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Coronavirus Regulations: Assisted Deaths Abroad

Volume 683: debated on Thursday 5 November 2020

To ask the Secretary of State for Health and Social Care if he will make a statement on the impact of new coronavirus regulations on the ability of terminally ill adults to travel abroad for an assisted death.

Issues of life and death are some of the most difficult subjects that come before us in this House, and the question of how we best support people in their choices at the end of their life is a complex moral issue that, when considered, weighs heavily upon us all. My right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) has asked an important question and I want to set out the precise position. Under the current law, based on the Suicide Act 1961, it is an offence to encourage or assist the death of another person. However, it is legal to travel abroad for the purpose of assisted dying where it is allowed in that jurisdiction. The new coronavirus regulations, which come into force today, place restrictions on leaving the home without a reasonable excuse; travelling abroad for the purpose of assisted dying is a reasonable excuse, so anyone doing so would not be breaking the law. These coronavirus regulations do not change the existing legal position on assisted dying.

As this is a matter of conscience, the Government do not take a position. It is instead a matter for each and every Member of Parliament to speak on and vote according to their sincerely held beliefs, and it is for the will of the House to decide whether the law should change. The global devastation of the coronavirus pandemic has brought to the fore the importance of high-quality palliative care, just as it has shone a spotlight on so many issues and, difficult as it may be, I welcome this opportunity to have this conversation about assisted dying, as it is one of the most sensitive elements of end-of-life care.

I have the greatest sympathy for anyone who has suffered pain in dying or suffered the pain of watching a loved one battle a terminal degenerative condition, and I have a deep respect for friends and colleagues in all parts of the House who share and hold strong views. I am pleased that the House has been given this opportunity to discuss the impact of the pandemic on one of the most difficult ethical questions that we face.

Thank you, Mr Speaker, for granting the urgent question, and I thank my right hon. Friend for responding himself.

This is an issue of conscience for us as Members of the House. I respect those who take a different view from me, not least because theirs was previously my view. Colleagues may have seen, over the weekend, the news reports about a woman who this week travelled to Switzerland to end her life in order to avoid travel restrictions. As a frontline NHS worker with terminal breast cancer, she did not want to run the risk of dying in great pain and without dignity. The new regulations that have come into force today could deter anyone else from travelling to Switzerland for an assisted death. That will undoubtedly cause many more Britons to suffer as they die, due to a lack of a safeguarded law here in the UK, although I am most grateful to my right hon. Friend for clarifying the precise legal circumstances.

In the light of the radical shift of the views of the medical profession two weeks ago, the recent legislative change in New Zealand this week and groundbreaking progress in southern Ireland, along with the continuing and massive support for law reform from the British public, will the Government, from their position of neutrality, enable all of us to understand three things—first, the extent of suffering that the blanket ban on assisted dying is causing dying people and their families; secondly, the challenges that the current law is creating for healthcare professionals, police officers and other public servants; and thirdly, what the UK can learn from international evidence on the operation of assisted dying laws, and their safeguards, in the United States, Australia and Canada?

I am supporting a very tight reform that would allow someone who is terminally ill, within six months of the end of their life, and who has themselves decided that this is the end of life they want, independently certified by two doctors and confirmed as their independent decision by a High Court judge, to end their life, as is their choice.

I pay tribute to my right hon. Friend for the way in which he puts his case. Of course, we acknowledge the changing views of many, including many in the medical profession, and, of course, we observe the changes in the international debate. I think it is absolutely reasonable for this House to have a conversation and discussion on what is an important topic, and it is right that we locate that question within a broader discussion of how we care for people at the end of their lives, which, because of the coronavirus pandemic, has sadly become a central issue of public debate in this country.

I thank the right hon. Member for Sutton Coldfield (Mr Mitchell) for the way in which he has put his questions, and the Secretary of State for the sensitive way in which he has responded and for the clarification he has offered to the House. I suspect there will come a point at which the Parliament will have to confront the it. I note that the Secretary of State has said that issue should be located within a broader discussion about end-of-life care, a perfectly reasonable position which I endorse, but can he reassure me that, as part of the broader discussion, there will always be thorough and transparent consultation with the public and with faith groups, and that physicians and healthcare professionals will always be fully involved?

