is a very real situation for
many people here today. I also hope that Members will allow me
the time to tell their stories without interruption. I understand
that colleagues will want to make their own points, but plenty of
time has been put aside for the debate this afternoon.
Opinion polls have shown that there is wide support for a change
in the law to make assisted dying legal in this country. Research
commissioned by Dignity in Dying in 2019 showed that 84% of
Britons supported assisted dying for terminally ill people. That
is a huge proportion of people who would like to see a change in
the way we deal with this situation.
We have not had a debate on this issue in this place for two and
a half years, and there has been no vote on it for seven. A lot
has changed in that time, including a pandemic that has shifted
the conversation that the country is having about death. There
has also been a change in attitudes in other countries and in
other parts of the United Kingdom. Jersey, Scotland and the Isle
of Man are all looking at changes. Australia, New Zealand, Spain
and others have all introduced measures around assisted
dying.
In our meeting, we spoke to Jan and her daughter Sarah. Jan is
currently planning for the end of her life after receiving a
terminal diagnosis. She explained to me that she has three
options: going to a hospice, ending her life in a hospital, or
receiving hospice care at home. Jan is worried that hospice at
home care will cause untold problems for her family. Not only
will it mean that her loved ones are largely responsible for her
care in her final days, but there are long-term effects of the
trauma that her dying at home will cause. Jan is worried that
hospice care will not be appropriate and there will be limits on
the number of people who will be able to visit her at the end of
her life. Jan said that it would not be a good place for her to
die. All she wants is a choice of a peaceful end surrounded those
she loves.
With no other viable option, Jan has signed up to Dignitas, so
that when it comes, she has a choice about her end of life. That
in itself causes problems, as she would probably have to do it
before she is ready because she needs to travel independently.
Jan and her daughter both spoke of the anxiety that it has caused
them and their loved ones. The worry and anguish that the
decision causes for many families was a theme through all the
stories that I heard.
I spoke to Carol, whose sister Alison died just over a year ago.
Alison had head and neck cancer. She was only 63 years old. Her
sister went through lots of treatment—radiotherapy and
chemotherapy—and was given lots of opiates to deal with the pain.
Alison was persuaded to go to a hospice for the end of life care
that she needed, but only after her pain and anxiety became
unmanageable. At the hospice, Carol noticed that the care that
Alison was receiving was governed by strict protocols that were
not appropriate for Alison’s needs.
As a retired doctor, Carol thought that she would be able to
advocate well for her sister, but that did not turn out to be the
case. Alison saw eight different doctors in two months while she
was at the hospice. She was given different information by
different people. Some agency staff were not sufficiently trained
in palliative care to look after Alison as well as they could.
Protocols dictated that pain relief medication could only be
increased by 25% in every 24 hours, but Alison had built up a
tolerance to opiates over the course of her illness and was in an
incredible amount of pain. All those things culminated in what
Carol described as a horrible death, which left everyone
traumatised—Alison’s husband and children, and Carol, too.
Alison’s family stayed with her 24 hours a day in the last couple
of weeks because she was so anxious about a lack of medicine.
I also met Gareth. Gareth’s dad had prostate cancer. He lived for
10 years on hormone treatment. When he was given his diagnosis,
as a military man who always had guns, he said, “I’ll just shoot
myself.” No one thought he was serious, but Gareth said that it
gave him an element of control. As his illness got worse, Gareth
said it was like his dad was “dying in front of our eyes.” He had
no quality of life.
Finally, Gareth’s dad said that he was ready to go into a
hospice, but that did not seem to be his intention. One day,
Gareth’s dad rang him to say that he could not deal with another
night like the last one and said, “I’m going to shoot myself. See
ya.” Gareth immediately rang his dad back, but his dad did not
speak. Gareth rang the police. He spoke to his sister, who lived
close by, and she rushed to her dad’s house. Gareth’s sister went
in, hoping that she would be in time to stop her dad, but he had
already shot himself in the head.
Gareth’s sister’s husband was also, at the time, terminally ill
with brain cancer. She and her daughters then had to watch her
husband die at home after he stopped all his medication. That
took a week. Gareth’s sister now suffers from post-traumatic
stress disorder, and his nieces are traumatised by the
experience. Gareth wants people to be more open in their
conversations about death. Speaking about death and not being
afraid to discuss it can only lead to better decisions for
everyone.
(Knowsley) (Lab)
The examples my hon. Friend is using powerfully make the case.
Does she agree that now is the time to legislate so that the end
of life care issues she mentions can be accommodated? As she
points out, there are people in circumstances where all quality
of life is gone, yet the legal situation is, at best, muddy and
unclear; at worst, it works against the interests of people whose
quality of life is completely gone.
I thank my right hon. Friend for his contribution, because that
is often the case. Clearly, Gareth wanted people to know that he
does not think what his dad did was actually suicide, but
bringing an end to his suffering.
Susan’s husband, Duncan, was diagnosed with motor neurone
disease, which we all know has no cure. Susan described Duncan as
a very strong character who, after researching MND, determined
straightaway that he was going to be in control of his own death.
Until he had a plan in place, he was distressed and unhappy, but
once he had a plan, he could start to live again. Three years
after his diagnosis, Duncan took his own life at home with help
from Susan. He left information for the police about how and why
he had done it. Although his intention had been to do it when
Susan was not at home, Susan said that, after 42 years of very
happy marriage, she could not not be there for him at the
end.
Despite the information that Duncan left, it was six months
before the Crown Prosecution Service deemed that it was not in
the public interest to prosecute Susan. She was interviewed for
six hours under caution by the police, which, after the death of
her husband, was obviously very distressing. I cannot imagine how
it must feel to have something like that hanging over you when
you should be grieving the loss of a loved one. Susan had the
means to fight these charges and her solicitor eventually got her
arrest removed from her record. What happens to someone who does
not have the money to stand up to a criminal justice system that
demonises people who find themselves in this invidious
position?
Susan also believes that because Duncan made his intentions
clear, the doctor seemed reluctant to give him drugs to help him
sleep, which exacerbated his problems. Ultimately, Susan takes
comfort in the fact that Duncan got the death he wanted. However,
it is a tragedy that his death was not within the law. We know
that people falling foul of the criminal justice system is not
uncommon in situations where someone ends their life, but empathy
and sensitivity are required in these situations—not the
heavy-handed approach we have seen too often.
Tim was a carer to his friend, David, who also had motor neurone
disease. Within two days of his diagnosis, David had signed up to
Dignitas. It was more than two and a half years before he died,
after travelling to Switzerland. There is only one end to a
diagnosis of MND, and David was not willing to be trapped in his
body while his brain was still functioning. By making the
decision to join Dignitas, David had some peace of mind. However,
even with his membership, the process was not always easy;
information was not forthcoming until certain points in David’s
illness, and the full picture was not available until they
reached Switzerland.
It would have been so much easier if David could have done it at
home. At home, the only option David was given was to be sedated
for three weeks while his body shut down—as Tim said, prolonging
the suffering. When Tim spoke about the inevitability of David’s
death, he said that doctors were willing to prolong his life to
the extent where the consequences were not worth it. Pain was not
really an issue for David, but the suffering that he went
through—not being able to sleep due to choking; having to be fed
through a tube in his stomach—was unbearable.
Throughout this process, all participants have spoken of the
anxiety that they faced because they or their loved ones did not
have the option of assisted dying. As Jan said in her
contribution, knowing that there is an option for assisted dying
is an insurance policy: it may not be something you decide to do
in the end, but having it there is a comfort. We have to consider
the impact on the families who are left behind. Having to watch a
loved one die is never easy, but prolonging the suffering can
lead to trauma and PTSD for families and friends. I have already
spoken on the record about my father dying.
(Bristol South) (Lab)
My hon. Friend is representing the Petitions Committee superbly
and speaks on behalf of the families we have met outside.
I think we all appreciate how difficult it is for people to come
to us to talk about personal experiences. My hon. Friend has
spoken about her father before. I know he would be very proud of
her. We all know how strong her support is for this cause.
I thank my hon. Friend for that intervention to save me from a
few more tears. I wanted to say that the PTSD my brother suffers
as a result of my father dying is something we will all have to
live with as a family. I think that is worth mentioning.
Tim said that palliative care can mitigate some of the pain, but
it can never mitigate the suffering. This seems to be so true.
Even the best palliative care cannot make it easy, and it never
is going to be easy, but we could do a lot more to make it
better. Research has shown that where assisted dying is an
option, palliative care improves. I truly believe that everyone
in this debate can get behind that. We must do better for those
at the end of their life.
I am also grateful to Liz Carr for taking the time to speak to me
on Friday evening. The worries that Liz and other campaigners
have need to be heard, and I believe we have a duty as Members of
Parliament to open up this debate and listen to all sides. There
are so many debates where people are very polarised in their
arguments, particularly in this House, and I feel very strongly
that both sides should be heard and that we should listen to
everyone.
(Bexhill and Battle) (Con)
I thank the hon. Member for giving way and for the way in which
she is leading the debate. I voted for reform several years ago.
I am really glad she has mentioned palliative care. There seems
to be a misconception that those who support an avenue that
people do not currently have unless they go to Switzerland are
somewhat not supportive of good-quality palliative care. It is
possible to have different paths for different groups of people,
and I support everything the hon. Member has said so far.
I thank the hon. Member for his contribution. He is right that
palliative care is important for everybody. We must have a
conversation about death. Dying will happen to us all and we must
talk about it. Palliative care is something we need to
improve.
(Rutland and Melton)
(Con)
The hon. Lady is right that dying is not about ending life. It is
about shortening death. She makes a point about the importance of
Parliament. My constituent Phil Newby, who was diagnosed with
motor neurone disease—a disease that has blighted my family very
cruelly—went to the High Court and asked it to make a judgment
about assisted dying. It said that it would not and that it was a
matter for Parliament. Would the hon. Lady support my belief that
it is vital we move past Westminster Hall and have a meaningful
debate and vote on the Floor of the House, which will allow the
people of Britain to have their say on this, since the judiciary
will not?
The hon. Member makes a very valid point. It is one of the points
I will make in this debate. We have not had a debate on this
issue on the Floor of the House for a very long time, and the
vote was seven years ago. I concur that that needs to happen.
Liz talked about Daniel James, a rugby player who was paralysed
from the chest down in a rugby accident. Liz is disabled and a
well-known actress and campaigner. She explained that, without
exception, the press coverage said that Daniel had been brave,
stressing how tragic it was that this man had been cut down in
the prime of his life. Liz wanted to make the point that there
was another side to the story that had not been told. People with
a disability are seen as something to be pitied and as people who
will never live a full life. I want to make clear today that I do
not believe that. There are people with disabilities who make
invaluable contributions to British life, and we should listen to
them and their concerns.
Being disabled does not mean living a second-class life. I cannot
even begin to understand how being considered in that way would
make somebody feel. There are bigger problems in the health
service, however, including dehumanising treatment—such as when
someone waits hours for a carer to visit to take them to the
toilet—and insufficient pain relief because the National
Institute for Health and Care Excellence has made an economic
decision about someone’s worth versus the cost. That is what we
faced as a family—I have experienced it.
Liz also raised concerns about trust in the healthcare system.
She said:
“The NHS has both saved my life, and destroyed my life.”
If we want to have a grown-up conversation about death, we need
absolute commitment to properly funding end-of-life care and
hospices. Some on the Government side will say that they are
campaigning for “dying well”. They are in a position to make that
happen, so I say to them: please do so. The palliative care
system has been underfunded; rather than talking about dying
well, please do something about that. As Liz said, it is
outrageous that hospices are mainly charity funded. If we want
people to be able to die well, let us fund palliative care, give
people options and make everyone feel valued at the end of their
life.
One word that I have not yet used in my speech is
“autonomy”—deliberately so, because I had it explained to me in a
way that I had never previously considered. I have always been a
great believer in the idea that it is my body and I will do I
want with it, thank you very much, but Liz said that disabled
people can embody what most people are afraid of: a lack of
autonomy and a loss of dignity. That understandably frightens
many disabled people. When you think society does not value you,
or that it considers you a burden, you must fear that society
will find a way to rid itself of that burden.
I thank everyone who has spoken to me. It is amazing to see
Westminster Hall packed with people who care about their death
and the deaths of their loved ones, however they wish for it to
end. The petition is very important to me and many others. We
need a calm and clear conversation. Will the Minister find a way
for the Select Committee to hold an inquiry on it, and will he
take the time to meet some of the campaigners who took the time
to speak to me? Their voices have to be heard, and the least we
can do is hear them and make informed choices about where we go
from here. Most importantly, it is for parliamentarians to debate
and discuss future legislative opportunities.
In conclusion, I thank everyone. I understand the strength of
feeling that this issue evokes, and I look forward to listening
to a meaningful discussion this afternoon.
Several hon. Members rose—
(in the Chair)
Order. May I invite any Members who are standing and who have not
taken a seat to come and take one if they wish to do so? We do
not stand on ceremony on occasions like this; you may well want
to sit.
4.53pm
(Sutton Coldfield)
(Con)
I draw Members’ attention to my entry in the Register of Members’
Financial Interests and to the fact that I am co-chair—with the
hon. Member for Bristol South ()—of the all-party parliamentary
group on choice at the end of life.
I speak today as a convert to the campaign for the legalisation
of assisted dying. My mind has been changed over the years,
principally because of the number of constituents to whom I have
spoken who have faced terrible suffering at the end of life, or
who have witnessed loved ones dying in painful and undignified
circumstances. I want the change for my constituents, for myself
and for those whom I love.
Last Friday, in the royal town of Sutton Coldfield, I met Lyn
Ellis, a constituent from Wylde Green whose husband died from
prostate cancer. During covid, he was told that he had three to
six months to live, and he died not long afterwards. Lyn told
me:
“Until you’ve been through something like this, you don’t realise
how hollow the argument is that there is a palliative answer. As
John died, he shrank to nothing; he couldn’t eat; he was in pain;
suicidal. I felt we’d been cheated. What could be a better way to
go than a glass of champagne and saying goodbye to each
other?
Those last few weeks of his life were incredibly painful; he shut
down, wouldn’t speak, and we’d always had such a close and loving
relationship. I feel the state let me down. A good and decent
country would not have put us through this.”
We in the Commons have not been asked to vote on assisted dying
for almost seven years. A great deal has changed in that time:
California, Colorado, New Jersey, Maine, and even the District of
Columbia have legislated for choice at the end of life. In just
the past five years, every state in Australia has passed laws on
assisted dying; New Zealand, too, legislated on assisted dying
following a referendum that showed 66% support for the proposal.
Other jurisdictions have gone further than the proposals that I
support, including in Canada and Spain, and change is on the
cards in Italy, Portugal and even Ireland. Proposals are under
consideration in Scotland, Jersey and the Isle of Man that could
be voted on before the end of next year.
Our hospice and end-of-life care in this country is superb, but
nobody—not even the most ardent defenders of the palliative
provisions that are in place—can claim that every person who dies
in their care does so without pain, in peace and with dignity.
For those facing even the prospect of a traumatic death, knowing
that they had the option of choosing the moment and manner of
their end would offer so much reassurance.
