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12,832 spoken contributions under 12 words (interjections such as “Will the hon. Member give way?”) are hidden. Show them
That is a part of our usual parliamentary process and the hon. Lady is right to raise that point. By sending the Bill back to the Lords as it stands, we will prevent that same small group of peers who talked it out last time from doing the same thing again. It is my fervent wish that all the peers—
No, I am sorry; I will make some progress. It is my fervent wish that all the peers in the House of Lords will accept that important distinction between their Chamber and ours, and fulfil their role in the usual way. In doing so, they can consider and send an amended Bill back to us for a final vote before Royal Assent.
No, I will make some progress. If, at that point, Members of this House decide to vote the Bill down, I and many others, in this Chamber and outside, would be upset and disappointed, but I would accept that as a result of the proper democratic processes being followed. What I cannot accept, and what many people both inside and outside the Chamber cannot accept, is the current situation, where a small number of unelected peers filibustered legislation that was supported by this Chamber. That is not how our democracy is supposed to function.
They were dropped in favour of a stronger safeguard, which was a multidisciplinary panel of people with different perspectives who were trained in spotting coercion—a psychiatrist, a legal expert and a social worker, bringing other people in with different perspectives—to ensure that the person taking the assisted death decision was doing so in an informed and settled way, free from coercion. That was a strengthening of the Bill, not a weakening.
I will make some progress. Members took the best part of a year to grapple with this issue: spoke to constituents; engaged with the organisations that would be affected; read the materials; thought deeply; consulted their conscience. They arrived at a decision—whatever that decision was and however they voted or, indeed, did not vote at all—but it was a difficult process. It is not acceptable that the outcome of those deliberations has not been respected. We owe it to the people we represent to find a resolution on this issue one way or another within this Parliament.
We have been through that process. There was a Committee that had hundreds of hours of scrutiny and properly kicked the tyres on the robustness of this legislation. What we need to do as a House is send the Bill back to the House of Lords so that they can finish their job. We did ours.
I will make some progress. As important as a democratic point of principle is to the argument I am making, we must not lose sight of the people who are relying on us most: the terminally ill and their families. The Gallery today is filled with inspirational people campaigning for this much-needed change in the law—people who are themselves terminally ill and who, due to the passage of time, may never get the opportunity to choose a dignified death surrounded by their loved ones, but who nevertheless spend the time that they have left campaigning so that others in future may have that choice.
I am sorry; I will not. Those people include Christie Arntsen, who has lived for more than a decade with incurable metastatic breast cancer, which has sadly returned for the fifth time. She is undergoing what may be her final treatment of chemotherapy. Christie speaks eloquently about how her fear of a difficult death has weighed on her mind since her diagnosis and affected her life: “For me the scariest part of having the diagnosis was that I had no control over the last few weeks of my life…If I had known that assisted dying was an option, a weight would have been lifted from my mind for the last 10 years.”
I will make a little more progress. This is the cost of accepting the status quo: the fear and worry for those who know that palliative care may not be enough to avoid a difficult and painful death. It snatches away their final moments, which, as I know from speaking to friends and family in Australia, can be much better spent when there is a safe voluntary assisted dying system in place.
I would point out that there is a range of views among those in the palliative care community. It is specifically for that reason that the Bill allows them not to be involved in the process if they do not wish to be.
No, I am sorry. I end with the words of Elise Burns, who, like me, called Kent home, and who sadly died in July with secondary cancer of the lungs, liver and bones. She said she would love peers “to look me in the eye and tell me why me and my friends, and anyone with terminal illness, don’t deserve to die with dignity and to have the choice to die…without pain.” We owe it to terminally ill people like Elise, who are relying on us and who were so filled with hope when we voted in favour last time. Quite rightly, they cannot understand how, having secured the support of the people they elected to represent them, the issue that is so important to them has been frustrated by a small group of people with no democratic mandate. The important conversation that we have been having on assisted dying, as legislators and as a society, has been interrupted. To leave it so would have a profoundly negative impact on people’s trust in our political system. If we fail to support the Bill’s Second Reading, are we not saying that it is fine for a minority of unelected peers to defy the will of the House of Commons? Are we really prepared to cede that point and accept the consequences not only for this vital legislation but for future legislation too? I ask hon. Members to join me in sending a clear message that the will of this Chamber should be respected, on behalf of all the people that we represent, and to support this Bill on Second Reading.
