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Dignity in Dying

Volume 705: debated on Wednesday 8 December 2021

Motion made, and Question proposed, That this House do now adjourn.—(Steve Double.)

I express my thanks to Mr Speaker for granting this Adjournment debate.

Assisted dying is an immensely sensitive and emotive issue of conscience over which each of us individually, as Members of this place, must wrestle, and which this House will have to address collectively before much longer. In my role as co-chair of the all-party parliamentary group for choice at the end of life—I have the pleasure of co-chairing it with the hon. Member for Bristol South (Karin Smyth) in this House—I have had discussions with many colleagues, including the Prime Minister, and I know how seriously this issue is taken. I know that many colleagues are yet to come to a firm conclusion on it. I respect that position. I respect it not least because I have completely changed my mind on this issue since I arrived in the House of Commons. After listening to many constituents in my office in Sutton Coldfield, often with tears of solidarity in my eyes, as with inordinate sadness they have told me of the painful and undignified death of someone they loved, I have concluded that I want the law changed to benefit my constituents, to benefit those who I love, and possibly, indeed, to benefit myself.

Our constituents are, according to every single opinion poll over the past three decades, in strong support of this change in the law. I remind the House that the Bill introduced by the noble Lady Meacher in the other place, which has recently commanded their lordships’ support and builds on the consensus so painstakingly and skilfully assembled over many years by Lord Falconer, sets out that those who are within six months of the end of their life and who, in the opinion of two doctors and a High Court judge, have reached the decision independently and in sound mind that they wish to end their life to avoid the often undignified and extraordinary suffering that would otherwise assail them, should be able to do so.

Is it not extremely difficult to assess when a life will end? Is that not one of the challenges that we have with regard to this proposal of a timed end to a life?

My hon. Friend is right, but I used to be a junior social security Minister, and I know that social security law means that the Government—society—already have a way of determining a period six months before the end of someone’s life. We can of course reflect on this, and on whether there is a better way of doing it, but that facility in fact already exists.

How would my right hon. Friend’s Bill prevent relatives or others from putting pressure on the person to ask for this procedure to be put in place?

My hon. Friend makes a very good point, and I will come directly to that.

My aim in this debate is not to persuade all colleagues of the rightness of this cause but to make two clear points: first, that this is a debate about the real-life consequences of our blanket ban on assisted dying; and secondly, that there are real examples from overseas of how it can be done better.

In the past several days, we have seen the rules on international travel tighten once again; in the space of a week, the Swiss Government closed their borders to travellers from the UK unless they undertook a quarantine of 10 days, before changing the rules back a few days later. The dismay that that has caused people seeking an assisted death in Switzerland is overwhelming, with their having to spend their final days confined to a hotel room, scrambling to update plans when time and energy are in such short supply, and unable to have all—or perhaps any—of their loved ones there to accompany them. The already cruel situation where British citizens can have the death they want only if they travel to another country becomes yet more unacceptable when even that most exceptional option can be withdrawn with such short notice. That is not to blame Switzerland; it is the fault of our own failure as a country to provide that option at home, preferring to outsource our compassion to another country.

Last year, I raised the question of travel during the pandemic with the Secretary of State for Health and Social Care. He confirmed that the ban on travelling overseas did not apply to those travelling for an assisted death in another country. That announcement was a welcome relief to many, although it once again highlights our heavy reliance on other jurisdictions to provide our own citizens with the deaths that they want.

I will get a little further with my case, and then I will certainly give way.

Furthermore, this leniency does nothing for those who cannot afford a trip to Switzerland; who cannot access the necessary medical records; who cannot travel due to illness or disability; or who cannot access the services of Dignitas for a host of other reasons. It forces all those who accompany the dying person to break the law and run the risk of prosecution on their return to this country.

I am saddened to tell the House that David Peace has today died at Dignitas; it is a coincidence that he happened to die today. Many colleagues may have seen a touching interview with David over the summer, in which he spoke about his desire to control his death, rather than let motor neurone disease choose his death for him. Earlier this week, before he left this country—his home—for Switzerland, David said:

“I have terminal motor neurone disease, a fatal illness for which there is no treatment or cure. It has robbed me of my ability to speak, swallow, balance and walk. It is rampaging through my body, paralysing my muscles. Nothing will stop it. Palliative care cannot give me the death I want, I simply want the right to die on my own terms...My only option has been to plan an assisted death at Dignitas in Switzerland, which I have done in meticulous detail over the past few months. Though stressful and hugely expensive, this has given me comfort and peace of mind. Covid-19 measures have been a real concern throughout this year, knowing that travel restrictions or lockdowns could jeopardise my plans”.