Right now, some people with terminal illnesses feel they have no
other option than to take their own life into their own hands.
They do so privately and alone so as not to incriminate their
loved ones, and they often do so in violent and distressing ways.
The Office for National Statistics published data in April
demonstrating that those with severe health conditions are twice
as likely to end their own life as those without. Estimates
suggest that every week, between six and 12 people with terminal
illnesses choose to die in that way.
We have evidence of the harm caused by our existing laws, and
growing evidence of the reforms we could adopt from overseas. New
polling from YouGov shows that three quarters of the British
public support an inquiry into assisted dying, including 80% of
Conservative voters, 77% of Labour voters, 80% of those who voted
remain and 79% of those who voted leave. It is refreshing to find
unity in our politics at the moment, and it is clear from every
opinion poll on the subject that assisted dying is a unifying
issue for people across the country. I understand that the Health
and Social Care Committee is considering conducting an inquiry
into the subject, including looking at the experience of
countries that are ahead of us on the issue. I very much hope
that it will do so, and that its report will inform the thinking
of the Government and the House.
In closing, I ask that when my hon. Friend the Minister replies
to the debate, he acknowledges the enormous changes that have
taken place over the past couple of years, both internationally
and in UK jurisdictions. We cannot continue to let dying people’s
suffering go unanswered; it is time for dignity, for compassion,
and for a choice at the end of life.
4.58pm
(Bristol South) (Lab)
It is a pleasure to serve under your chairmanship, Sir Roger, and
to follow my fellow chair of the all-party parliamentary group on
choice at the end of life, the right hon. Member for Sutton
Coldfield (Mr Mitchell).
I am not a convert. I have wanted to change the law on assisted
dying since I became a Member of Parliament, following my
experience 14 years ago working with clinicians on how to
communicate with patients about how to live and die with
respiratory disease. That is not terminal, but the work opened my
eyes to how we talk about death—how we do not prepare for the
inevitable and, although we seek to have choice, agency and
freedom throughout our lives, we have no power at the end. There
will be many people listening to the debate who are facing death
or the death of their loved ones. As we debate this issue, we
must be mindful of the personal circumstances and experiences of
those people, and of all of us in the Chamber.
End-of-life care has improved since my work in the health service
14 years ago, but there is still a contrast between how we talk
about dying and how we attempt to talk about other care, which is
indicative of the problem. In all my years working in the
planning and commissioning of services in the NHS, it was all
about co-production—the importance of patient voice and
choice—but the co-production partnership disappears at the time
we can least fight: the time we die. However, the reality is that
a person can have choice—if they have an average of £12,000
spare. We can debate all we like, we can pretend this is not an
issue, and the Government can turn an eye, but if a person has
the money, they have the choice.
For campaigners, that is a really frustrating position. As we
have heard, poll after poll suggests that we as MPs are far from
our constituents on this issue. I have been humbled today by
meeting families and friends who have travelled to speak to us
and share their stories. It is absolutely right that, if Members
of Parliament have not previously engaged with this subject, they
should engage with it, they should be properly informed, and they
should have the opportunity to scrutinise all the proposals and
to be convinced that change is better and safer than what we have
now. We seek parliamentary time to do just that.
First, we must understand that the current situation is not safe
or sustainable. Secondly, we want to learn from those who have
safely operated an assisted dying law for over 20 years. Thirdly,
we want to ensure that we address all the concerns expressed,
especially about safeguarding.
We have heard some shocking examples of people taking their own
lives. My hon. Friend the Member for Sheffield Central () spoke movingly about that
three years ago, and we see it in the ONS data. Currently, there
are no up-front safeguards to stop people taking their own life
or refusing food, water or ventilation. There is no regulation on
people choosing not to have treatment. People live in fear of
accompanying their loved one and getting that knock on the door
from the police—that happens. Additionally, as I said, there is
choice for those who can afford it.
We need to scrutinise the proposals and learn from Oregon and
from recent debates in Australia and New Zealand. Since we last
debated the subject, as the right hon. Member for Sutton
Coldfield said, six states in Australia have legalised assisted
dying, as have several states in the United States, New Zealand,
Canada and many other countries. I have had the pleasure of
talking with parliamentarians from across those countries about
the debates they have had. We can learn from them. The concerns
raised by opponents have not come to pass. Medical opinion has
shifted dramatically, and new evidence has been published that
demonstrates how unsafe our current law is. That is why I am
confident in these proposals.
We need time to go through the arguments and the safeguarding
concerns. I have spoken to several MP colleagues and I understand
those concerns, but they have not come to pass elsewhere. The
rights of people in different parts of the United Kingdom are
dominating our politics. In fact, in the main Chamber, Members
are currently talking about Northern Ireland as part of the
United Kingdom. With proposals coming through in Jersey and
Scotland, the United Kingdom Parliament and the United Kingdom
Government will have to engage with assisted dying here in the
United Kingdom. It is useful to have debates like this one, but
what we need is Government time. I hope the Minister will take
the Government’s head out of the sand and respond positively to
the request for just that.
5.02pm
(Devizes) (Con)
It is an honour to serve under you, Sir Roger, and I welcome the
debate. I should declare that I am chair of the all-party
parliamentary group for dying well.
Let me start by saying how much I recognise the good faith,
integrity and powerful arguments of the hon. Member for Gower
(), all hon. Members
speaking in support of the petition and all the campaigners who
support it. I recognise the extreme distress and anxiety felt by
families who have been through the agonising death of a loved one
who experienced suffering that no human being should go through.
I will address the issue of bad deaths in a moment, but first I
want to look at the implications of assisted dying as I see them,
and what would happen if we did it in this country, based on our
experience and that of other countries.
I do not have a suite of powerful personal stories, although I
recognise the enormous moral value of them all; I invoke the
nameless and numberless people who will be affected if we
introduce this law. The main argument for assisted dying is the
simple one of autonomy. I think a lot of the support for assisted
dying comes from the simple and natural resentment that anybody
should try to stop people doing what they want, especially about
something as important as this—literally a matter of life and
death. But in this case, things are the other way around for many
people. In my view, we need to keep assisted dying illegal
because, as a matter of practical fact, for many people, it would
narrow their autonomy. It would reduce their freedom
substantially, because it would put them on a path with only one
destination. That is because of the incentives that assisted
dying would introduce.
The first incentive would be in our healthcare system. The
simple, blunt fact is that it is cheaper for the system to help
people end their life early than to care for them for weeks,
months or years. That is not an argument we hear for assisted
dying, but it is compelling. The cat was let out of the bag
rather when the Member of the Scottish Parliament who is trying
to legalise assisted dying in Scotland cited research from Canada
showing that the health service there has saved hundreds of
millions of dollars in care costs. We see, in contraction to a
point made by the hon. Member for Gower, that where assisted
dying is introduced, investment in palliative care stalls or
recedes in comparison with countries where assisted dying is
illegal.
Meanwhile, in Oregon, we see people being refused palliative care
on cost grounds and then choosing assisted dying because there is
no other option. I know we pretend that we do not have rationing
in the NHS, but obviously, with finite resources, we do. Do we
really imagine that assisted dying will not become an option that
doctors and medical managers will not tacitly—even
unintentionally—encourage?
(Thirsk and Malton)
(Con)
My hon. Friend is making some very interesting points, although I
am on the other side of the argument. With such controversial
issues, we tend to point to facts on either side of the argument.
Would it not be sensible to have an independent inquiry, by the
Health and Social Care Committee or otherwise, to look at the
points that he raises and the points that others would raise on
the other side of the argument?
I recognise the force of that point, but the fact is that
Parliament has debated the topic repeatedly over the last 20
years. We have devoted considerable hours of parliamentary time
to it already.
(Telford) (Con)
We had the opportunity to vote on the matter in 2015, but that
was a great many years ago and many people who are Members of
Parliament today were not present. Does my hon. Friend agree that
“repeatedly” was perhaps the wrong word to use in that
context?
As I understand it, we have had 14 hours of parliamentary time
devoted to the topic in this Parliament alone. I suggest that
there are other topics that we could address. I recognise that
assisted dying is worth discussing, but there is something that
we should do first, before we consider it. I will come to that
point in a moment.
Members who think we can prevent people from being put on the
pathway to assisted dying by good drafting, or because doctors
are good people—obviously, they are—should think about the “do
not resuscitate” scandal we had during the pandemic, and about
the Liverpool care pathway, and then suggest there is no risk. I
think there is a risk. I know that doctors are good people who
want the best, but if we force them to make utilitarian decisions
about the best use of resources, will they not push people in
this direction?
As well as the pressure on the healthcare system to take this
route, I worry even more about the pressure on patients
themselves to request assisted dying if it is an option. It will
be an option for almost everybody approaching death—that is the
proposal. Clinical guidelines for many terminal or chronic
illnesses will likely require doctors, at an early stage of
planning treatment, to ask patients whether they would wish to
have assistance in taking their own life. What a question to ask.
Whatever the guidelines, every family will be required to have
the conversation, in whispers or openly. In some families, we
know how that conversation could all too likely go.
Over half the people in countries where assisted dying is legal
choose it because they feel they are a burden to their family.
Tragically, a lot also say that they are lonely. Is that not
terrible—people getting the state to help kill them because they
do not want to be a burden on a family that never visits them?
Talk to any hospice manager about relatives and they will quietly
confirm it. There are a lot of people who want granny or grandpa
to hurry up and die.
(Edinburgh West) (LD)
The hon. Member is making a number of points. Like the hon.
Member for Thirsk and Malton (), I am on the other side
of the debate. Is it not the case that many of the people who are
being characterised as wanting granny or grandpa to hurry up and
die, are in fact simply wanting their pain to end, and want a
compassionate way to bring that to an end? They do not want them
to die; wanting them to die is the furthest thing from their
mind. However, they are going to have to die, and they want to
make it a better death.
I really do thank the hon. Lady for that intervention. She is
absolutely right, and I thank her for allowing me to make it
abundantly clear what I hope I made clear earlier: I recognise
the enormous power of the campaign, and that the overwhelming
majority of people want it for the best of intentions. All of the
people campaigning for this, and the overwhelming majority of the
people who imagine making use of this law, do so for the absolute
best of intentions. Please can we not have a deliberate
misunderstanding of the points I make? I represent a lot of
people who think this way, and I am making the point in all
sincerity.
I challenge Members, many of whom must visit their hospices and
know what is acknowledged as the fact of elder abuse. Tragically,
we have a rising epidemic of elder abuse in this country. Half of
elderly people who are victims of financial crime are victimised
by their own adult children. It is not just the elderly we need
to be concerned about. It is no surprise that no disabled
organisation supports the proposal. It is the most vulnerable
people, who by definition rely on the support of other
people—their families and professionals—who are most at risk of
assisted dying laws being misapplied, which is what I fear would
happen. Suddenly, every controlling and coercive relative, every
avaricious carer or neighbour, every overstretched or
under-resourced doctor or hospital manager would have the means
to cut their cost, and I do not believe it is possible to design
out the risks.
(South Holland and The Deepings)
(Con)
My hon. Friend is making a compelling case. We have heard a lot
about quality of life, but who are we to judge what a quality
life really is? Is someone who is profoundly disabled without
quality? Is someone with profound learning difficulties without
quality? Why do we assume that the only lives worth living are
those that are perfect or of high quality in the eyes of
others?
(in the Chair)
Order. I fear that we shall never hear the answer to my right
hon. Friend. We have to stick to the five-minute limit, and you
get injury time only on the first occasion that you give way, I
am afraid. That is a message for all Members.
5.10pm
(North Antrim) (DUP)
Each of us has personal experiences of our closest, our nearest
and dearest, dying—if we do not, we one day will. I watched my
father die, I watched my father-in-law die and I watched my
brother-in-law die. One was in a hospice, one was at our family
home and one was in a hospital, and the experience is shocking.
That is life: in the midst of life, we are in death. Here we have
no continuing. This is not our final resting place.
As a nation, we need a national conversation about death. The
hon. Member for Gower () mentioned that briefly,
but we need to focus on it. It was said during the last debate
that that should happen, but no one bothered their backsides
doing it; no one took it forward. This House really should have a
proper conversation about death, and let us put into that
conversation real palliative care.
My dear friend, the right hon. Member for Sutton Coldfield (Mr
Mitchell), who I oppose, said that our hospice care in this
country is superb. Indeed, there is an element of it trying to be
superb, but let us be clear: our palliative care and hospice care
system in the United Kingdom is struggling. It does not have the
resources it requires. Hence, people say, “Let’s give hope to
someone in a different way. Let’s try to find a way of ending
pain.”
When we were faced with the coronavirus, did our Government give
up hope, or did they put massive resources into funding a way to
find a vaccine? That vaccine gave hope. When our country was
struggling with the AIDS epidemic, did we give up hope? Did we
say, “That’s a life sentence. Tough luck”? No, we put money and
resources into medication and medicines that now ensure that it
is not a life sentence.
What more can we do if the Government, with our help, put
resources into cancer care and cancer research, incurable
diseases and care, and palliative care? If we do that, we will
achieve so much more, and as a Parliament we will give hope to
people. Today, I am afraid we are giving hopelessness to some and
saying, “This is the only way out. We can’t do anything more.” We
can do more if we find the courage to do so. I appeal to the
Minister: if there is a national debate—a national conversation
about death and dying—will he make sure it is also a conversation
about palliative care, faith, spiritualism and all the things we
need a conversation about? If we have that conversation, we will
find that we can give people hope.
Mr Mitchell
I hope I can just nail this point about palliative care. Both
sides of this debate are strongly in favour of increasing
palliative care. Does the hon. Gentleman accept that all the
jurisdictions that have gone down the route that I and many of my
colleagues have proposed have also prioritised palliative care
and increased spending on it?
I am not for one moment saying, and I do not think that I can be
accused of saying, that those who look at assisted dying do not
care about palliative care. I do not think anyone is—are we
really that heartless?—but I think we have to give hope to
people. We need to turn this debate around into a debate about
palliative care and helping people when they are at their
lowest.
It is a fact that our health service is struggling; it is a fact
that our cancer waiting lists are the worst in western Europe;
and it is a fact that we need to do much more when it comes to
giving care and carrying out research into rare and unique
diseases, so that people can find a way out.
It is also very important that the statistics are not with this
blasé view that says, “This is where Britain stands. They want to
see a law change.” First of all, in the Republic of Ireland the
assisted dying law was rejected overwhelmingly by Dáil Éireann,
because it did not believe that it was a way that could bring
satisfaction.
The threat to the disabled and the vulnerable has been raised by
Disability Rights UK, Scope and the United Kingdom’s Disabled
People’s Council, all of which say that this debate on assisted
dying causes them great concerns. The British Medical
Association, the Royal College of General Practitioners, the
Royal College of Surgeons and the Royal College of Physicians do
not support moves towards assisted dying.
I think there has been some—
(Brentford and Isleworth)
(Lab)
Will the hon. Gentleman give way?
No, I do not have injury time.
The hon. Member for Bristol South () touched upon the issue of
Oregon. It is not a debate that is widely discussed and we should
say that within 10 years we could see times fifteen—I repeat:
times fifteen—the number of people wanting to explore and use
assisted suicide. There is something seriously wrong when that is
where this debate takes people.