I am very grateful to the hon. Member for Havant (Alan Mak) for securing this important debate. He spoke movingly and has given the House an opportunity to mark the 25th anniversary of the deadly terrorist attacks of 11 September 2001. Twenty-five years on, it can be tempting to think of 9/11 as a moment in history—an event, perhaps, for a textbook, museum or documentary. Those, of course, are important, and I will come to them later, but for thousands of families, 9/11 is not history at all; it is a memory deeply felt of someone who left home that morning and never returned. So today we begin with them. We remember the nearly 3,000 people killed in New York, at the Pentagon and in Pennsylvania. We remember the victims from more than 90 countries. We remember the 67 British citizens who lost their lives. We stand with those who lost people they loved and those who have carried that loss for a quarter of a century. The hon. Member for Havant spoke movingly about his constituent Sally Taber and the loss of her godson, Oli Bennett. I pay tribute to Oli and offer my deepest sympathies to Sally, to all his family and to all those who knew and loved him. The charitable work established in his memory is a truly powerful example of how a life can continue to inspire hope and opportunity for others. We should also remember and honour the extraordinary courage that was shown that day by the firefighters who climbed the stairs of the World Trade Centre while thousands of people were trying to escape, and by the police officers, paramedics and ordinary members of the public who did extraordinary things, putting the safety of others before their own. Passengers aboard Flight 93 acted with remarkable bravery. As my hon. Friend the Member for Edinburgh South West (Dr Arthur) said, many first responders lost their lives, but others have lived with the physical and mental effects of what they experienced. Their courage deserves more than our admiration; it deserves our lasting remembrance. The courage we remember today was individual, but the response that followed was truly collective, as the hon. Members for Christchurch (Sir Christopher Chope) and for Strangford (Jim Shannon) have told us. For 25 years, the United Kingdom and the United States have stood together in remembrance, and we do so again as we mark this anniversary. The hon. Member for Havant asked about closer educational and commemorative links with the National September 11 Memorial & Museum. Our diplomatic network in the United States has worked closely with American partners and other stakeholders in support of this anniversary, and we will continue to look for opportunities to deepen US-UK co-operation in that regard. My hon. Friend the Minister for the Americas represents His Majesty’s Government at commemorative events in New York today, including at the National September 11 Memorial at Ground Zero and at a special memorial at the Queen Elizabeth II September 11th Garden. There, he will join victims, families, survivors, first responders, American representatives and international partners. Here in the United Kingdom, the anniversary was marked this morning with a special changing of the guard ceremony at Buckingham Palace. It echoed the special programme of music played there on 13 September 2001, when the British and American national anthems were played as a clear signal of our unity and support. Their Royal Highnesses the Duke and Duchess of Gloucester and my right hon. Friend the Foreign Secretary stood alongside the United States ambassador to the United Kingdom, Warren Stephens, to remember. They were joined by representatives of victims’ families and UK emergency services. Those events cannot undo the pain of the past, but they are a way of us saying that all lives that were lost still matter, their sacrifices still matter, and we will never forget what happened. The hon. Member for Havant rightly focused on our responsibility to pass the memory of 9/11 on to a new generation. Many of us remember where we were when we heard the news, and my hon. Friend the Member for Watford (Matt Turmaine) reflected on that powerfully, but many young people have no memory of that day; many were not yet born. Future generations should understand what happened and why it mattered. Education should explain clearly the harm caused by terrorism. It should tell the stories of the victims, and it should recognise the courage of the first responders. The National September 11 Memorial & Museum plays a vital role in preserving such stories and helping new generations understand both the scale of the attacks and the individual lives affected. Wider digital archives allow people around the world to hear testimony, see photographs and explore historical records, and the UK is playing its part too. Through institutions such as the National Archives, records connected to September 11th are being preserved so that future generations can continue to learn from them. The hon. Member for Havant asked about how 9/11 is taught and remembered in schools, and I will ensure that his points are drawn to the attention of my right hon. Friend the Education Secretary and the Minister for the Americas. The attacks of September 11th demonstrated, with truly tragic clarity, why our collective security matters. Following 9/11, NATO invoked article 5 for the first time in its history, because our allies recognised that an attack on one was an attack on all. In the years that followed, British and American service personnel would stand side by side once again in Afghanistan. Many never returned home, and we remember them today, too, and recognise the lasting impact on veterans and military families. Today, this House has come together to remember those who lost their lives, honour the courage shown that day, and stand with the families and communities whose lives were changed forever. As we mark this 25th anniversary, let us remember that behind every single statistic was a person, behind every headline was a family and behind every act of remembrance is a promise: “You will never be forgotten.” Question put and agreed to.
The right hon. Lady is making a very important point, which I have considered at length during the last two years. Many amendments relating to coercive control were made to the Bill to ensure that all professionals involved have training, and there are multiple checks for coercion throughout the process, which do not currently exist. At present we check for coercion only when someone is dead.