Members across the House will have sincerely held views, and whatever one’s views on the principle, the House should be aware that before the pandemic a person from Britain travelled abroad to Dignitas every eight days and that charities have warned that since the March lockdown some terminally ill people are ending their lives in the most traumatic circumstances because of a lack of clarity about the law—the Secretary of State has given clarity today, but until that point there was a lack of it. We know that a second lockdown will take a heavy toll on people’s mental health, especially over the winter, so can he tell us what mental health support will be made available to people facing this most awful of choices and what mental health support is available to people more broadly?

People deserve dignity in dying and palliative care needs to be improved at the best of times, but lockdown means that palliative care is particularly under pressure. Can the Secretary of State assure us that hospices will have full support throughout the lockdown, that hospice staff will have regular access to regular testing and that we have a supply of enough of the vital drugs which palliative care relies on for the lockdown period?

This is an immensely sensitive topic. I repeat that I appreciate the way in which the Secretary of State has dealt with it this morning, but many people will be deeply concerned. We look forward to working with the Government on this important issue.

The hon. Gentleman is quite right that this is not an issue in which there is any party politics, and there is rightly no Government position. On the specific question of assisted dying, I am glad to have been given the opportunity to clarify the impact of the coronavirus regulations on that law, but he also asked the wider question about palliative care. It is important that we support palliative care, and that we locate this question in a wider question about how people can have choice. After all, patient choice has been a growing feature within healthcare—in my view, rightly so—over the last generation. This is one area where that choice is constrained in law.

It is important that we invest in high-quality palliative care. We have put further funding into palliative care and hospices because of the pressures caused by the coronavirus pandemic. Making sure that we have high-quality palliative care services and a hospice service that we can all support fully is obviously very close to my heart.

The hon. Gentleman also asked about mental health support. There has been increased investment in that to ensure that people get the support they need in what are inevitably difficult times.

At this time, when the whole country is making huge sacrifices to protect life, at a time of exceptionally high levels of physical and mental stress, and when many people may feel very vulnerable, does the Minister understand and accept the views of many, including in this House, that it would be completely inappropriate—indeed, insensitive—of Parliament to go anywhere near considering making access to any form of suicide easier?

I respect my hon. Friend’s views, which are deeply and sincerely held, and I respect the fact that the House will debate all views. It is right that that debate is taken forward and led by Parliament, rather than by Government, as my hon. Friend has just demonstrated.

I congratulate my co-chair of the all-party parliamentary group on choice at the end of life, the right hon. Member for Sutton Coldfield (Mr Mitchell), on securing this urgent question, and I thank you for granting it, Mr Speaker. I have sought to change the law since entering the House. In the last five years, I have learned that many colleagues are worried about safeguards. There is an assumption that the law is currently safe, but it is not. In June, here in London, a man threw himself in front of a heavy goods vehicle on the North Circular. He was suffering from throat cancer and knew his tumour would continue to strangle him. He could not bear it. He took his own life because this country denied him the option of choosing the timing and manner of his death. I appreciate that this is a sensitive and difficult issue, but is it not time we recognised that the law is not compassionate or safe, and leaves behind bereaved families and members of the public because of the absence of a safeguarded choice at the end of life?

The hon. Lady draws a distinction between the issue of those who have a terminal illness and the broader issue of suicide, which is an important part of this debate. I respect her sincerely held views. The exchange between my hon. Friend the Member for Congleton (Fiona Bruce) and the hon. Lady exemplifies why it is right that Parliament debates and decides on these matters.

Is my right hon. Friend aware that a British Medical Association survey of its members on assisted suicide and euthanasia found that 83% of those involved in providing palliative care—those who have the most experience of dealing with people at the end of their lives—would oppose any legalisation of euthanasia, and that 84% declared that they would be unwilling to participate in any such activity? Surely we should be guided, in many ways, by the professionals in this regard.

My hon. Friend makes another important contribution to this debate. There is inevitably a discussion within the medical profession about this important question. That should be taken into account, alongside the views, as the hon. Member for Leicester South (Jonathan Ashworth) said, of faith leaders, the public and those who face terminal disease, as Parliament debates this subject.

Terminally ill people are travelling prematurely and alone to end their lives abroad for a number of reasons, including covid. Another is that they wish to save relatives from the risk of prosecution. Will the Secretary of State liaise with his Home Office colleagues and the police, who themselves find these cases difficult, to ensure that any response is sensitive and proportionate?

That incredibly important and sensitive matter needs to be considered as part of the overall approach. These questions should all be brought out in a debate on this subject. That is Parliament’s role, given that this is an area of conscience on which the Government do not take a view.

It is very sad that anyone has to go abroad to end their life when they have a terminal illness—I find that dreadfully sad. I ask my right hon. Friend, because I am unsure of this: how many people on average go abroad to end their lives every year?