We need to focus on things that will give people hope and the
opportunity to find a better way. When we walked into this
Chamber today, we walked under a portrait of Moses. That portrait
carried with it a biblical and, indeed, faith inspiration that we
can make good laws. We can make the best laws. Changing the law
on this would be the wrong choice, and if it ever comes to a
debate on the Floor of the House, I will vote against it.
5.17pm
(Worthing West) (Con)
I pay tribute to the hon. Member for Gower (), who introduced this
debate. I will not go through my list of family members, friends
and constituents whose deaths I have been present at, or who I
saw just shortly before their death; we can all do that and do it
with sincerity. I am aware that my parents agreed to my brother’s
life being ended after an accident when he could not live.
What I want to do is briefly to pick up two points about hospice
end-of-life care and death on request—which is my neutral way of
describing what we are talking about. In the Netherlands, people
are not allowed to have death on request in or from a hospice;
they have to ask to leave the hospice to have their life ended by
euthanasia. Incidentally, the Dutch distinguish between
euthanasia and assisted suicide, and nearly all are by
euthanasia; they are not assisted suicides. The proportion of
people and the number of people in Dutch hospices who ask to
leave so that their life can be ended is very, very low; it is
less than one in fifty.
Secondly, I have heard people say that people often commit
suicide because they want their life to end and they cannot find
another legal way of doing it. The Dutch rate of euthanasia—death
on request—and assisted suicide is between 6,000 and 7,000 cases
a year. The Netherlands has a population of about 17 million. If
we translated their numbers to this country, we would have well
over 25,000 people a year. How many suicides a year do we have in
this country that we know about? Obviously, some are not
classified as suicides, but the conventional figure is about
5,000 to 6,000. We are in effect being told, “Everything’s all
right, because it’s been all right in the Netherlands. And by the
way, expect death on request and euthanasia figures to be four
times the level of our known suicides.” I do not sign up for
that.
The last thing that I want to say is that some people say that
two out of three suicides may be because people want to end their
lives early because of some medical condition, or whatever. We
are not talking about the depressions or the other things from
which people often recover. I just put it on record that for
every person who successfully commits suicide, there are probably
20 people who may have tried, one way or another.
If we seriously want to believe that bringing in legal euthanasia
or assisted suicide—death on request—will drop the suicide rate,
look at the Dutch. While their numbers of assisted deaths have
gone up significantly—the law was passed in 2001 and enacted in
2002—from 2003-04 onwards, there has been a pretty consistent
rise in the number of suicides in the Netherlands. The idea that
changing the law will drop the suicide rate, or act as a
substitute for effective end-of-life care, is, I believe,
wrong.
The more often we debate this in the House of Commons, the
better, as far as I am concerned. I am willing to acknowledge
some points that people make, but most of my friends—not all—who
had motor neurone disease did not ask for death on request. Most
of the people who told me in advance that they were going to end
their lives if they were in the last days of a terminal condition
did not end their lives. We ought to be far more careful about
the way we debate this. It is not a one-sided debate.
5.20pm
(Sheffield Central)
(Lab)
I pay tribute to the 155,000 people who signed the petition
prompting today’s debate and to my hon. Friend the Member for
Gower () for the way she
introduced it.
It is an extraordinary coincidence, but today is the 11th
anniversary of my father’s death—more extraordinary, because the
last time the Commons debated assisted dying on the Floor of the
House was the eighth anniversary of his death. Like an estimated
300 people in the UK every year, he took his life after a
terminal diagnosis. Although I still find it difficult to talk
about, I want to share his story today, because he would have
wanted me to, and because his experience echoes that of so many
others and informs a central issue in our discussion. Inevitably,
the debate on providing choice at the end of life often focuses
on the impact of the change that is being proposed, but I think
we should start from a different place: by looking at the
existing law and recognising the pain it causes, and the way it
forces so many into desperate and premature deaths.
Eleven years ago today—also a Monday—I got a phone call here: he
had been found dead in his garage. I had spoken to him the
previous night on the phone as I walked through St James’s Park.
An ordinary conversation that gave me no inkling of his plan. But
later he obviously tidied up his belongings, left some small
piles of money to settle bills with—with the newsagent and one or
two others—and wrote some final notes. He then walked to the
garage, connected a hosepipe from his car exhaust into the car,
took an overdose and switched on the engine.
I was shocked and clearly still struggle with it, but I should
not have been surprised, because he had always believed that the
law should be changed to allow assisted dying. And let us be
clear—we should be very clear about the terms we use—my dad was
not suicidal. He loved life; he was 87. But at that age he had
inevitably watched many of his friends go, often
miserably—horrific deaths. He talked with me about their last
days and he had always been clear that he would rather end things
than face a lingering and degrading death, but I still was not
expecting it.
He was somebody who had made the most of life. He had a tough
east-end upbringing, became an RAF pilot during the war and built
a successful business career. He had had his share of health
problems, but he faced them all positively, until a terminal
diagnosis of inoperable lung cancer clearly led to his decision
to take his life. He could not talk to me or his partner about
it, because he would have made us complicit. The current law
forced my father into a lonely decision and a lonely death. And
he died prematurely, because I am sure that what drove him to end
his life at that point was the fear that if he did not act when
he was still able to do so, he would lose the opportunity to act
at all.
My hon. Friend is making a very powerful speech. I am grateful to
him for sharing his story with us again. What he exemplifies is
the wider impact on the family. Families are loving places to be
for most people, and the impact goes on for a number of years.
The inability to have those conversations with family is one of
the things that my hon. Friend is highlighting for us today. The
current law inhibits honest conversations in families to help a
more supportive situation to go forward. I think that is
something we should all take with us this afternoon.
I thank my hon. Friend for that intervention. She is absolutely
right, and I appreciate the breathing space that she has given
me.
Some people have already said in this debate that we simply need
to improve end-of-life care. We should, and I say to the hon.
Member for Devizes (), contrary to his comments,
that many of those states, for example in Australia, that have
introduced assisted dying have, at exactly the same time,
substantially increased the amount of money spent on palliative
care. We should do that, but it would not have changed my dad’s
decision. He supported our local hospice. I have raised funds for
it. It does a great job. But no hospice can enable everybody to
die with the dignity that they would want.
Indeed, for my father, it was soon after his appointment with the
palliative care nurse, where together they talked about his last
months and how that would pan out, that he took the decision to
end his life. My hon. Friend the Member for Bristol South () alluded to the fact that, if
the law had made it possible, he could have shared his plans with
us. And knowing that he could, with support, go at the time of
his choosing would have enabled him to stay longer. If the law
had made it possible, he would have been able to say goodbye and
go with his family around him, not in a carbon monoxide-filled
garage. He deserved better and many others like him deserve
better. And we, here, can make that possible. We simply need to
change the law, as the overwhelming majority of the British
people want.
I appreciate that there are those whose personal belief makes my
father’s choice unacceptable. I respect those beliefs. Live your
life by them. But do not impose them on others. Let people have
the choice at the end of their lives. Allow them the dignity in
dying that we would want to give them during their life.
5.27pm
(West Suffolk) (Con)
I think that the sheer number of us in this room today and the
power of the testimony from so many is itself the strongest
possible case for the motion that Parliament must have an
informed, compassionate debate on assisted dying. We know and
have heard that the vast majority of people support choice in how
they die. Indeed, we know that an even higher proportion of
people who live with disabilities support having choice in how
they die. And I think we all agree, on both sides of the debate,
that the debate should be informed and compassionate.
It is seven years, as many have mentioned, since we last had a
substantive vote on this subject. Since then, out of the 650
Members of Parliament, more than 200 have changed. The
composition of Parliament has changed. Many Members have not had
the opportunity to consider this question and express their view.
The issue is not only that changes have been brought in in other
countries. The Royal College of Nursing has dropped its
opposition to assisted dying. The British Medical Association has
removed its opposition. I can speak as a former Health Secretary
and say that the medical movement as a whole is also changing its
view, and I think it is appropriate that we raise these questions
in a votable manner on the Floor of the House proper once
again.
I have a few personal reflections. As Health Secretary, I found
this area of policy bereft of data. I found that there had been a
muddle in the way Government think about it. Because this has
been a conscience vote for parliamentarians—and rightly so—the
Government felt that they had to step back from the debate as a
whole, so I wrote to the Office for National Statistics to ask it
to investigate this area, as it does so brilliantly in every
other area of life. That is how we now know that twice as many
terminally ill people take their own life as people who do not
have a terminal diagnosis. That is a striking fact. We should
encourage the Office for National Statistics, and every other
part of Government, to publish data to inform this debate in
exactly the way that it would for any other area—for most of
which, of course, there are whipped votes.
(Winchester) (Con)
It is really good to hear from my right hon. Friend, given his
experience. I know that this is a very difficult debate. I lost
both my parents when I was 46. I watched both of them pass away
—with dignity, I have to say. Does my right hon. Friend, with
whom I served in government at the Department, recognise the
problem that, although this debate has moved on and we have seen
great progress in survival from the acute episodes that some of
our loved ones face, that has not been matched by the development
in pain relief? I wonder whether that is why so many people,
including myself, who voted against the Marris Bill seven years
ago, are on a journey and listening intently today.
Yes, I think there is a lot in that. As Health Secretary, I met
people on both sides of the argument. I admire so much those who
give palliative care. I took the opportunity to put more funding
into palliative care, although I also support the mixed model of
funding because I think that the funds raised through voluntary
efforts and philanthropy are important—I have raised money for my
brilliant local hospice, St Nicholas Hospice in Bury St Edmunds.
But the truth is that even the best palliative care in the world
cannot stop the deep pain and trauma that comes with some
diseases, especially but not only cancers, at the end of life.
Medicine simply cannot stop the pain in every case.
As Health Secretary, I also heard from supporters of change. I
want briefly to mention two examples. The first is Sir Paul
Cosford, the former medical director of Public Health England—my
hon. Friend the Member for Winchester () will have worked with him—who
gave enormous and great service during the pandemic. Everybody in
this Chamber will have heard him on Radio 4. What most people
will not know is that he was living with cancer for the entirety
of the pandemic. The work from home provisions allowed him to
keep serving right up until very shortly before his death. A
month before his death, he asked for some time with me, one on
one, and he explained to me that he was nearing the end. As a
doctor, he had seen many, many patients go through what he was
about to go through, and he did not want to go through that. He
said to me, “The end, when it comes for me, will be brief, but
others do not have that choice.” He asked me this question:
“Would you want the choice of how to die?” I ask everyone in the
Chamber that same question.
As a local MP, I was honoured six weeks ago to meet David Minns,
who has terminal myeloma. He told me a heart-rending story about
how he saw in recent years his daughter die of a very painful
cancer without successful pain mitigation, and he does not want
to go through that. Nor does he want to go to Switzerland; he is
a proud, patriotic man. He could potentially live longer if he
knew that he could be assisted in his death, as we have heard
from so many others.
Nine countries now allow assisted dying in a highly specific
form. There are reasonable arguments on both sides, so there are
constraints in place. We can learn from the experience overseas.
There are countries with our common law tradition and parts of
this United Kingdom that are considering assisted dying.
Does my right hon. Friend not acknowledge that in every single
country where measures such as assisted dying, assisted suicide
or euthanasia have been introduced, there is only one direction
of change, which is towards more progressive liberalisation of
the law? It always goes towards more liberalisation, including in
Canada, where euthanasia is now being proposed.
I heard that argument, so I looked into it. In Oregon, for
instance, which is the originator of the proposals that many
people support, that is simply not the case. There was one change
made many years ago and the law has now rested. There is
essentially agreement about it.
I cannot see how the Minister can argue for anything other than
an informed, compassionate debate on the Floor of the House. For
50 years we have had a legal choice over who to love. For a
decade we have had a legal choice over who we can marry. Let us
have an informed debate about, when the end is inevitable and the
pain insufferable, how we die.
5.35pm
Sir (East Ham) (Lab)
I commend my hon. Friend the Member for Gower () for the very sensitive
way she opened the debate. I also commend the powerful speeches
we have heard so far.
I oppose the view expressed in the petition, essentially for the
following reason: if we were to legalise assisted dying, we would
impose an awful moral dilemma on every conscientious frail person
nearing the end of their life. We have probably all known a
number of such people. They have a lot of anxieties at that stage
of their life. They worry very much about being a burden on their
children, needing care from them and consuming resources that
their children would otherwise inherit. If ending their life
early were legally permissible, many who do not want to end their
life would feel under great, probably irresistible, pressure to
do so. There is no way to stop that happening.
Knowing my right hon. Friend as I do, I know he is sincere in his
views. He talks of the group of people who are at the end of
their life and might feel under pressure to conserve the
inheritance of their children or not to be a burden on them, but
there is another group, rarely talked about, who put pressure on
their parents or loved ones to stay alive. They do so out of
love. Would he accept that both sides, more often than not, act
out of love, rather than for venal reasons, so does not one
argument cancel out the other?
Sir
I accept wholly the point my right hon. Friend makes. I think a
lot of the people I am concerned about, and expressing a worry
about, are deeply loved by their children but do not want to put
an undue burden on them. I am not saying that those children want
to hasten their death or anything like that. I do not think that
is often the case, although occasionally it might be.
I do think that conscientious and frail elderly people will feel
that they ought to avoid being a burden, and they will feel a
pressure to end their lives prematurely as a result. I would say
that we ought not to impose such a burden on vulnerable people
nearing the end of their lives. The penalty that would come from
doing so would be significantly greater than the considerable
benefits we have heard set out in the debate.
(Newcastle-under-Lyme)
(Con)
Will the right hon. Member give way?
Sir
I will make a bit more progress.
In setting out this view, I am mindful of the stern instruction
we all received last week from the National Secular Society,
which wrote:
“Dire warnings about the coercion of disabled, elderly, sick or
the depressed can mask true motivations for opposing a change in
the law…disguising religion objections as secular concerns,
rather than seeking ways to mitigate potential risks of
legalising assisted dying, opponents can exaggerate the risks,
weaponising them to spread fear.”
The National Secular Society will probably regard me as one of
the guilty parties here, but I do not think the concerns I am
expressing are apparent only to religious people. Disabled
people’s organisations have been very clear—in the interests of
all the people they represent, and certainly not on any religious
grounds—that legalising assisted dying would be a deeply damaging
change. I think they are right.
I have heard that argument made a couple of times, and I respect
the associations involved, but how would the right hon. Member
reflect on the fact that, according to polls, 86% of people
living with a disability are in favour of a change? That figure
is greater than in the population as a whole, so I do not
understand the point he is making.
Sir
I have not seen the polls that the right hon. Member refers to,
but I think it is the case that all the major organisations
representing disabled people in the UK oppose this change in the
interests of their members.
There are good and compassionate arguments—we have heard a number
of them—in favour of the change that the petition calls for. I do
not agree with those arguments, but let us be clear that they are
not the only arguments for the change. In some minds, they are
clearly not the decisive arguments either. As we have been told,
in some countries where the change has been made, it is
explicitly about saving the health service money.