He continued:

“The emotional and logistical nightmare I have endured over the past few days would have been avoided entirely under the Assisted Dying Bill, which would have enabled me to go peacefully and with dignity in my own home at a time of my choosing.”

David’s call is echoed by another proud Englishmen, Ray Illingworth, the legendary English and Yorkshire cricketer, who was diagnosed with oesophageal cancer a year ago. He said this of having to go abroad to obtain an assisted death:

“If that was the only option I would, but we shouldn’t have to do that. I’d like to be put to sleep in peace in my own home in Yorkshire.”

Ray has represented his country, and is now asking his country to help him have the choice of dying on his own terms.

Those who cannot travel to Switzerland have only a few agonising choices here at home. For many, our world-leading palliative and end-of-life care will ensure a peaceful and dignified death, but even with the very best care, 17 people a day will die in excruciating pain, to say nothing of those who die with uncontrollable symptoms, or without dignity in their final days. For those who wish to hasten their death, the option remains open of withdrawing from life-sustaining treatment, or voluntarily stopping eating and drinking with the intention of hastening death; but there is no option to take direct steps to end one’s own life with medical support.

Perhaps most tragic are the cases in which dying people, trapped in pain and despair, decide to end their life by suicide. The best estimates are that hundreds of suicides every year are of people living with a terminal illness. I know from speaking to people who have direct experience of losing their loved one to suicide that these dreadful decisions are taken not lightly, but as a last, desperate choice, due to the lack of a safeguarded assisted dying option.

We must be honest about recognising the victims of our laws—the dozens of our citizens who feel they must travel overseas to achieve the death that is right for them; the hundreds of terminally ill people who die by their own hand; and the thousands of people who die beyond the reach of the very best end-of-life care we can offer. Every year, we condemn too many people to becoming casualties of a law that lacks compassion and public support, and belongs to a bygone age.

My right hon. Friend is making a powerful speech, as expected. He refers to a very small number of people to whom he wants to give this new right. I recognise the extraordinary pain and distress of those individuals and their families, but is he aware that in Oregon—the legislation being proposed in the other place is based on the law there—over half the people who apply for assisted death do so not because of terrible pain and suffering, but because they do not want to be a burden on their family? That is the consideration that motivates them. Does he not agree that that is likely to be replicated here, given the sad prevalence of abuse and neglect of elderly relatives in our country?

Surely the answer to the distress of people facing death is to improve palliative care, which, as he says, though it can be excellent in this country, is tragically patchy, which is not good enough. Surely we should invest significantly in palliative care to ensure that everyone in this country has the opportunity to die with all the care that they need, and does not have a terrible, distressing death, before we ever consider this terrible step of allowing assisted suicide.

My hon. Friend and I will no doubt continue this argument for many months. He and I are as one on the importance of improving palliative care, but alas, there are those who will never benefit from those improvements because of the nature of their illness. I will come to Oregon in a moment, but to address the very point that he made, we emphasise the importance of a High Court judge being involved.

What can we learn from overseas, as others like us struggle with this issue? We know that this can all be done better. Indeed, with each year that passes, yet another jurisdiction takes a step forward to provide choice at the end of life for its citizens. Eleven states in the USA and five Australian states have legalised assisted dying, with New South Wales likely to follow suit very shortly. New Zealand permits assisted dying, following a nationwide referendum that found an overwhelming majority of New Zealanders supported a change in the law. In Europe too, in the past couple of years, laws have been passed by the Spanish and Portuguese Parliaments, and court judgments have overturned the bans on assisted dying in Germany and Austria.

In places such as Oregon, which my hon. Friend mentioned, assisted dying has been legal for a quarter of a century, and the eligibility criteria and processes remain essentially the same as the day they were introduced. Of the jurisdictions that have introduced assisted dying solely for people who are terminally ill and mentally competent, not a single one has subsequently extended its laws beyond that point.

The other important point is the direction of travel in this area: we are told by those who oppose law change that other countries provide clear warnings of the horrors that would befall the elderly, the vulnerable and others in society if we were to legalise assisted dying. Not only is there no evidence to that effect, but no single jurisdiction has legalised assisted dying and then subsequently repealed that law. Do we as a House consider ourselves to be more blessed with wisdom and foresight than the parliamentarians of all of these other jurisdictions or think that they have simply turned a blind eye to those concerns? The truth, of course, is that these fears, as seriously as we take them, simply have not come to fruition.