The Government do not collect data on the number of people who travel abroad for an assisted death. We would consider collecting data on assisted dying if it was felt that that would improve and contribute to a sensitive debate in Parliament on this subject.

We have seen that there is widespread support in this House, and the research tells us that there is widespread support in the country, for a review of the law, so will the Government look at what has happened in other countries such as New Zealand and promise that there will be a review, with a view to decriminalising the situation and bringing some compassion into the law?

As I said, the Government are neutral on this matter. It is a question for Parliament. There are many ways in which such a review could be brought forward, but the Government’s position of neutrality is important, because this is a matter of conscience on which there are deeply held and very sincere views on all sides. I think it should rest that this is a matter for Parliament, rather than Government.

In the past two years, we have seen a significant shift in the views of the medical profession, with the Royal College of Physicians neutral on assisted dying and the British Medical Association poised to drop its opposition. Does the Secretary of State recognise that where there was widespread opposition to changing the law, there is now support for a full review of how the prohibition of assisted dying affects healthcare professionals and patients?

Yes. I think it is clear that there are changing views on this subject and that there is a very strong view that any change should be dealt with carefully and sensitively. In fact, the tone of this debate and discussion today reflects the seriousness and sensitivity of this topic and the need to make sure that all the issues are very carefully considered.

Does my right hon. Friend agree that those who are terminally ill deserve the very best palliative care available, and that rather than facilitating overseas travel for those terminally ill patients, the Government should ensure that they receive world-class palliative care here in the UK?

Yes, I think this is a really important point, because high-quality palliative care and the question directly of assisted dying that is before the House today are not separate questions. They are intimately tied together and whatever view the House takes on assisted dying—and it is for the House—it is the Government’s intention to support and strengthen palliative care to make sure that we give the very best support for people towards the end of their life.

I welcome the Secretary of State’s clarification today to support people’s choice and their dignity in dying. He has spoken about palliative care at length, and I understand that there is further funding for hospices, but charities, such as cancer charities that support people with those choices, have had to make drastic cuts to their staffing and funding as a result of covid. What conversations has the Secretary of State been having with the Treasury, and what commitment will they make in the November spending review?

Obviously the hospice sector, which often relies on charity shops to fund its services, has had a very difficult year. We therefore have put funding support in and we always keep that under review. I applaud the fact that our hospices are funded both by taxpayers and through a huge amount of philanthropy. It leads to a stronger sector that is rooted in the communities that it serves. Nevertheless, I acknowledge that that has led to some significant challenges this year. We have put more funding in and will, of course, always keep that open to review.

It is very difficult to tell somebody who is in pain and suffering and who wants to die that the state is going to prevent them from doing that. As a Roman Catholic, I recently changed my mind on the issue because of my constituent Mr Noel Conway, who lives in Garmston near Shrewsbury. I said to him, “Why don’t you go to Switzerland?” and his answer will stay with me forever: “No, I’m an Englishman. I want to die in England.” It is extremely important that our citizens have that right. Will the Secretary of State do me the courtesy of agreeing to a short Zoom call with my constituent Mr Noel Conway, who is getting a national reputation as a leading campaigner on the issue?

I would be happy to have that meeting with Mr Conway. I have spoken to others in the same circumstances who have made the case strongly. The compassion of the case cannot be overstated. I also respect the fact that many hon. Members, as has been reflected today, have deeply held views. We should make sure that the conversation happens; that there is, rightly, a debate about the topic, as there is in many other countries right now; and that it is conducted in an evidence-based, sensible and compassionate way.

Clearly, we are debating the most sensitive of issues, and we need more investment in the research and practice of palliative care. I ask the Health Secretary what additional resources will come forward, because at the end of October the grant funding for covid-19 and hospices came to an end. Of course, we are entering a further period of lockdown in which charity shops will be shut and fundraising opportunities will come to an end. Hospices need resourcing now, so what additional support will he bring forward?

The hon. Lady is absolutely right to raise that issue. We provided more than £150 million of extra funding to hospices during the first peak. Locally, many clinical commissioning groups fund their local hospice and contribute to that support, but we always keep it under review, because hospices are such an important part of the provision of end-of-life care.

I am concerned that in this discussion there is a danger of focusing too narrowly on the specific option of assisted suicide. Modern medicine can palliate the pain of dying in almost all cases, but it can also extend life, in many cases artificially, beyond what most people would consider its natural span. Before we enter into a parliamentary review, Government review or Select Committee review of the precise options around assisted suicide, should we not have a much broader conversation about how we manage death and dying in this country?