My party introduced the national health service, which is our
proudest achievement. It needs to be adequately funded. The fact
that it is not being adequately funded at the moment must not
become an excuse for giving up and accepting that painful deaths
are unavoidable. Instead, as all right hon. and hon. Members have
agreed so far in the debate, we need to invest in palliative
care, where there have been big advances and where there could be
many more, and to ensure that adequate care is provided to
everybody who needs it.
I agree with the organisation Care Not Killing that we want
“a funded policy for comprehensive hospice, community and
hospital specialist palliative care services across the country
with a duty placed on NHS trusts to ensure these services are
made available to all who need them.”
I visited my local children’s hospice on Saturday—we have heard
from a number of Members who have made such visits—and it had a
fête to raise funds, because it is struggling for cash. In my
view, it should not have to do that.
“In Place of Fear” was how Nye Bevan summed up what had been
achieved in founding the NHS. Let us not give up now and decide
that we can no longer afford the relief from fear that he rightly
promised.
Will the right hon. Gentleman give way?
Sir
I cannot give way again.
We should renew our determination not to impose fear and an awful
moral dilemma on frail and conscientious elderly people
approaching the end of their lives, and insist on modern
palliative care for those who need it and a properly funded
health service that supports living.
5.42pm
(Hastings and Rye)
(Con)
It is a pleasure to speak under your chairmanship, Sir Roger. I
welcome today’s important debate on what is undoubtedly an
evocative issue. As I am sure will be the case for many Members
present, I have been contacted by many of my constituents.
Both my parents died of cancer. My mother had a very short and
aggressive illness, and my father had to switch off her life
support machine. For my father it was rather more prolonged, but
he died peacefully, surrounded by his four daughters. He chose
when to die, and it was a natural death. It was very difficult to
witness, but the comfort comes from witnessing someone who died
in peace, surrounded by love.
There are many areas in need of thorough consideration when it
comes to potentially legalising assisted dying, and each person
suffering deserves heart-felt compassion, as do their families.
Given the great number of speakers in the debate, I will focus my
comments on one aspect that is at risk of being overlooked. As
has already been mentioned, there are now a number of countries,
territories and jurisdictions where assisted dying has been
legalised. Evidence from these places—particularly surrounding
the negative impact on doctors—is a legitimate cause for concern,
and such evidence suggests that the practice of assisted suicide
or assisted dying has a severe and detrimental impact on medical
professionals and the provision of palliative care more
generally, as has been highlighted.
Emotional, medical and practical problems faced by doctors have
grown in countries where legalisation is already in place, and
these issues should not be taken lightly. A review of the
official data by Living and Dying Well found that between 30% and
50% of clinicians describe an emotional burden or discomfort
resulting from participation in assisted dying, assisted suicide
or euthanasia, and that 15% to 20% experience a lasting adverse
psychological or emotional impact.
More specifically, turning to the example of Canada across the
pond, Living and Dying Well also found that clinicians reported
five specific issues surrounding legalisation, including that it
complicates the management of pre-existing symptoms; adversely
impacts the important doctor-patient relationship; causes tension
for families during what is often an already deeply challenging
period; diverts resources away from crucial palliative care
services; and confuses patients as to the nature and purpose of
palliative care. When considered as a whole, those issues
reported by practising clinicians in Canada are not something
that we as lawmakers can or should overlook, and I believe that
the highlighted impacts on palliative care provision are of
particular concern.
This discussion is no longer solely theoretical or philosophical.
The countries, territories and jurisdictions where assisted dying
or assisted suicide has already been made legal can be used as
real-world case studies of its impacts, and that which has
already been recorded by clinicians—for example, those in
Canada—should make us all pause for thought.
We all want to see the best support available for those people
who are nearing the end of their lives, as well as for their
families. Looking at the evidence that I have highlighted today,
I remain convinced, as many are, that palliative care and support
for people physically, mentally and spiritually—and it is the
latter that must not be overlooked—remains the most appropriate
and ethical approach.
5.46pm
(Glasgow Central)
(SNP)
It is a pleasure to see you in the Chair, Sir Roger. I thank all
Members who have spoken so far for their bravery. The hon. Member
for Sheffield Central () in particular was
incredibly brave, and I am sure that his father must be very
proud of him.
The petition has 185 signatories from the Glasgow Central
constituency. I have had 236 cases, both for and against, raised
with me as an MP since 2015, and that is despite this not being
an issue with which I would usually get involved, because it is a
matter for the Scottish Parliament. I am mindful of Liam
McArthur’s Bill in the Scottish Parliament, picking up from where
, and have previously led the
debate on assisted dying. As we have heard this afternoon, this
is an all-party/no-party issue. There are a range of views among
members of all of our parties, and I wish very well in his endeavours
in the Scottish Parliament.
I want to reflect on the views of a few constituents who have
been in touch with me, because their words really are more
powerful than anything I could say. Bryony got in touch with me
in remembrance of her mother, Jenny Randall:
“She was an extraordinary, brilliant woman, and a wonderful
mother”,
but she
“spent most of her final months in terrible pain, indignity and
discomfort”.
Bryony says that
“had assisted dying being legal in the UK, it would have provided
her with immense comfort in her final weeks, and might have
enabled her to draw her suffering to a gentle and humane close
sooner than was the case.”
Karris reflected the story of her father, who died of motor
neurone disease in 2016. She says:
“My dad was a proud man, an intelligent man and one of the
strongest people I know. He was sound of mind and heart and I
know, because he told me whilst he still could, that he did not
want to prolong his suffering. Or the suffering of his family,
who had to watch him live out his dying days unable to move or
communicate, with oxygen pumping into his mouth through a mask
that had he taken off, he would not have survived. In fact—I’m
fairly sure that had he been able to he would have ripped that
mask off himself. He would have made that choice, had he been
allowed, to pass peacefully before he reached those…end
stages.”
Lillian has experience of a family member wanting to die after
suffering from systemic heart failure. She also has experience as
a bereavement counsellor, which is an important perspective to
bring to this debate. She says that, as a bereavement counsellor
for many years, she has spoken to many people
“who struggle to deal with the end of life experiences of their
loved ones who have died in pain, feeling the loss of all dignity
and choice at the ending of their physical life.”
She says:
“Some of my counselling clients have been left suffering from
trauma with flashbacks having witnessed the horrendous and
prolonged suffering of a loved one, in some cases where the
sufferer has begged to die quickly.”
We need to think about the burden that that clearly puts on other
people—the people who carry on after their loved one has passed
away. We have a responsibility and a duty to them, too, in trying
to find a good death.
I want to mention the names of some of the people who got in
touch with me, because I want them to know that I have read all
of their emails and that they matter very deeply: Barbara, Lynne,
Andrea, Georgia, Lynn, Dave, Archie, Jo, Hugh, Naomi, Sian,
Elizabeth, Lucy, Jane, David, Mary, Simone, Wendy, Edward,
Gabriel, Charles, Ann Ellen and Brenda. They all have strong
views on assisted dying, and some of those views are very
different. They reflect the wider debate about how we get to a
place where everybody can be satisfied that the end people will
face will at least be fair, and one that they would choose for
themselves.
I will finish with the powerful words I received from Joyce.
“Assisted dying should be the right of every citizen facing a
terminal illness. Of course high quality end of life care should
also be the right of every citizen. However, it is foolish to
imagine that every dying person can be made comfortable. And even
if that were possible, all of us should have the option to end
our lives at the time of our own choosing.”
It should be a choice for all of us, not to impose what we
believe on other people, but to have a good death—a death that
will leave us with memories of the people we loved, rather than
memories of the suffering of their last dying days.
5.51pm
(New Forest West) (Con)
My father’s last six months were horrible and frightful. Yes, I
did want him to die more quickly, to end his suffering. However,
he did not. He wanted to come home. I would therefore not change
the law.
We have heard much about the polling, but the fact is there is
nothing new there. Ever since we started polling on this
question, there have been large majorities in favour of changing
the law, so there is nothing new in that phenomenon. However, a
poll is not an argument. The Association for Palliative Medicine
of Great Britain and Ireland believes that the polling is driven
by reports in our newspapers of the awful deaths that some people
experience, without giving proper consideration to the advances
in palliative care and the fact that many people with terminal
illnesses die a peaceful death with their family around them. It
is not as if that case is presented fairly and equally.
We have also been told that the medical profession is changing
its view, with the Royal College of Physicians changing its
position from being against assisted dying. I understand that in
a vote by its members, 43% voted to retain its opposition to the
proposals, 31% wanted to support assisted dying and only 25%
wanted to adopt a neutral position. The Royal College of
Physicians is now in the absurd position of having adopted the
position that was voted for by the fewest of its members.
We have also heard about the impact on palliative care.
Obviously, there is a difference of views. However, I have sat in
this Palace and heard clinicians from Canada tell us in terms
that palliative care budgets were being squeezed to provide for
the new service of assisted dying.
We have to be clear on both the implications for the medical
profession—the way the nature of the medical profession will
change when doctors can bring death as well as life—and the
scale, which my hon. Friend the Member for Worthing West ( ) touched on. My figures are
rather different from his. I understand that about 400 people a
year take their own lives in this country as a consequence of a
terminal diagnosis. I understand that if we were like Holland,
the figure for deaths assisted by the medical profession would be
21,000, taking account of the different size of population and
all the rest. As many as one in six deaths in Holland may be
accounted for by deaths assisted by the medical profession. Once
we normalise that as a way of death, I think we would definitely
dealing with dangers—
[Steve McCabe in the Chair]
Clearly, it would depend on how we drafted any legislation
brought forward, but my right hon. Friend mentioned 16%—in
Oregon, 0.7% of deaths are through assisted dying. It depends on
us.
I was speaking about the Dutch figures, not Oregon, but my hon.
Friend is right that it depends on us.
I last debated this issue at Durham University earlier this year
against . She wanted to confine the
debate clearly and specifically to the terms that she had set out
in her Bill, with all the provisions and the safeguards, such as
that it has to be within six months of the end of life prognosis
and all the rest. Unfortunately, she was rather undermined by the
seconder of her motion, who was a psychiatrist and, I understood,
represented an organisation called My Life, My Death, My Choice.
There was no question that this was a service that should be
available for us all at whatever stage of our lives. Once we open
the door and go down that road, it is a one-way street. We have
certainly seen that in the evidence from Canada.
Mr Mitchell
Will my right hon. Friend give way?
I have given way enough and my right hon. Friend has had his
say.
I accept entirely that people are put in a dreadful position if
they have a terminal diagnosis. They have the capacity to end
their lives but they want to live a bit longer and are worried
about the loss of that capacity to end their lives, putting their
friends and relatives in a difficult position. But it is a
mistake to believe that for every one of life’s horrible dilemmas
there is a lever that we can pull to make things better. My fear
is that we will make things so much worse for those elderly and
infirm people who will feel under pressure to do the “decent”
thing and not consume resources.
Several hon. Members rose—
(in the Chair)
To get everyone in, I will have to reduce the time limit to four
minutes. If there are interventions, not everyone will have a
chance to make a speech.
5.57pm
(Chesham and Amersham) (LD)
It is a pleasure to serve under your chairmanship, Mr McCabe, and
to hear such powerful contributions. In 2003, John Close, the
brother of my constituent Lesley, became the seventh Briton to
travel to the Dignitas clinic for help to die. Lesley is sitting
in the Public Gallery. Since she lost John, hundreds more have
taken the same journey to Dignitas that he did.
Sadly, the financial cost of such a trip means that many
terminally ill, mentally capable Britons who want that do not
have access to what Lesley described as the “gift” of medically
assisted dying. Too many of them take things into their own
hands, often in far more distressing ways, as we have heard. It
is clear that our country’s current blanket ban on assisted dying
is failing. That creates additional torment and suffering at an
already painful time for those who have decided to die, along
with their loved ones.
Many Members will be familiar with the case of another of my
constituents, Ann Whaley, and her husband Geoff. Some may have
even had the privilege of meeting Geoff when he visited the House
of Commons before his passing. Ann is also sitting in the
Gallery. In 2015, the police arrived on Ann and Geoff’s doorstep
to investigate an accusation of domestic abuse—something that
shocked them both, given they had shared a loving marriage for 52
years. Ann was put in a police car, driven to the station, locked
in an interview room and interviewed under caution.
Having never committed a crime in her life, Ann found herself the
subject of a criminal investigation for booking flights and
organising an appointment at Dignitas, according to Geoff’s
wishes: he had been unable to take those actions himself after
motor neurone disease had robbed him of the ability to operate
his iPad or hold a phone. Having already suffered so much as a
result of his illness, Geoff and his family faced further
suffering as a result of UK law—our law. It was Ann’s arrest that
prompted Geoff to come here to speak to parliamentarians and
explain his choice in his own words.
Ann was never prosecuted, but that did not mean that she did not
suffer. Director of Public Prosecutions guidelines give some
indication of when it is likely that someone will be prosecuted,
but that is not enough. While the law imposes a blanket ban,
there seems to be an acknowledgement that it will be broken, and
even encouragement to break it, as an untidy compromise. That is
not good enough. It did not stop Ann, Geoff and their family from
going through a horrendous ordeal with the police during the
final weeks of Geoff’s life.
Allowing assisted dying would permit terminally ill people to
leave this world in the way they have decided to, without the
additional pain of knowing that they risk criminalising their
loved ones for assisting them in the ultimate act of compassion
and love. Last week, Lesley told me that knowing he would have
some control over the end of his life was like a weight lifted
off her brother’s shoulders. In his open letter to MPs, Geoff
described it in the same way, yet for Ann and Geoff, that relief
was cruelly marred by anguish and uncertainty over the future
legal consequences for Ann. It is clear that our law on assisted
dying is broken, and we must be allowed to re-examine it.
6.01pm
(Telford) (Con)
It is a pleasure to serve under your chairmanship, Mr McCabe. I
am pleased that we have the opportunity to debate the issue of
assisted dying, and I am grateful to every single one of the
people who signed the petition—it is a healthy part of our
democracy. We need to recognise that public feeling on this issue
is strong, and people want us in Parliament to consider it. It
would be wrong to shut down debate or pack it up as too
difficult. We cannot ignore this issue, and we cannot simply look
away.
When terminally ill people have taken their cases before the
courts, as in the case of Shropshire resident Noel Conway, the
courts have repeatedly affirmed that assisted dying is a matter
for Parliament. We cannot shirk that responsibility. As we have
heard today, assisted dying is happening, whether that is the DPP
exercising discretion after the event, a compassionate doctor
giving a little more morphine than he perhaps should, or people
travelling to Dignitas. It is time for reform, and for legal
clarity on this vital issue.
As a member of the Health Committee, I very much hope that we
have the opportunity to hold an inquiry into the issue of
assisted dying. There must, in any event, be a full inquiry, and
I beg the Minister to listen to that plea and for legislative
time to be made available, because our role as legislators is to
find a solution to this—to allow the terminally ill the right to
determine the manner of their own death, as well as providing the
necessary safeguards for the vulnerable and, as many people have
said, improving palliative care for all those at the end of life.
