Monday 4 July 2022
[Sir Roger Gale in the Chair]
Before I call Tonia Antoniazzi to move the motion, I need to make a short statement about sub judice. I have been advised that there are ongoing cases relating to the subject of today’s debate, which, for the sub judice resolution, have not been waived. All Members must refrain from making reference to any active court cases. The Chair, whether it is me or my successor in the Chair, will call you immediately to order should you seek to raise any individual case. I have to make that point very strongly and clearly.
After the opening speech, it is already apparent that we shall have to confine speeches very rigidly indeed. As a courtesy to all colleagues, given that there will inevitably be some interventions, we had better start from the premise that we will limit all speeches to five minutes only. I am sorry about that, but I wish to accommodate as many people as possible for what is clearly a very important debate. I call Tonia Antoniazzi.
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.
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.
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.
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.
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.
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 (Karin Smyth)—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.
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 (Paul Blomfield) 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.
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 (Tonia Antoniazzi), 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?
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?
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.
The hon. Member is making a number of points. Like the hon. Member for Thirsk and Malton (Kevin Hollinrake), 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.
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?
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 (Tonia Antoniazzi) 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.
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—
No, I do not have injury time.
The hon. Member for Bristol South (Karin Smyth) 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.
I pay tribute to the hon. Member for Gower (Tonia Antoniazzi), 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.
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 (Tonia Antoniazzi) 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 (Danny Kruger), 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 (Karin Smyth) 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.
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.
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 (Steve Brine) 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.
I commend my hon. Friend the Member for Gower (Tonia Antoniazzi) 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?
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.
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.
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.
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.
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.
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 (Paul Blomfield) 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 Margo MacDonald, Patrick Harvie and Jeremy Purvis 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 Liam McArthur 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”,
“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.”
“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.
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 (Sir Peter Bottomley) 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]
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 Baroness Meacher. 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.
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.
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.
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?
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.
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.
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—
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.
It is a pleasure to serve under your chairmanship, Mr McCabe, and I congratulate the hon. Member for Gower (Tonia Antoniazzi) 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 (Matt Hancock) 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.
It is a privilege to serve under your chairmanship, Mr McCabe. I thank my hon. Friend the Member for Gower (Tonia Antoniazzi) 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.
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 (Tonia Antoniazzi), 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 (Danny Kruger) 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 (Matt Hancock) 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—
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 (Matt Hancock), 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 Liam McArthur 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.
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 (Peter Gibson) 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.
Mr McCabe, you and many of the Members in this room will know Frank Field. We are debating today whether to have a debate, and there was a debate in the House of Lords on 22 October, at which Baroness Meacher spoke for Frank Field, 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. Frank Field 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.
I thank the hon. Member for Gower (Tonia Antoniazzi) 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.
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 (Alison Thewliss) 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 Margo MacDonald, who was very much the face of this debate in Scotland for many years, and I congratulate the hon. Member for Gower (Tonia Antoniazzi) 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 (Sir Edward Leigh) 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.
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 (Rachel Hopkins) 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.
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 (Paul Blomfield) 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.
It is a pleasure to serve under your chairmanship, Mr McCabe. I thank the hon. Member for Gower (Tonia Antoniazzi) 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.
It is a pleasure to serve under your chairmanship, Mr McCabe. It is a pleasure to follow my hon. Friend the Member for Sevenoaks (Laura Trott) and to speak in the debate. The opening speech from the hon. Member for Gower (Tonia Antoniazzi) 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 (Christine Jardine), 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 (Jill Mortimer)—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 (Wera Hobhouse), 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 (Paul Blomfield). 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.
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.
That was a very good speech. I thank the hon. Member for Gower (Tonia Antoniazzi) 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 (Sir Edward Leigh) 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.
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 (Paul Blomfield) 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.
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 (Tonia Antoniazzi), 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 Lord Faulks, 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 (Matt Hancock), 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 (Wes Streeting) 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 Baroness Finlay of Llandaff 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.
It is a pleasure to serve under your chairmanship, Mr McCabe. I congratulate the Petitions Committee and the hon. Member for Gower (Tonia Antoniazzi) 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 (Robin Millar). 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 (Andrew Selous) and for Devizes (Danny Kruger) 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 (Ian Paisley) and the hon. Member for Bristol South (Karin Smyth), 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 (Matt Hancock) —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 (Sally-Ann Hart) 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 (Kevin Hollinrake) and for Boston and Skegness (Matt Warman), the hon. Member for Brentford and Isleworth (Ruth Cadbury), and my right hon. Friend the Member for West Suffolk. The hon. Member for Glasgow Central (Alison Thewliss) said it is about the right to choose “a good death”.
I was particularly moved by the hon. Member for Sheffield Central (Paul Blomfield), 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 (Laura Trott) and others. However, against that—we must remember this—the right hon. Member for East Ham (Sir Stephen Timms), 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 (Peter Gibson) 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 (Sir Edward Leigh) 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 (Sir Desmond Swayne) 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 (Geraint Davies) 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.
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.
That this House has considered e-petition 604383, relating to assisted dying.