I agree with my hon. Friend that the question should be located within that broader debate. I understand the yearning from people not to shorten life, but to shorten a painful death. Of course, no specific proposal has been put forward; that would be for Parliament to develop rather than the Government.

Does my right hon. Friend agree that at the heart of the issue is properly established personal autonomy over the time and manner of someone’s death when they are terminally ill? The safeguards around that have been operating for more than two decades in other parts of the world, as I saw on a visit to Oregon 20 years ago. He is right that this must be led by Parliament, but the evidence is developing all the time and the Government will have to make time for the debates and opportunities to assess that evidence. Parliamentarians should proceed on the basis of the evidence available to them, because if they choose to impose faith-based views on others, it can result in the most terrible cruelty.

We would consider collecting more data on these questions, because it is important that any debate is based on the evidence, but it is also important that the debate takes into account all views that are sincerely held and very reasonable.

I refer the House to my entry in the Register of Members’ Financial Interests.

Is the Secretary of State aware that research indicates that individuals go through a number of psychological stages—such as shock, denial, anger, bargaining, depression and then acceptance—after they have been given a diagnosis of terminal illness? We are failing so many people right across the United Kingdom by not giving them access to adequate psychological support to enable them to reach that stage of acceptance, in themselves and for their families, and then not providing the therapeutic support that they need alongside the palliative care already mentioned by colleagues.

The hon. Lady makes an important contribution to the debate in respect of how we should consider these issues.

I respect the views, which are all earnestly held, on either side of this issue. As my right hon. Friend has said, this is a matter of conscience. I am happy to put on the record that I am with the 80% of British people who think that to bring forward assisted dying with the proper checks and balances is the right thing to do. What are my right hon. Friend’s personal views on this issue, as the Member for West Suffolk?

Order. I will be quite honest: I do not want to enter into personal arguments. I am not giving my view, and I do not think it is right to put the Secretary of State on the spot in that way.

No, I think I will make the decision, Mr Mitchell. You have had a good day. The Secretary of State is not here to be responsible for his personal view; he is responsible as the Secretary of State answering questions. Please, let us not try to take advantage of the Chair.

Right, let us go up to Manchester with Sir Andrew Gwynne—sorry, just Andrew Gwynne.

Thank you for the promotion, Mr Speaker.

I have always been internally torn on this issue. Setting aside my own personal beliefs and the fact that my constituency is still dealing with the very real legacy of Harold Shipman, I will always be haunted by my mum’s painful end of life in hospital, where final decisions were in effect given to me, aged 19, and to my dad, aged 48. The reconciliation of all these things is incredibly difficult, but what I do know is that the current system is too often pretty inhumane. I agree with the right hon. Member for Sutton Coldfield (Mr Mitchell) that we need a review to consider how we deliver better end-of-life care and support in England. Is that a way forward?

I do think it important that we consider the question of end-of-life care, and support for palliative care is important. The coronavirus epidemic has shone a light on palliative and end-of-life care in the wider public debate, and that is right and good. That is a matter for the Government, but the specific question of assisted dying is, of course, a question for this House, and we need, together, to find a way to ensure that we all serve our constituents as best we can, taking into account the best possible evidence and all the sincerely held views on this sensitive subject.

Thank you for allowing me in, Mr Speaker.

On the piano in my home in Lincolnshire, I have a lovely photograph of Pope Francis embracing a very old and very sick woman. At the bottom it says, “Cherish life, but accept death.” I was struck by what the Secretary of State said earlier—that we do not need to extend death or suffering; we can help people through this extraordinarily difficult time. I think we do need a review. Many people are helped into death. I remember my best friend, Piers Merchant, a former colleague here. I was at his side, and as he died, morphine was being pumped into him. No doubt he was killed by the morphine, but that was a humane and right thing to do. We need to have a review on the basis of cherishing life but accepting death, and not necessarily pounding very old and sick people with more and more operations and pain.

As a highly respected and very significant voice among Catholics in this country, my right hon. Friend speaks powerfully, from both a position of his faith and a compassionate position of respect for what the current rules mean in practice. The whole House, and indeed the country, will have heard his contribution and it leaves us all to ponder this question.

In order to allow the safe exit of hon. Members participating in this item of business and the safe arrival of those participating in the next, I am suspending the House for three minutes.

Sitting suspended.