It is not for Parliament to deny someone at the end of life the
option of a peaceful death. As parliamentarians, we all want to
improve the lives of our constituents, and as we have heard
today, the prospect of a good and peaceful death is something
that improves the lives of those facing a terminal illness. The
debate needs to be about giving people that option, even if most
terminally ill people never take it up. That peace of mind helps
them to face death.
I deeply respect the religious views of others on all subjects,
and it is their right to express their views and live them out.
However, in a liberal democracy, the religious views of some do
not restrict the rights and freedom of others, and so it is with
this issue. When we debated assisted dying in Parliament in 2015,
it was done with great respect for differing views, and it has
been disappointing to see that polarisation is creeping into this
debate. Instead of debating the arguments, we have seen attacks
on campaign groups and a determination to conflate the tragedy of
suicide with the right of the terminally ill to decide the manner
of their death. We must choose our words with care and have the
humility to understand that those who disagree with us are not
motivated by malign intent, or are somehow less virtuous.
I want to end with the voice of my constituent Sarah. She
said:
“My beloved husband Steve was diagnosed with motor neurone
disease in 2011. What a day that was. It was like a tsunami had
hit us. Steve was so brave—a true warrior—but MND is not a fight
that can be won. To watch the man I loved, the father to my three
children, lose every single scrap of dignity for so long was
completely heartbreaking. In truth I was never ready to say
goodbye to him, but watching him suffer in that way was so cruel.
Steve deserved the right to choose, the right to say when enough
is enough.”
Who are we to deny Steve and others like him that freedom and
that choice?
6.05pm
(Portsmouth South) (Lab)
I rise to speak on behalf of my constituent David Denison. Mr
Denison is a resident of Southsea and one of 264 people from my
constituency to have signed this important petition. Six months
ago, Mr Denison went to his GP with a persistent cough. Following
some tests, he was eventually diagnosed with an aggressive form
of pancreatic cancer. He has been given just six months to live.
He was offered a Whipple procedure, which involves removing some
of the pancreas, some of the small intestine, the gall bladder
and the bile duct. It is complex, invasive and would provide only
a very slight improvement to his overall prognosis. At 77, he
understandably does not want to endure that. Having discussed it
with his family, he will instead accept his prognosis and will
live out the rest of his life as comfortably as possible.
Of course, Mr Denison does not want to die, but he knows he is
dying and he wants control. He has made a practical assessment of
his options, but he knows that his decline will sadly be steep
between now and his passing. He will experience great pain,
nausea, anxiety, agitation and even confusion. He will also
likely experience urinary and bowel problems. There will be
little that his family or doctors can do but manage his pain.
Having discussed it with his partner and sons, Mr Denison is
clear that he would prefer to end his life on his own terms, yet
the law prohibits him from doing so. In fact, he explains that in
some cases people feel it is taboo to discuss the concept because
they do not want to upset their families or appear ungrateful for
the medical care they have been offered and are receiving.
I completely understand the sensitivity of this topic, but it is
a matter of conscience. With 300 dying people ending their own
lives every year, and almost half of people saying they would
break the law and risk prison to help a loved one, burying our
heads in the sand is no longer an option. Mr Denison would like
legislation to allow for assisted dying for terminally ill,
mentally competent adults like him. He has been working with the
charity Dignity in Dying to raise awareness and restore the
choice and control that ugly terminal diseases take from us. That
is something that the majority of adults and GPs now support.
I pay tribute to Mr Denison for his openness and frankness about
such a difficult issue. I wish him and his family the very best.
It is time for a national conversation about this sensitive
issue—one that respects the sanctity of life and, importantly,
the choices of those who are living it.
6.08pm
(Gainsborough) (Con)
Those who favour assisted dying will get their wish: there will
be a debate on the Floor of the House of Commons, and if there is
one more debate, there will be others. They will go on through
the years, and the majorities against assisted dying will get
smaller and smaller, because of course we are up against it.
Overwhelmingly, the economics are against us—[Interruption.] It
is about economics. We have a vast, ever-growing population of
people who are very frail and very elderly, who are a burden on
society and know it. Therefore, I predict that, sooner or later,
the House of Commons will debate this issue and, sadly, pass a
law as so many other countries have done.
This is not a debate about assisted dying. We all want to help
people to die peacefully and painlessly. It is a debate about
assisted suicide—helping people to kill themselves.
Will my right hon. Friend give way?
(in the Chair)
I would rather the right hon. Gentleman did not, actually.
My right hon. Friend says that this debate is about suicide, but
I wonder whether he has a family member, as I have, who took
their own life through suicide, and whether he understands the
difference between that and what we are talking about today?
I have not had a family member do that, but we have all
encountered friends and relatives who have been under intolerable
pressure. Hon. Members have cited examples, and I can do so
too.
I simply take a very pro-life point of view. It is not from my
religious conviction or my belief that everybody is beautiful and
wonderful, however small, however tiny in the womb, however old
or frail, how much of a burden they are, whether they are a
convicted murder or whether they are one of our military enemies.
I take a pro-life view, and I think so much of the misery in the
world in the last 100 years has been because people are casual
about taking life. Many of the arguments that we hear in favour
of assisted dying are based on very appalling, horrible and
extreme cases. They are similar arguments to what we heard when
we had the initial debates on abortion, with foetal abnormality,
rape and all the other things. Then we had abortion on demand,
and now we are going to get death on demand. That is what it is
all about. All the pressure, particularly on the frail and
vulnerable, will be about that.
I want to make a theological point. A friend of mine died in the
first months of covid. He died in agony. He died in a part of the
country where he was sent out of hospital because the medical
profession was panicking. He was not given adequate palliative
care and he died in agony. It was appalling. We are all agreed
that we are still not doing enough about palliative care. We have
to do much more. We have to tell everybody that they have the
right to go into a hospice—a right that so many people are not
given—and receive the full benefit of modern medical technology
to die peacefully and painlessly. For the overwhelming majority
of people, if they are given palliative care, it is an option
they can enjoy.
I actually watched another friend of mine die. He was my best
friend and former colleague in this House. He was dying of
terminal cancer; I was sitting beside him and I could see the
morphine pumping through his wrists. He died peacefully and
painlessly, but I have no doubt that it was the morphine that
killed him. Theologically, morally and legally, there is nothing
against a doctor helping me to die by pumping morphine into me,
even if that is the immediate cause of my death. [Interruption.]
I can see people shaking their heads, but I have actually seen it
happen. Is there anyone in this room who would blame a doctor who
helped someone to die if they were in agony? The doctor was not
trying to kill them—they were trying to ease the pain. And in
easing the pain by delivering that amount of morphine, that might
have hastened their demise.
Let us be realistic about it. Let us try to take a pro-life view,
and let us remember—
(in the Chair)
Order. I call .
6.12pm
(Bath) (LD)
I want to thank the tireless campaigners, especially Pauline
Carroll from our local Bath branch of Dignity in Dying, who has
taken me on a journey over the past five years. Due to her
courageous campaigning—she never let go—I gradually changed my
mind over this difficult and complex issue, and Pauline is in the
Public Gallery today.
The Government have amended the Health and Care Act 2022 so as to
fully fund palliative and hospice services in the future. That is
very welcome, but it is not enough. Our current law needs to
change. One approach should not exclude the other. It is
disappointing that no time was given to debate Baroness Meacher’s
Bill and that Conservative peers were whipped on 16 March to vote
against Lord Forsyth’s proposed assisted dying amendment to the
Health and Care Act. It is time to apply honesty and justice to
the debate. Constituents of mine have campaigned for years for a
safeguarded assisting dying law for mentally competent,
terminally ill adults with a six-month prognosis. I do not accept
that this is the thin end of a wedge.
Whatever might otherwise be heard, it is a fact that palliative
medicine and care has its limitations, even at its most
excellent. Figures from the Office of Health Economics in 2019
show that every year, 6,400 terminally ill patients in hospices
have horrendous deaths. One of my constituents wrote to me:
“I watched my mother being tortured to death with care, she was
in extreme pain and was given the maximum level of pain relief.
This only works for a time and between doses she was in
agony.”
Those who suggest that palliative care can manage pain are
ignoring what happens. In too many cases, pain cannot be
alleviated. We should not hide that truth.
It was disappointing to learn in 2021, in a piece of research on
end-of-life preferences by my local hospice, that assisted dying
was not to be included. The reason given was that it is not
legal. We cannot leave out the most pressing topic for
end-of-life preference. Some people wish for assisted dying.
Discounting it as a patient’s preference from the start is
ideologically blinded and suggests that blanket opposition to
assisted dying is supported by the hospice movement, for which I
otherwise have the greatest respect.
In a BMA survey, 4,500 doctors voted in support of assisted dying
legislation, whereby they could assist patients who can
voluntarily take life-ending prescriptions under very clear and
defined legislation. Recent evidence from a Royal College of
General Practitioners survey shows that opposition to such
legislation has fallen from 77% to 46%. Here in Parliament, we
are falling very far behind public and medical opinion. We
continue to force people to suffer a protracted death against
their wishes, to spend £10,000 to go to Dignitas at a rate of one
a week, or to add to the horrific new suicide statistics from the
ONS.
Some terminally ill people will not choose palliative care but
will opt for the choice of a safeguarded, doctor-assisted death,
and that should be their right. I have gone on a journey to
believing truly that prolonging an agonising life is not what I
should stand for, and I speak as a Christian. Instead, we should
allow for a compassionate death when that is what the dying
person wishes for.
6.16pm
(Darlington) (Con)
It is a pleasure to serve under your chairmanship, Mr McCabe, and
I congratulate the hon. Member for Gower () on leading today’s
debate and on her carefully considered speech. I also thank the
262 people of Darlington who signed this petition. In addition to
those signatories, I have also received correspondence from
constituents with views from both sides of this debate.
I am not in favour of assisted dying. At the age of 14, I
witnessed my own father die at home, suffering from cancer.
Although it would be simple to form the view that it would have
been “better” or “easier” for him to have been able to choose his
time of passing, it never once entered our family’s minds that
that should be done while medication could eliminate the pain he
was suffering.
As a high street solicitor handling the affairs of many clients
who were sick, infirm or suffering from terminal disease, I
regularly attended upon those who were contemplating the end of
their lives and often took instructions in a nursing home or at a
hospital bedside. This was a deeply personal and private role in
speaking to people about the most intimate of family matters.
This role also often allowed me observation of those closest to
them. Although the overwhelming majority of families I met in
such circumstances had their loved one’s comfort and wellbeing at
heart, I have seen the most rapacious of family members seeking
to manipulate. I fear that even with all the safeguards possible,
such individuals could exercise the most sinister of coercion
were we to permit assisted dying.
The death of my father could have led me to change my view about
assisted dying, but it actually cemented a firmly held belief in
the choice of the individual to die at home and of the importance
of the hospice movement in ensuring that such deaths are good
deaths. Hospice UK has estimated that since the beginning of the
pandemic, more than 100,000 people have died at home without
receiving the care and support they needed.
I declare my interest as a trustee of a hospice and as the
co-chairman of the APPG on hospice and end-of-life care. When
discussing matters relating to death, it is important that we
listen to those in the hospice sector and understand that one in
four people do not receive the appropriate palliative care.
With an ageing and growing population, we know that more people
will die at home. Hopefully, they will die in their own bed,
surrounded by their loved ones, just as we would all want.
However, in order to ensure that such good deaths happen, as a
society we must commit to ensuring that our hospice sector is
properly funded and resourced.
The Government rightly provided massive support to our hospices
during covid. I see my right hon. Friend the Member for West
Suffolk () here, and I thank him for his
engagement and the support he provided to our hospice movement
during covid. I believe that now is the time to ensure that the
postcode lottery of hospice and palliative care is ended, with a
long-term plan to support our hospices.
I fear that if assisted dying is legalised, terminally ill people
may feel pressured into ending their lives. I do not believe that
we should place anyone in that position. Such a change in the law
would have a profound impact on the relationship of terminally
ill patients with their doctors. While I have every sympathy with
those who, for the best of intentions, seek this change, I do not
support a change in the law.
6.20pm
(Luton South) (Lab)
It is a privilege to serve under your chairmanship, Mr McCabe. I
thank my hon. Friend the Member for Gower () for leading this debate
and for the emotion she put into her speech.
The blanket ban on assisted dying has resulted in unacceptable
failings in patient safety. As we have heard, dying people are
forced to matters into their own hands without sufficient
protection or support for them, their families or the clinicians
who care for them. Through the APPG on choice at the end of life,
of which I am a member, I have heard from families who have seen
family members have a difficult and undignified death not of
their choosing. As a humanist, I believe that people are
fundamentally good, so I struggle to accept some of the
caricatures of people being cynical with their loved ones at the
end of life.
Assisted dying reform is a matter of freedom of choice at the end
of life. Assisted dying laws can be introduced with robust
safeguards. The current system is broken. Research from the
Assisted Dying Coalition found that more than one person per week
is forced to end their life abroad. This demonstrates an inbuilt
inequality in the current system, as only those who can afford
the high costs are able to go abroad to do so. If someone is
rich, they have a small amount of choice, but if someone is poor
and of limited means, they have no choice.
Looking at examples of legislation abroad, we see that all six
states in Australia have legalised assisted dying, joining an
ever-expanding list of states in the USA, New Zealand, Canada and
many countries in Europe that give their dying citizens choice. I
want to make one thing very clear: there is no credible evidence
from jurisdictions that have legalised assisted dying that
vulnerable people will be pressured to end their life.
As has been said, this debate is not about choosing between
assisted dying and palliative care. International evidence shows
that assisted dying does not harm access to palliative care. A
report by Palliative Care Australia concluded that there is no
evidence to suggest that the palliative care sectors were
adversely impacted by the introduction of the legislation. If
anything, in jurisdictions where assisted dying is available, the
palliative care sector has further advanced. Evidence shows that
the current law is not only cruel but dangerous, as there is
little oversight of death by suicide linked to terminal illness
or Dignitas deaths, and no formal monitoring. We need
transparency and upfront safeguards in legislation, not a
continuation of lonely, secretive deaths, with oversight
occurring only afterwards.
We have heard how medical opinion supports assisted dying. The
British Medical Association decided in 2021 to end its opposition
to assisted dying, following a survey of its members. The BMA
survey found that half of all doctors personally support
legalising a right to die for those who are incurably suffering
or are terminally ill.
Thanks to increasing public awareness, the public mood is
changing. The petition to legalise assisted dying for terminally
ill and mentally competent adults gained more than 100,000
signatures, 120 or so from constituents in Luton South. Public
support for assisted dying is unwavering, regardless of age,
class, gender or political persuasion.
Whether through an inquiry, a commitment to parliamentary time
from Government, or the Government simply recognising that the
current law in England and Wales fails dying people and their
families, the UK needs to explore whether current laws are fit
for purpose. The public need action from the Government and from
us, their representatives. It is my opinion that the status quo
is failing the public. This is not about either/or. It is about
different pathways at the end of life and the right to have a
choice.
6.24pm
(Aberconwy) (Con)
It is a pleasure to serve under you, Mr McCabe. I have been
contacted by many constituents eager for me to engage on this
matter, but I make my contribution also as someone who has
experienced the loss of a loved one through suicide and as
someone who has witnessed at first hand his mother wrestle with a
chronic degenerative disease, Parkinson’s, which ultimately
claimed her life.