Very close to our shores, change is on its way. Two weeks ago, the States Assembly of Jersey voted by a large margin of 36 votes to 10 in support of a proposition on assisted dying, with draft legislation to be introduced by 2023. A widely signed petition led to the establishment of a citizens’ jury of islanders, which found that more than 75% of participants wanted to legalise assisted dying.

Ireland’s Parliament has given its support in principle to assisted dying in October 2020 and a new special committee has been established to begin working on legislation that will command the support of their MPs. That work will commence early next year and demonstrates the renewed commitment of the Irish Parliament to progressive causes.

Perhaps most important is the proposed legislation in the Scottish Parliament, introduced by the long-serving and well respected Liam McArthur MSP. Indications are that the resulting legislation is likely to secure the support of MSPs, as long as it is tightly drafted and contains robust safeguards. Scotland would become the first constituent nation of the United Kingdom to legislate on assisted dying and, inevitably, that may shine a light on our successive failures to progress law changes here in Westminster.

The right hon. Gentleman is making a very powerful speech on a highly emotive issue. He mentioned Liam McArthur’s Bill in the Scottish Parliament, which was the subject of consultation, and there is movement in Scotland. The right hon. Gentleman spoke of the reticence of some Members or their reluctance still to make their minds up. Does he share my hope that they will take confidence from what is happening in the Scottish Parliament and the support among the public to have the courage of their convictions, if and when legislation comes before this place?

I thank the hon. Lady very much for her intervention. It must be the case, and I am sure my hon. Friend the Member for Devizes (Danny Kruger) will agree, that all Members of Parliament will be following what happens in Scotland with the greatest possible care. It is an issue that, wherever we stand on the debate, greatly exercises Members of the House of Commons.

I wish to draw colleagues’ attention to the process envisaged by the Scottish Parliament for a debate on this issue. A proposal has been lodged in the Parliament and the initial consultation will close in two weeks’ time. In the new year there will be an analysis of the responses to the consultation, which will feed into the drafting of the Bill. Once drafted, the Bill will be examined in detail by Select Committees, calling for evidence from stakeholders across society. Only once that pre-legislative scrutiny has been completed will the legislation be debated on the floor of their Parliament.

Here in this House we lack anything like such a comprehensive system. Our system for considering private Members’ legislation is entirely inadequate when debating such an important issue. The Government have rightly determined that it should be neutral on the principle of assisted dying, but I invite my hon. Friend the Minister to recognise that neutrality on the legislative process, rather than on the principle, has the effect of siding with the status quo. A refusal to facilitate the debate is a de facto opposition to law change.

Finally, I will ask the Minister some questions about specifics of how the laws in neighbouring jurisdictions would work together. As she will no doubt be aware, the General Medical Council, the Nursing and Midwifery Council and other healthcare regulators operate on a UK-wide basis. Can she confirm that if either Jersey or Scotland were to legalise assisted dying, any health and care professional who participated in and followed the requirements of that law would not face prosecution?

The Minister may also be aware that the issue of conscientious objection has previously been treated as a reserved matter by the Scottish Parliament. It should be common ground that, whatever our view on assisted dying, health and care professionals should not have to actively participate in the practice if they believe it contravenes their conscience and beliefs. I understand that the Government’s position is that conscientious objection is in fact already within the competence of the Scottish Parliament: can she confirm to the House that that is the case, and to what extent any legislation on conscientious objection in the Scottish Parliament would contravene the devolution settlement or require the approval of the UK Government?

Finally, I ask the Minister to update the House on the work commissioned by the former Secretary of State, my right hon. Friend the Member for West Suffolk (Matt Hancock), to be undertaken by the Office of National Statistics on the number of terminally ill people who end their own lives by suicide. All of us in this House wish to tackle and reduce the number of suicides, attempted suicides and incidents of self-harm, but in order to do that, it is imperative to understand why many people take that most desperate decision.

I thank the right hon. Gentleman for giving way. As a fellow member of the all-party parliamentary group on choice at the end of life, is this not fundamentally about enabling everyone to have a good death—be it through palliative care, if that is their wish, or the choice of an assisted death? It is a matter of choice at the end of life. Does he agree?

I very much agree with what the hon. Lady says. She has thought about this very carefully. We all want to see choice extended wherever possible in our daily lives, and she is right in what she says.

Many colleagues and former colleagues, including Lord Field of Birkenhead, have changed their mind on assisted dying, whether informed by their constituents or by their personal experience. This House is in a very different place from when this issue was last voted on, more than six years ago. I am afraid that we as a House will continue to find ourselves running to catch up with the public view on this unless a serious process for consideration of this issue is put in place.

I begin by thanking my right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) for securing a debate on this issue and for not only outlining his views on assisted dying, but taking many interventions on both sides of the debate.