It seems to me that already in this debate clear positions are
emerging. A summary, which I offer humbly for colleagues to
consider, is the saying, “We shape the law and the law shapes
us”, because on one side I hear arguments for the former, and on
the other for the latter. On one side, I hear story after moving
story of suffering—not least from the hon. Member for Gower
(), whom I thank for
introducing the debate—and on the other, I hear concern for the
impact that these laws would have on others.
I want to start by just thinking briefly about the importance of
language, because today’s debate is looking at the e-petition
relating to “assisted dying”, but that is an undefined term,
without clear meaning. It does have the attraction of a blank
canvas, in that we can ascribe to it whatever meaning we may
desire, but it should also give us cause for caution. The
proactive ending of one’s own life, by consent or otherwise, in
law is suicide—in this case, presumably, by the
self-administration of lethal drugs. The House of Commons
Library’s own briefing note adopts the term “assisted suicide” in
order to reflect the law. Therefore, another title for this
debate, which would reflect where we actually start from, might
have been, “Debate on e-petition relating to assisted suicide”. I
think that this is an important place to start—not to cause
offence or distress and not for any obstacle that it may present,
but simply because it is where we are. We cannot start in some
place yet to be defined, where some may wish us to be one
day.
There are many terminally ill people—those without name and
number, as my hon. Friend the Member for Devizes () said—who want to live and
who need to know that society wants them to live. They want and
need to feel valued. They need to feel safe. A move towards an
assisted suicide society risks introducing an obligation on an
individual who is terminally ill to seek or consider an assisted
death through lethal drugs, and suggests that it may even be
their moral duty to do so. We cannot simply dismiss that
unintended consequence. Assisted suicide legislation has the
potential to create exactly that powerful counter-narrative of a
duty to society or family and loved ones to remove the
inconvenience, the burden and the cost. That is not a message I
believe we should send or have bound into the fabric of our
society through law; nor is it a duty that should bind those in
the caring profession, which is driven by the preservation of
life.
I say to my right hon. Friend the Member for West Suffolk () that the 2020 survey of BMA
members that he referred to showed in fact that the majority of
those licensed to practise and closest to terminally ill and
dying patients—those in palliative care, geriatric medicine and
oncology, and GPs—do not support legalisation. As it stands, the
best that can be argued is that the BMA’s position is one of
neutrality.
It is worth mentioning, in the context of other countries —for
example, Belgium and the Netherlands have been mentioned—that
there was in fact no growth in services per 100,000 of population
in Holland from 2012 to 2019. That must be a concern for all. It
is also important to note the context, and the context must
include reference to the fact that Holland has approved
plans—
(in the Chair)
Order. I call . [Interruption.] Sorry, I
mean . My sincere apologies—I
will get these glasses fixed. I call Christine Jardine—my
apologies.
6.29pm
(Edinburgh West) (LD)
Accepted, Mr McCabe. It is an honour to serve under your
chairmanship—although Joanna may have something else to say about
it.
In today’s debate, one thing has jumped out at me: the remark
from the right hon. Member for West Suffolk (), who said: “What would you
do?” The truth of the matter is that I do not know what I would
do in this situation. I know that I do not know what I would do
because I have sat with relatives—I sat with my mother, who
struggled to breathe but struggled to keep going. I do not know
what, in that situation, she would have wanted, because she did
not have the choice. That is where I think the crux of this
argument is. This is not about what any of us want or might want,
or the kind of death that we would like. It is about allowing
that choice for other people—allowing them to have a say over
their final hours or days. That is the message in the petition,
which 273 of my constituents have signed, and many more have
written to me. They want Parliament to take the time to listen,
debate and lead a national discussion on a topic that affects us
all. In Scotland, my colleague is bringing a Bill to
Parliament there. As has been mentioned, it is not the first time
the issue has come to the Scottish Parliament. I hope he will be
successful—not because I want everyone to choose an assisted
death, but because I want everyone to have the choice.
It is not an either/or on palliative care. We need better
palliative care as well. People should be able to choose between
better palliative care or an assisted death. We have seen across
the world what has happened. There is no rush to change. There
are 11 states in the United States where terminally ill patients
have the right to choose. I am not aware that any of the six
Australian states or any parts of Canada, New Zealand and
Spain—other countries that have taken this difficult
choice—saying publicly that they regret it. I may be wrong, but I
am not aware of any great movement to reverse the decision.
On the point of elderly people feeling pressured to accept an
assisted death for the sake of their family, life is precious and
I believe it is at its most precious when we know we are about to
lose it. The thought that anyone would say, “Well, I have to do
this because my family wants it” is astonishing. I do not believe
for a minute that that is what this debate is about. It is about
those people who are faced with death being able to choose. I
know that I would like to die at the point where I am still able
to walk along the beach with the dog and enjoy a laugh with my
friends and family—to end my days with a smile on my face and
know they will have happy memories of my last few moments. I also
know that as the law stands, I will never have that choice. I
will never be able to have the death that I choose, and that is
why this is the moment where we need to find compassion and
listen to what the public want.
6.32pm
(Hartlepool) (Con)
It is a pleasure to serve under your chairmanship, Mr McCabe. I
have heard from lots of sides and have walked a tightrope on this
issue for quite a long time. One thing I would like to say is
that in this country, there is a choice—a right to die—for some
people: those who decide to have treatment withdrawn, but they
die horribly. They suffocate, starve or die of dehydration, but
doctors are allowed to withdraw that care, so they are allowed
passively to intervene. Is it such a great step to allow people
in that position to have drugs—modern medicine—that allow them to
slip away?
We have heard my hon. Friend the Member for Darlington () talk about coercive abuse
from relatives. That could already exist because of DNR. How many
times are relatives sitting round hospital beds deciding whether
to put a DNR order on their relative? It does not stop us having
it because it is the right thing to do. People have a choice to
say, “If I go, don’t bring me back.” Even if modern medicine
could bring them back and extend their life for many weeks, we do
not do that to them. All we have heard in this room today is the
need for more debate. We need to talk about this issue properly
and have a proper vote. We need to ensure that if someone has a
right to life, they should have the right to a dignified
life.
6.34pm
(Swansea West)
(Lab/Co-op)
Mr McCabe, you and many of the Members in this room will know
. We are debating today whether
to have a debate, and there was a debate in the House of Lords on
22 October, at which spoke for , who could not be there because
he is in a hospice. In that debate, he said:
“I changed my mind on assisted dying when an MP friend was dying
of cancer and wanted to die early before the full horror effects
set in, but was denied this opportunity.”
People we all know are changing their mind in the light of real
circumstance. went on to say:
“It is thought…that people will be pressurised into ending their
lives. The number of assisted deaths in the US and Australia
remains very low—under 1%—and a former Supreme Court judge in
Victoria has concluded about pressure from relatives that ‘it
just hasn’t been an issue’.”—[Official Report, House of Lords, 22
October 2021; Vol. 815, c. 394-395.]
So there are legitimate fears, but they have not been borne out
empirically.
A senior consultant surgeon who has served in Swansea for 30
years wrote to me and said:
“I know that terminal care services here are inadequate”,
which is of course something we need to change. The surgeon went
on to say:
“Even in the best areas, several conditions cannot be
successfully managed. In all other areas of healthcare, the
patient’s wishes are paramount. So it should be here. The new
proposals are modest and in line with current national survey
reports. Think for a moment of what your personal view might be
if you were diagnosed with a condition like motor neurone
disease.”
The question is whether the state should be allowed to force
people into a condition of escalating physical and mental trauma,
and of debilitation and pain, as with motor neurone disease.
Should it have that right? I do not think the state should have
that right because it is worried about the slippery-slope effect,
which has not been borne out empirically in Australia and the
United States.
Palliative care must be an option and we need to invest more in
it. People may have palliative care and then turn to assisted
suicide in a planned way—if they have the money to do so—without
being forced by the current system to die prematurely. The truth
is that people should not be forced against their will, and
against the will of the families who look on in sadness and who
want to move forward in the light of what is being said, into
growing trauma and indignity. At the minimum, we need to have a
proper debate on this issue. My position is clear: there should
be safeguards, constraints and adequate palliative care but,
ultimately, if somebody is dying in an appalling, debilitating
and chronic way that cannot be reversed and if we can avoid that,
we have a duty to do so.
6.37pm
(St Ives) (Con)
I thank the hon. Member for Gower () for opening the debate
in the way that she did. I understand how difficult this issue
is, and I ought to say that I am a member of the APPG for dying
well and that I chair the APPG on brain tumours, although I speak
for myself this afternoon. I have sat at the bedside of people as
they have neared the end of their lives, and I have met many
constituents who mourn the loss of loved ones and who are
distressed by the manner in which they died. I am really grateful
to all those who have taken time to speak to me.
My own personal story is that my mum and dad travelled up to
London to watch a parliamentary debate—I think it was in 2016—on
assisted dying. At that time, my mum had been given a terminal
diagnosis. She lived on after the debate, and my parents were
absolutely opposed to assisted dying at the time. She suffered
quite horribly at times, and she had fantastic support from the
hospice to help her. My dad went through all of that journey,
sometimes providing all the care she needed, but at no time—even
since my mum passed away—has he changed his view about this
issue, and I agree with him.
We must do something to change the status quo, but if the answer
is to introduce assisted dying, as the petition proposes, it is
my belief that this would mean the Government and the NHS
admitting failure in the way we care for, support and treat
people at the end of their life. The tragedy that this debate has
highlighted once again is that, despite making tremendous efforts
and improvements in end-of-life care, we have consistently failed
to provide the best and most appropriate end-of-life care at the
right time and in the right place.
Today my constituents do not have the right or opportunity to
choose the best palliative care, because it just is not available
to them. The sad truth is that much of the suffering that has
been described this afternoon could have been managed and
eased—much of it, not all—with higher standards of end-of-life
care. That must be much further up the agenda. The workforce
challenge in health and social care must be addressed and
advances in pain control must be available to everyone who needs
it. On that, I believe there is a consensus in this room.
I fully accept that if excellent palliative were readily
available, it would not bring an end to suffering for everyone. I
suspect that many of those who signed the petition we are
considering today would have had a very different experience in
the loss of their loved ones had the palliative care that we have
all described been available. I suspect that many signed the
petition because they lack confidence in the current availability
and quality of end-of-life care.
We have made significant improvements in the way we care for
those at the end of their life. I have seen the tremendous care
and expertise of those in the hospice movement, and of the care
staff and others such as community nurses and organisations such
as Macmillan. However, despite that knowledge, we do not make
palliative care available wherever and whenever it is needed.
Even today there will be people—patients—in need of palliative
care in an acute hospital setting, rather than at home or in a
hospice. It is right that we have a grown-up conversation about
death, not least because we plan end-of-life care far too late in
many cases, which means that care treatment and support is not
available and not in place when it is needed. I support the call
for a proper parliamentary debate in the Chamber, but in the
meantime the Government must get on and improve the palliative
care available for all.
6.42pm
(Kirkcaldy and Cowdenbeath)
(Alba)
I thank my 267 constituents who reached out to me and signed the
petition, and also the many other constituents who contacted me
with other views. The hon. Member for Glasgow Central () mentioned that assisted
dying is a devolved matter, but I hope to be able to represent my
constituents who have taken an interest in this debate, which is
why I agreed to speak. I also want to pay tribute to , who was very much the face
of this debate in Scotland for many years, and I congratulate the
hon. Member for Gower () on her sensitive
introduction.
This is a deeply personal situation for me. It is something that
I have been immersed in in my professional career. I have been
present at many, many deaths, and each of them has been unique
and different and personal. Some of them have been very peaceful,
some have been different or less successful, and some have been
very distressing. To answer the point that the right hon. Member
for Gainsborough ( ) made about being pro-life, I
say that being pro-life does not necessarily help us avoid the
ultimate endeavour of death. We cannot sidestep death.
The most distressing case that I can recollect was someone who
was very pro-life—a young man of 19 who did not want to die. His
lungs were full of disease and he pleaded with me to find a way
to help him breathe so that he could continue to live. Having a
good death is not always possible, but I add my voice to the
concerns around palliative care and funding. If we want to
provide an effective and efficient service, supporting good
quality palliative care is essential.
I want to pick up on other points, particularly around capacity
and the presence of coercion, which can exist in many different
ways. It is not just family members who want to get their hands
on the assets of parents, although that is a realistic fact,
unfortunately; it is also the coercive effect of pain. Pain can
push people to make decisions that they otherwise would not make,
and if they are not getting good-quality palliative care, they
might not have had access to the correct pain pathway to manage
their symptoms.
On a purely personal level, this is a conversation that we have
had in my household. I am steadfastly ambivalent about the issue,
despite all my experience, because I listen to points made on
both sides of the argument and think, “Yeah, great point—great
point.” To me, that illustrates the need for a mature and honest
discussion, and a deep consideration of the many challenges that
exist in this debate. That is not about being on one side or the
other; this is a complex, deeply difficult issue. We must address
every single point that has been raised, including
safeguarding—which is a real concern of mine and something that I
feel very strongly about—and not just through this lens, but
through the lens of the rights of women and girls. If we want to
deliver something whereby choice is available, we must be clear
whose choice it is.
6.46pm
(South West Bedfordshire)
(Con)
I, too, have had many emails from my constituents, all of which I
have read carefully. I fully respect the strong feelings on both
sides of this issue, and this has been a respectful debate today
in the main.
One of my constituents, an ex-police officer, writes:
“I have an elderly mother who sometimes worries about being a
burden and once said it would be better if she died and I didn’t
have to look after her…As an ex-police officer I have dealt with
people who have been manipulated into doing completely awful
things…I do not think you can legislate against the very real
possibility of some people being manipulated into that death is
their only option.”
She is not alone in that view. I understand from polling that
twice as many people feel concerned about people being pressured
to end their own life so as not to be a burden as are not
concerned about it.
I do not think, amazingly, that we have had reference so far in
today’s debate to the fact that under the Health and Care Act
2022, for the first time ever, palliative care will be a core
service in the NHS. We have only just done that, and everyone
here welcomes it, whatever their view. We should perhaps just
give that a little time to bed in and see what it actually
means.
My experience is that my dear mother-in-law died at the end of
March. I was very close to her, and I thought the provision of
morphine was slow and it was difficult to get hold of. I drove to
a number of GPs at weekends to get the paperwork signed for her.
We always seemed to be chasing the tail a little bit. If we could
have been ahead of the curve and got it more easily—perhaps some
people do not have families that are as engaged to help them—that
would have been better. Perhaps that is something we can do that
we would all be supportive of.
Our hospices do an amazing job. We have Keech Cottage Hospice,
which the hon. Member for Luton South () will also have supported,
and my children have volunteered at local hospices. Hospices are
struggling and we need to support them properly, as they do
absolutely amazing work. I do not think there is anyone here who
would disagree with Dame Cicely Saunders, who really founded the
modern hospice movement and said:
“You matter because you are you, and you matter to the end of
your life. We will do all we can not only to help you die
peacefully, but also to live until you die.”
I think probably all of us could unite around that quotation.
I worry about disabled people. My mother was in a wheelchair her
whole life, and I understand their vulnerabilities. Baroness
Campbell in the other place has said:
“I am fearful that any change to the current law prohibiting
assisted suicide may adversely affect how I, other disabled
friends and the wider community of disabled people are treated in
the future”.
Whatever our views on this, we need to respect the very real
worries of disabled people, who think somehow that they will
matter less.
I will provide a few facts on the CPS. I understand the horror of
being prosecuted. I do not minimise that at all, but I looked at
the figures on the CPS website this morning. Of the 174 cases
between April 2009 and this year, 150 were not proceeded with, 33
were withdrawn, four were successfully prosecuted and eight were
referred for prosecution for homicide or another serious crime. I
do not know the details of the last eight, but it might be worth
looking at that further with the CPS.
I want to make two brief final points. We have not talked a lot
about mental health today, but there is no health without mental
health. Are we going to get a psychiatrist to certify whether
people are medically competent to do this? That is a pretty awful
job to ask a psychiatrist to do, as was raised with me at the
weekend, so we need to think about the pressures we are putting
on clinicians. However, there is probably some progress we could
make that we would all agree on.
6.50pm
(Brentford and Isleworth)
(Lab)
It is a pleasure to serve under your chairmanship, Mr McCabe. I
support a change in the law—a change that will impact only a few
of those who are terminally ill. It is not normalising assisted
dying: it is giving choice and some element of control to those
of sound mind. Many terminally ill people will not make that
choice, but I and 200 of my constituents who signed the petition
support a law change with a full set of safeguards. On the issue
of palliative care or assisted dying, a useful statistic is that
86% of people in California and 82% of people in Victoria who had
assisted deaths—two jurisdictions that have changed their
law—were already enrolled in hospice and palliative care.
As many speakers have said, some people with terminal illnesses
across the UK are currently being forced to make awful decisions
about the end of their life—decisions that also have an impact on
their loved ones. Some people may think our current, outdated
laws stop those appalling issues from arising, but they do not.
People with funds are forced to travel to Switzerland, often
before they would need to if they did not have to travel. Those
people often travel alone, as they risk their loved ones being
arrested. My hon. Friend the Member for Sheffield Central () described how too many
people are not only making the choice to die alone, but have to
plan their death alone, in secret. His speech brought home to me
the fact that those people and their loved ones could not say
goodbye to each other. The ban on assisted dying is causing those
traumas. This is an issue of personal choice, and we as
legislators must ensure that the law reflects the need for that
choice.
To provide some history about legislation, the ban on abortions
until the 1960s did not stop abortions; it simply banned safe
abortions. That ban sent women to the trusted aunt, the
neighbour, or the doctor running a backstreet clinic—too often in
unsafe and dangerous conditions, too often while terrified or
alone. Similar feelings have been expressed today. We cannot
prevent assisted dying from happening, but we can condemn
decisions and actions to take place in darkness, alone; to
involve journeys abroad while in pain; or to risk criminalising
loving family members or friends. We place those issues out of
mind and pretend they do not happen here, but they do.
Only by reforming the law and introducing safeguards to address
the concerns that hon. Members have raised can we address this
situation, which is about personal freedom and morality. Only by
doing so can we step out of the darkness, and only Parliament can
make that change. The significant majority of British people
support a change in the law on assisted dying. Our history of law
change on issues of personal conscience or moral issues shows
that Parliament is too often behind the curve of public opinion.
The laws on divorce, on blasphemy and obscenity, and on
homosexuality and same-sex marriage are just some of the examples
that occur to me. We are beholden to the people to respond to
that change in public opinion, and change the law to give people
who are terminally ill a choice about whether they end their
life—if they want that choice—and control over when, where and
how they do so. Seven years ago, I voted to change that law. I
hope we get another opportunity to do so before too long, but
after thorough consideration, including that of the Health and
Social Care Committee.
6.54pm
(Sevenoaks) (Con)
It is a pleasure to serve under your chairmanship, Mr McCabe. I
thank the hon. Member for Gower () for introducing today’s
debate on this most difficult of topics. Both sides of the debate
have been informed, compassionate and courageous.
With the permission of her friends and fellow campaigners, I want
to share the story of my constituent, Dawn Voice-Cooper, who died
in November last year after travelling to Switzerland. She came
to see me in a surgery before she died, and it was one of those
surgeries, which all Members in this room will have had, that
will stay with me forever. Dawn suffered from a long-term,
degenerative and incurable medical condition. By her mid-30s it
was affecting all her joints, including her neck and spine. After
several years of anti-inflammatory medication, she was left
suffering with internal damage as well as battling with balance
problems.
Over the years, Dawn’s quality of life steadily declined. She
told me of the increasing pain that she was under and the
challenges she faced with reduced mobility. She was losing the
feeling in, and the use of, her left arm. Due to increased brain
haemorrhaging, she was finding it increasingly difficult to find
the words when writing and speaking. She lost her autonomy and
she was worried about her ability to manage areas of her life.
She worried about what the future held: loss of independence,
more pain, less mobility, and worsening health. Due to that
outlook, Dawn decided that when the time was right, she wanted to
end her life with dignity at a centre in Switzerland. Sadly, in
November last year, that day arrived.
As with other cases we have heard about, that day was earlier
than would have been the case otherwise because Dawn knew that
she needed to have full competence in order to travel. Having
saved the money, she travelled to lifecircle clinic with friends
and fellow campaigners. She spent her final moments listening to
her favourite music and enjoying a glass of champagne. Her bed
had been positioned in front of the window so she could look out
at the trees.
Let us be clear: Dawn had that choice because she had money.
Other people do not. I am immensely proud that the UK is a fair
and compassionate society, but we must now uphold those values.
As overseas evidence continues to grow, our own reasons not to
legislate in some form are becoming less and less convincing. To
use Dawn’s own words,
“There is no escaping death. And as things are in the UK at the
moment; there is no escaping pain, lack of dignity and total
deterioration in life.”
We have heard many moving stories today. I encourage the Minister
to take forward some of this work, because there may be some
areas that all of us can agree on. We need an informed conclusion
on this issue. We need to debate it. It is time.
6.57pm
(Newcastle-under-Lyme)
(Con)
It is a pleasure to serve under your chairmanship, Mr McCabe. It
is a pleasure to follow my hon. Friend the Member for Sevenoaks
() and to speak in the debate.
The opening speech from the hon. Member for Gower () was extremely sensitive.
I speak not on behalf of the all-party parliamentary humanist
group, of which I am a secretary—I draw the House’s attention to
that—although I note that its position is not only to support
this motion, but to extend assisted dying legislation to those
who are incurably and intolerably suffering. I put that out there
for further discussion, perhaps at a later date. I also speak,
not on behalf of the 189 of my constituents who signed the
petition, but in sympathy with them, and I have also had many
people write to me from the other side.
I spoke in the debate on 23 January 2020, which was secured by
the hon. Member for Edinburgh West (), in one of my first
contributions in this place. I still support a Government-backed
inquiry, but perhaps we need to be moving a bit quicker, because
it was two and a half years ago when we had that debate. This
House should always proceed carefully, but we should also be
careful not to get too far away from the public.
In time, I believe a change in the law along the lines as the one
proposed in this debate will come to be seen as natural as
previous changes of law on other moral topics, whether it is
universal suffrage, gay sex or equal marriage. Those things are
now things we accept and take for granted in this place and this
country; in due course we will come to think of assisted dying in
the same way. There will be some who are never reconciled to it,
but I believe that is where the country is headed. I note, as I
did in that debate two and half years ago, that the existing law
is profoundly unsatisfactory for those dying, their families, the
police and the Director of Public Prosecutions alike.
This is fundamentally about bodily autonomy, and about the pain
and suffering that my hon. Friend the Member for Hartlepool
()—who was not even here two
and a half years ago—drew to our attention. It is not as rare as
people think. It is not unique. We hear about those cases because
people are brave and they talk about them, but there are lots of
people who have painful and unpleasant deaths. There is still an
omertà about death in this country. The more we talk about it,
the more we will open up and move forward as a society. The
reality is that our constituents are having to go abroad. There
is more than one person per week going to Switzerland, often
without their relatives, for the reasons we have heard. There is
an inequity there based on the cost of going to Switzerland—not
everybody can go—and it is earlier than they would like. We need
to move forward urgently on this, in line with the shifts in
professional medical opinion that we have also heard about.
Turning to arguments about faith, which we have not heard too
explicitly today, I do respect the sincerity of people who make
faith-based arguments here. However, many of us do not have
faith. Increasingly, that is the case for many of our
constituents. We can see that in the census. Many people who do
have faith, such as the hon. Member for Bath (), do not necessarily feel the
same way.
As I say, do as you wish by yourself and your God, and vote
accordingly, but recognise that those of us in the opposite
position are motivated also by the deepest humanity and love. I
heard that point most profoundly from the hon. Member for
Sheffield Central (). I heard his speech three
years ago, before I was a Member in this place. It is still
clearly as painful an issue for him today as it was then. That
goes to show that we can do so much good by addressing it.
Finally, people going through this issue now do not have the
luxury of time. We have taken too much time already. The public
interest in this topic in both senses of the word is clearly
obvious. The interest in this House is obvious. It is time to
look at what more we can do. We must dedicate time in the House
to actually debating what a new law could and would do, and at
some point—very soon—we should have a vote on it.
7.00pm
(Boston and Skegness)
(Con)
In my family, there is a history of cancer, heart attacks,
multiple sclerosis, strokes and a whole host other genetic
nasties that I would prefer not to dwell on. It makes a terminal
diagnosis a pretty good bet. There is one thing I do not
understand: if I were to get ahead of myself now, I could plan
the good death that I might want, but this House tells me I
cannot wait until the terminal diagnosis to do what I would hope
is the right thing. It tells me that I must not do that. I ask
myself, who do we think we are to make that personal choice a
matter for Parliament? I do not want to make assisted dying
compulsory, but I do want to make it a choice. So I ask: who do
we think we are?
When I voted seven years ago for assisted dying, I thought of my
own mother dying of cancer in the brilliant North London Hospice.
Without picking a fight, let me tell you that I have never been
more in favour of female bodily autonomy than I was when watching
what she was going through. This is about autonomy. I hope I can
try to address some of the arguments that have been made.
We have heard that doctors will think about the cash in the
health service when they look at these choices. I humbly suggest
that the GMC would have something to say about that. I would also
say that we should not patronise doctors. I am married to one; it
ends badly. Doctors already routinely and regularly assess
coercion. They look at what is going on in the background of a
patient’s life. They look at what the right thing to do is, and
under the piece of legislation we are being asked to think about
today, they would only be doing so in cases of a terminal
diagnosis with six months to live. Let us not get ahead of
ourselves.
The British Medical Association has moved to a position of
neutrality. There is a clear majority of the Royal College of
Physicians that has moved to a position of neutrality. The Royal
College of Nursing and the Royal College of Psychiatrists is
neutral on this. There is a clear majority and a clear direction
of travel. We should acknowledge that and have a debate on that
issue. I very much welcome the news—it seems to be increasingly
obvious—that the Health and Social Care Committee will be looking
at this issue, and I strongly urge the Minister to work as
closely as he can with the Committee and provide it with as much
information as possible.
Finally, we have heard a lot of arguments today about standing on
a slippery slope, and we do stand on a slippery slope. It is our
job in this place to stand on slippery slopes. It is our job to
look at what the right difficult position to take is. I say
simply to the Minister: right now we are standing in the wrong
place on a very tough slippery slope. We know from the polling
that we have a duty to our constituents to look at this, and I
hope he and the Government will facilitate that as rapidly as
they possibly can.
7.04pm
(Thirsk and Malton)
(Con)
That was a very good speech. I thank the hon. Member for Gower
() for securing this
debate. I thought that her speech was excellent; it was
incredibly touching and very sensitive. It was a perfect opening
on this very difficult subject.
Of the public, 74% want their Member of Parliament to vote for a
law on assisted dying. I did that in 2015 and I would do it
again, given the chance, today. By a remarkable quirk of fate, in
that vote in 2015, 74% of Members of Parliament voted against
bringing in a law on assisted dying, which I think is entirely
unsustainable. It is not holding back the tide; it is holding
back a tidal wave of support for this.
We have heard so many times in recent years that we must trust
the public. I absolutely agree with that, and I trust the 350
people in my constituency of Thirsk and Malton who wanted this
debate. I do not agree with my right hon. Friend the Member for
Gainsborough ( ) on this. I agree with him on
many topics—he is a man of great common sense, normally—but this
is not about economics. This is about the people and what the
people want. I say to the very well-behaved members of the public
in the Gallery that I guess that the percentage who want assisted
dying is much, much higher, because this is such a sensitive
subject.
Will my hon. Friend allow me to intervene?
I will look to the Chair—who says no; I apologise. We will talk
about it afterwards.
As has been said any number of times this afternoon, this is
about choice. Of course, all of us in this country are so lucky
to have this free society we live in. This is about freedom of
choice, but it is not about freedom of choice over anything; it
is about freedom of choice about the thing we fear most in life:
death.
I would say today that I do not actually fear death; I might
think differently in a few years’ time—that point in time is
getting closer—but I will tell you what I fear, Mr McCabe. I fear
a painful death. I absolutely fear a painful death. I may have
options. Some of us are lucky enough that we could plan ahead and
say, “Well, we’ll make that trip to Zurich”, or we might take the
terrible path that the father of the hon. Member for Sheffield
Central () had to take. People have a
choice, of course, to do what they think is right and not to take
that option, but instead to take the natural path. However, I
think it is wrong to remove from people the choice, a choice that
other countries and other places allow and that we can choose to
have, as well—the ones who are lucky enough to have that
choice.
There is one thing that we have probably not discussed in this
debate. It is not just about the fear of dying; it is about the
fear of what might happen. There is a quote from Dr Sandy Briden,
who died of a form of cancer that is rare in the UK:
“Knowing I had the option of an assisted death when things get
too much would allow me to live now, without the constant fear of
what might happen at the end. For me, assisted dying isn’t about
dying; it’s about living.”
It is about living that last time we have, knowing we have the
choice—away from that anxiety, which must be terrible for people
nearing these situations—and it is certainly something that I
would have wished for my mother when she passed away at the end
of 2019. The palliative care was there, but still it was, for all
those around her, a traumatic experience.
I do not get the slippery-slope argument. We have seen that in
Oregon, which has not changed its law in 25 years, a very low
percentage of people—0.7%—take this path of death through
assisted dying.
However, I understand that there are really cogent arguments as
to why we would not have this law, which is why I support an
inquiry. I just do not see what the argument against an inquiry
is. We could look at best practice around the world and decide
what is best practice for the United Kingdom.
(in the Chair)
We have got 31 speakers into this debate. We have had to squeeze
the Front Benchers a little bit to do that, so if they could
confine themselves to nine or 10 minutes, the mover of the motion
might just get a last word.
7.09pm
(Hammersmith) (Lab)
It is a pleasure to see you in the Chair today, Mr McCabe.
I start by thanking everyone for their contributions to today’s
debate. Members have spoken with personal sincerity and
faithfully represented their constituents’ views on a very
emotive issue. We have heard passionate speeches this evening,
proving that the topic of assisted dying is a compelling one for
those on both sides of the argument.