It remains the Government’s view that any change to the law in this sensitive area is a matter for Parliament to decide and an issue of conscience for individual parliamentarians, rather than one for Government policy. I have the utmost sympathy for all those who have suffered the pain of watching a loved one battle a life-threatening or degenerative condition; many of us will have witnessed that, and it will inform our decisions.

As my right hon. Friend mentions, in order to develop more precise estimates of suicide risk for people with specific debilitating and terminal illnesses, the Office for National Statistics is consulting with clinical experts and is due to publish its report next year. We will consider its findings carefully.

We know that this issue is also being considered across the wider UK family, with—as my right hon. Friend mentioned—an ongoing consultation with the Scottish Parliament and legislation being drafted by Jersey’s Council of Ministers. We will await further details of any proposals that may be presented, at which point we will be able to say more about how medical professionals can work within the different countries. The Government are, however, committed to ensuring that patients of all ages are treated with dignity at the end of life, and have the opportunity to benefit from high-quality personalised care that takes account of their wishes.

The NHS constitution states our commitment to putting respect, dignity, compassion and care at the core of the way in which patients are treated. Dignity means different things to different people, but as the Parliamentary and Health Service Ombudsman pointed out in a 2014 report, there are some key actions to ensure that people have dignity at the end of life They include allowing patient choice through appropriate care planning and promoting good and timely communication, with patients and their families and between the people and organisations supporting them.

We have seen many changes in the health system over the last decade, including an ambition to move more care out of acute, in-patient settings and make it available to people at—or closer to—home. The place where care is provided is particularly important for people at the end of life, and palliative and end-of-life care services have adapted to allow patient choice wherever possible.

We know that the covid-19 pandemic brought new challenges, with a sudden and significant increase in both the number of deaths overall and the proportion of people who passed away at home, but despite those challenging circumstances, our dedicated and exceptional palliative and end-of-life care workforce demonstrated their pragmatism and resilience and continued to provide world-class care for patients around the clock, working hard to adapt to meet the needs of patients and their families and ensure that dignity was maintained. We are immensely grateful to them. They have truly gone above and beyond throughout the covid response, and they deserve our unwavering support and recognition.

However, despite the efforts of our health and care colleagues across the system, before and during the pandemic, we know there is still more that we can do. Improving quality of care requires a confident workforce with the knowledge, skills and capability to deliver high-quality palliative and end-of-life care. Health Education England continues to provide comprehensive training for all health and care staff involved in palliative and end-of-life care through the availability of resources from the End-of-life care programme.

Furthermore, NHS England and NHS Improvement have committed themselves to supporting the transformation of palliative and end-of-life care services, as was pointed out by my hon. Friend the Member for Devizes (Danny Kruger). They have developed a three-year strategic delivery plan, aligned with the long-term plan, which prioritises the importance of improving access, quality and sustainability. They are committed to providing dignified, personalised care for people at the end of their lives, including opportunities for shared decision-making conversations about their treatment and support. Those conversations between healthcare professionals and patients ensure that patients’ preferences and needs are taken into account when their care is being planned.

NHS England and NHS Improvement will be publishing advance care planning principles in early 2022. They will focus on the importance of providing opportunities for a person and his or her family or carers to engage in meaningful discussions, led by the person concerned, which consider that person’s priorities and preferences when he or she is nearing the end of life. The Health and Care Bill presents a fantastic opportunity to strengthen the existing partnerships across the health and care system and continue the excellent work that non-statutory integrated care systems have started.

NHS England and NHS Improvement are already supporting commissioners through their strategic clinical networks. These networks are using integrated whole-system collaborative approaches to continue to drive improvements in outcomes for patients at the end of life, including through encouraging innovation and sharing best practice. One example is the work of the north-west palliative and end-of-life care strategic clinical network, which is focused on delivering activities to promote equity and reduce health inequalities in palliative and end-of-life care across the region.

If passed, the legislation will increase integration between health and social care further by removing barriers to data sharing and enabling joint decision making and collaborative practice. As a Government, we value collaboration at all levels, and just this morning I met colleagues from Marie Curie to discuss services for people at the end of their life. I am keen to continue to work with our passionate and dedicated stakeholders to further consider the opportunities for embedding best practice at local and national level, and to ensure that there is no postcode lottery or patchy services. Building on the great work that is already happening and looking to the future, we know that demand for palliative and end-of-life care services has increased and will continue to do so as our population ages. The Government will continue in their commitment to enable high quality personalised palliative and end-of-life care, and we are committed to ensuring dignity and choice for all, even at the most difficult of times.

Question put and agreed to.

House adjourned.