I am sure that Members will forgive me if I do not mention
everyone who has spoken, but I must acknowledge my hon. Friend
the Member for Gower (), who opened the debate
with a dignified, moving and well-researched contribution.
Although 31 Members spoke, I think around 50 Members were present
at the beginning of the debate. My maths is not brilliant, but
there were about 20 on one side and 11 on the other, which may be
interesting given the vote the last time this matter was
debated.
Seven years ago, I wound up for the Opposition—that shows how far
my career has progressed—on Rob Marris’s Assisted Dying (No. 2)
Bill. That is not the last time that this issue was debated—there
was a Westminster Hall debate a couple of years ago, and the
other place has debated it even more recently—but in 2015 there
was a five-hour debate in the main Chamber, which ended with a
vote.
Perhaps today is an opportunity to review how things have moved
on in this contentious area. The answer is in some ways
substantially, and in others hardly at all. It is clear now, as
it was clear then, that—in the words of the noble , who spoke for the Government
in 2014—
“any change in the law in this emotive area is an issue of
individual conscience. In our view, it is rightly a matter for
Parliament to decide rather than government policy.”—[Official
Report, House of Lords, 18 July 2014; Vol. 755, c. 919.]
That must be right, but it is also right that for Parliament to
decide properly requires the Government’s co-operation and
consent. I will come to that in a moment.
As a number of Members have mentioned, the higher courts have
been consistent in their view that this is squarely a matter for
Parliament. However sympathetic they may be to the harrowing
cases that have come before them, they look to us to set policy
in this matter.
Let us look at some of the areas where change has happened. Many
more jurisdictions have legalised assisted dying: all six
Australian states, seven more US states, New Zealand, Canada and
Spain. Over 200 million people in those and other democracies are
covered by such legislation. That shows not only the direction of
travel but allows more evidence to emerge of the effect of
legalising assisted dying, and whether the fears surrounding
it—especially those around coercion, the so-called slippery slope
and the challenges for the medical profession—have been proved
well founded. On the whole, those concerns have not
materialised.
One of the biggest arguments against assisted dying is concern
about the possibility of coercion. Vulnerable adults nearing the
end of their life could be at risk of pressure from family
members who feel incapable, for whatever reason, of providing
care and support for a terminally ill person. We must be alert to
such possibilities. If Parliament is to decide on this matter, it
is essential that there is a plan for robust safeguards against
that, backed by evidence that they work. Again, we are in the
fortunate position that other countries have walked this path
before us and we may be able to use their knowledge and
experience to our advantage. The petition makes it clear that
such safeguards are essential.
The opinion of significant parts of the medical profession has
moved to a neutral or more supportive view of assisted dying,
with the British Medical Association and the Royal College of
Physicians joining the Royal College of Nursing and several other
royal colleges in adopting a neutral view. More evidence has
emerged of the traumatic effect of the current restrictions,
including travel abroad to die for those who can arrange and
afford it, high suicide rates among the terminally ill, and many
people dying without effective pain relief and in distressing and
degrading circumstances.
Public opinion is overwhelming and clear, with over 80%
supporting assisted dying. This is an issue where the gap between
opinion in this place and in our constituencies has been at its
widest. I wonder if it is now narrowing. When 5,000 people were
polled on the subject, 84% of respondents were supportive of
assisted dying, with strong support across all demographics. This
petition, sponsored by Dignity in Dying, received over 155,000
signatures in support of legalising assisted dying. It proposes
the narrowest form of assisted dying, for those of proven mental
capacity nearing the end of their life. Some jurisdictions permit
assisted dying in cases of chronic suffering, but that is not
proposed here.
Some 75% of the public support a parliamentary inquiry into
assisted dying. That perhaps tells us where we should be heading.
An inquiry would allow us to learn more about the subject, hear
from people with first-hand experience of the scenarios we have
been discussing and look at the data from the countries that have
legalised assisted dying to get greater insight into how it is
working.
Does the hon. Gentleman accept that, once we have assisted dying
in this country, it will change the whole nature of the debate
between GPs and old people? At the back of every GP’s mind, and
for every old person, there will be that question: “Should I end
it?” That is not a burden that we should place on GPs.
I not only do not accept that; I find it the most appalling
scaremongering. I have never met a GP who I do not think has a
duty to their patients. They may vary in their competence and
skills, but in their duty to their patients there is a very
honourable tradition among general practitioners, and indeed the
whole of the medical profession in this country. To throw such
comments into this debate is not helpful to the right hon.
Gentleman’s own side, let alone anyone else’s.
It is right that recently, under the former Health Secretary, the
right hon. Member for West Suffolk (), who spoke earlier, the
Government undertook research, but they have so far not found the
time or resource for a proper investigation and debate,
potentially leading to legislation. I am a supporter of good
local palliative care, and for several years I have been fighting
to retain it for my constituents against attempts to restrict it.
We should strive to provide the very best palliative care to all
those who are nearing the end of their lives. For many families,
palliative care and respite care for family members is essential,
but in order to offer the very best palliative care, we need the
tools, the people and the money to sustain it.
My hon. Friend the Member for Ilford North () has recently spoken about Labour’s plan for a
national care service. To offer people real dignity in dying, we
need a focused approach to care and end-of-life care, which a
national care service could provide. Pembridge Hospice and
Palliative Care in North Kensington served my constituents for
many years until, several years ago, the in-patient unit was
closed because it could not recruit a consultant. That is where
we should look for problems. Assisted dying is not an alternative
to palliative care; the two complement each other.
Does the hon. Gentleman acknowledge that the Health and Care Act
2022 included the amendment proposed by my noble Friend to ensure that
palliative care becomes a commissioned service in the NHS for the
first time in its history? Does he welcome that?
I heard that from one of the hon. Gentleman’s colleagues earlier
and I absolutely welcome it. However, as I said, we need not only
a policy commitment but funding—and that includes workforce
planning, because palliative care consultants are in short
supply.
This should not be a debate only between different attitudes,
religious practices or medical treatments; it should be a debate
about ensuring that the needs of the terminally ill are met in
the most appropriate and compassionate way. I understand the
strongly held views of those who oppose assisted dying, but I am
a firm believer in freedom of choice and bodily autonomy—issues
that have come to the fore in the wake of the reversal of Roe v.
Wade, and not just in the US. This is a matter of conscience. It
is one of the most sensitive that we have to deal with, but we
must not shirk our responsibility on those grounds.
I agree with the petitioners’ request for the Government to grant
the means to debate and, if there is the will in Parliament, to
reform the law in the interests of those who find themselves at
the end of their life and in a perilous position. Whatever our
difference of opinion here, we all agree that those nearing the
end of their life deserve our compassion. There is more that we
can do, not just in the debate on assisted dying, but in how we
care for those who are terminally ill.
As the world changes around us, we cannot stand still. We have a
duty to bring this matter before Parliament again and allow it to
decide. How we begin that process is down to the Government. I
hope the Minister agrees that, if the necessary time is made
available in Parliament, we should be able to debate, vote and,
if there is the will, legislate on this issue. It would be
perverse if Scotland, Jersey and the Isle of Man had legislated
on this matter before we have even had a chance to discuss it in
a meaningful way. This has been a very good and measured debate,
but the next stage must be to allow the voices of our
constituents, which are very strong on this matter, to be
heard—not just this in Chamber, but the main Chamber, and
therefore through legislation.
7.20pm
The Parliamentary Under-Secretary of State for Justice ()
It is a pleasure to serve under your chairmanship, Mr McCabe. I
congratulate the Petitions Committee and the hon. Member for
Gower () on securing the debate.
Introducing a debate on a matter like this means speaking at a
very pressured moment. I thought she spoke with bravery and set
the tone for what has been a very moving, powerful debate with
high-quality contributions on both sides. It has shown Parliament
at its best, as is often the case when we are freed from pre-set
whipping, Government positions and so on.
I am grateful to the more than 155,000 people who signed the
petition. Obviously, we must not forget the role of our
constituents and the public in this matter. This debate is a
welcome opportunity for the House to debate, for the first time
in this new Session, an issue of such profound sensitivity and
importance. We all experience the death of people we care about
and, wherever one stands on the underlying issue, we must surely
all want dignity and compassion for those in their final phase of
life.
Before turning to the Government position and contributions from
colleagues, I want to start with a note on the language, as
referred to by my hon. Friend the Member for Aberconwy (). Some people draw a
distinction between assisted dying, which they see as allowing
dying people to have a choice over the manner and timing of their
imminent death, and assisted suicide, which they see as helping
people who are not dying to choose death over life. To be clear,
the criminal law currently makes no such distinction; under
section 2 of the Suicide Act 1961, the offence is “encouraging or
assisting” suicide, and my use of the term “suicide” reflects
that. It does not indicate prejudice either way, and it is not an
indication of the Government taking one side over the other.
The Government’s view remains that any relaxation of the law in
this area is an issue of individual conscience and a matter for
Parliament to decide. To be clear, that does not mean that the
Government do not care about the issue at hand—far from it. It
means that the ultimate decision on whether to change the law is
for Parliament to decide, in the tradition of previous matters of
conscience that have come before the House.
While I note the petition’s call for the Government to bring
forward legislation to allow assisted dying for adults who are
terminally ill and have mental capacity, our neutral stance means
that such a change would have to be made via private Members’
legislation. If, at a future date, it became the clearly
expressed will of Parliament to amend or change the criminal law
so as to enable some form of assisted dying, the Government would
of course undertake the role of ensuring that the relevant
legislation was delivered as effectively as possible.
Turning to the many contributions made by colleagues today—I
apologise if I do not cover all of them—I think it is fair to say
that there is a strong consensus on the need to ensure that we
have high-quality palliative care. Those on both sides of the
debate agree strongly on that. As my hon. Friends the Members for
South West Bedfordshire () and for Devizes () mentioned, the Government
have shown in recent legislation the importance that they attach
to the matter.
I can confirm that NHS England is developing an ambitious
programme focused on transformational approaches for the next
five years. The programme will build on the work of the
palliative and end-of-life care strategic clinical networks,
which sit across the seven regional footprints. The Government
recognise that high-quality palliative and end-of-life care
should include the opportunity for individuals to discuss their
wishes and preferences so that they can be taken fully into
account in the provision of their future care—also known as
advance care planning.
Of course, resources matter. Many Members made that point,
including the hon. Member for North Antrim () and the hon. Member for Bristol South (), who has NHS management
experience. Obviously, the Government strongly agree. We are
providing £4.5 billion of new investment to fund expanded
community multidisciplinary teams providing rapid, targeted
support to those identified as having the greatest risks and
needs, including those at the end of their life.
On hospices, my constituency neighbour and right hon. Friend the
Member for West Suffolk () —the former Health
Secretary—made a point about the joint funding model. Most
hospices are independent charitable organisations, and they
receive around £350 million of Government funding annually to
provide NHS services. As part of the covid response, which my
right hon. Friend of course oversaw, more than £400 million has
been made available to hospices since the start of the pandemic
to secure additional NHS capacity and enable hospital
discharge.
Turning to some of the core issues raised today, a number of
colleagues referred to what is happening in other jurisdictions.
My right hon. Friend the Member for Sutton Coldfield (Mr
Mitchell) and others made the point that change is happening in
many other jurisdictions and argued that we should be reflecting
that. Equally, however, my hon. Friend the Member for Hastings
and Rye () made the point that some
evidence from those jurisdictions may be negative. I think she
referred to the experience of the medical profession in Canada.
Clearly, whatever we do and however we move forward, we should
always be cognisant of what is happening in countries and
jurisdictions where the law has changed.
Perhaps the key point of principle here, which is where this
becomes a matter of conscience, is choice—choice versus the risk,
shall we say, of abuse, and the need for safeguards and so on.
Many colleagues spoke about choice, including my hon. Friends the
Members for Thirsk and Malton () and for Boston and
Skegness (), the hon. Member for
Brentford and Isleworth (), and my right hon. Friend the
Member for West Suffolk. The hon. Member for Glasgow Central
() said it is about the
right to choose “a good death”.
I was particularly moved by the hon. Member for Sheffield Central
(), who said that we should
consider the choice not just of the individual but of their
family, who, because of fear of the criminal situation, may feel
that they cannot discuss the matter. His was one of the most
moving speeches I have heard in my time as an MP, and I hope that
people on all sides respect the fact that he spoke under great
duress, shall we say, but added much to the debate.
Equally, there is a concern that choice is restricted by income,
particularly when we are talking about Dignitas. That point was
made by my hon. Friend the Member for Sevenoaks () and others. However, against
that—we must remember this—the right hon. Member for East Ham
(Sir ), whom I support, spoke
eloquently about the risk of pressure on those who may feel that
they have to take an action that they would not have felt they
should take before any change in the law. That is an incredibly
important point. My hon. Friend the Member for Darlington () made a similar point, as did
my hon. Friend the Member for Devizes, who said that it could be
argued that that actually restricts choice because of the
pressure it implies. My right hon. Friend the Member for
Gainsborough ( ) spoke about the proposed
change implying death on demand.
On the position of the public, polling does seem to have shifted.
My right hon. Friend the Member for West Suffolk and the hon.
Member for Gower both referred to what is happening with the
opinion polls. However, my right hon. Friend the Member for New
Forest West ( ) made the point that a poll
is not an argument and we are, after all, a representative
democracy. Ultimately, it will be for this House, through a
private Member’s Bill or another mechanism, to make the
change.
As there are only three minutes left, I will rattle through my
remaining points. There was much talk of the slippery slope from
the hon. Member for Swansea West () and others. I just say to
my right hon. Friend the Member for Gainsborough that if a doctor
were injecting drugs with the aim of ending life, that would not
be assisted suicide or assisted dying; that would be murder under
common law. [Interruption.] I am afraid that, because of the
time, I will finish with this point.
I think that colleagues on both sides are calling for a national
conversation and, if not an inquiry, then certainly an
investigation by the Health and Social Care Committee, for
example. Obviously, if any of those steps go forward, the
Government will do their best to assist, within the constraints
of their neutral position, which I take very seriously. The
matter was recently debated at length in the House of Lords. It
is for hon. and right hon. Members, if they wish, to bring
forward private Members’ Bills or debates in the usual way, such
as through the Backbench Business Committee.
Wherever we stand, I think we can all say that this has been a
very passionate debate that has moved forward the public’s
understanding of the key positions on both sides. We should all
be proud of the way in which the Petitions Committee has allowed
the public to see all the arguments, and I am grateful to all
hon. Members who contributed to the debate.
(in the Chair)
I call Tonia Antoniazzi—you must conclude before 7.30 pm or the
motion will lapse.
7.28pm
I thank everybody in the Chamber, including the people who came
to watch the debate, and all the petitioners. This has been a
very moving and important debate. I hope that the Minister will
agree to meet the people here today from Dignity in Dying who
have lived experience, and I hope that we can have a proper
inquiry and Government time to take this matter forward. I thank
everybody for the way in which the debate has been conducted,
because it is very important for everybody.
Question put and agreed to.
Resolved,
That this House has considered e-petition 604383, relating to
assisted dying.
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