I have struggled with this vote perhaps more than any other in Parliament. Had I been asked at any time in my life whether I was for or against assisted dying, I would have said that I am in favour of it. I believe that people have autonomy over their own bodies as a fundamental liberal principle. But we do not vote on principles here; we vote on legislation, and this Bill at this time is not one I can support. I do not believe that it is safe. I do not believe that it addresses the very legitimate concerns raised by disabled voices, and I do not believe that it has come at the right time. In my speech, I will cover the state of palliative care and fears of coercion, but first, I thank my constituents for the role that they have played in this, coming to meetings, speaking to me at surgeries, writing me emails in a respectful way—the way that we should conduct our politics in all things but particularly those that are so serious. I bring professional and personal experience to this debate. I have been a council cabinet member for social care, sitting on a safeguarding board, I have worked for the General Medical Council and for the past two years I have sat on the Health and Social Care Committee. Like many people, I have also sat with a loved one as they died. Ultimately, my experience means that I do not for one minute believe that this is simple. I know that if we do not pass this Bill, some number of people will die in preventable pain and suffer a painful death. I also know that if we pass any Bill, there will be some number of people who are coerced into taking their own lives. If you have moral certainty—
I will not give way just now. If you have moral certainty on this question, I honestly envy you. On the state of palliative care, we are told that this Bill is about giving our constituents more options—a choice between good palliative care or an assisted death. But in a world where there are such gaping holes in our health, social care and palliative care system, that is simply not the case.
Not just now. Our Committee asked our independent expert panel to look into the quality and availability of palliative care, and the results should give everyone in this room pause for thought, because we do not have a universal offer of palliative care in this country. The report points to a postcode lottery of provision. Hospices are largely funded through charitable donations, which means that in better-off areas there is better care. The Committee hears constantly about the social determinants of health. Let us not have one of them be that those in wealthy areas have the choice of a comfortable death, while the poor must choose an early one. Furthermore, there is a workforce crisis in palliative care. There are 700 palliative care doctor posts, but 70 vacancies. Add to that 130 doctors expected to leave the profession in the next five years while, to make matters worse, training bottlenecks mean that there will not be specialist doctors trained to replace them. All that is in a landscape where we expect demand for palliative care to increase by 55% in the current decade. I want a safe Bill that takes all those things into account. A safe Bill would give some discretion to the Health Secretary on when they implement it. This Bill does not.
I am sorry; I will not just now. This Bill has an auto-commencement clause, which means that within four years of the passage of this Bill—whatever the state of our health service, of our social care, or of our palliative care; even if there has been another pandemic—it will come into force. That brings me to our safeguards. I cannot vote for a Bill that does not sufficiently guard against coercion. That is what my constituents with disabilities say they fear the most and, having been in charge of social care, I know what that looks like. Let me be clear: the safeguards in this Bill are not enough. If the Bill in its current form passes, a patient would be subject to more scrutiny to give up a kidney than to give up their life. The ultimate weakness of this Bill is that the question being asked when a patient goes to the panel is a medical and legal one, not a social and psychological one. The main judgment will be an assessment of whether they are likely to die in the next six months, not of why they have chosen to die or whether there is a risk of coercion. Coercion is not always committed by the traditional villain; it is not someone who wants money. It is often committed by a loved one at the end of their tether, as support falls away, money drains, options narrow and people’s sense of what choices they have narrow, too. Without improving palliative care, we will put far too many people in that heartbreaking position. As MPs, we are used to being forthright in our opinions and advocating for ourselves and our constituents. On our Select Committee, we constantly hear from vulnerable patients who say that they are frequently ignored, talked about or talked over by medical professionals. They feel talked at, not talked to. When considering this legislation, I do not ask whether it will work for people like me; I ask whether it will work for the most vulnerable—those whose voices are rarely heard and who are most dependent on the state for protection. They rely on us to be their voice. The Bill comes from a place of compassion, but it could lead to a place where a disabled person feels that they are less. It could lead to a place where poor social care means that people do not feel that they have a choice between a comfortable life and an early death. That is why I say, with a heavy heart, not this Bill and not at this time.
Suicide currently outstrips homicide as the main reason for the deaths of women in cases of domestic abuse and coercive control, so what the right hon. Gentleman outlines is currently happening. Arguing for the status quo is not something I feel comfortable with. I feel considerably stronger about the safeguards that I worked with my hon. Friend the Member for Spen Valley (Kim Leadbeater) to ensure that the Bill had.
I pay tribute to my hon. Friend the Member for Filton and Bradley Stoke (Claire Hazelgrove). Mainly because I am a bit lazy, I rarely prepare to speak in debates, and never have copious notes. Her remarks have led where my remarks will go. I will cover the issue of coercion, which hon. Members have mentioned, and, like her, will talk about my mother, who also died when she was 61 years old, unfortunately when I was much younger than my hon. Friend. My mother died when I was 28 years old—many years ago now. My mother had a leiomyosarcoma, and suffered with it for around three years. The prognosis did change—I hear the arguments that some hon. Members are making—but towards the end of her life, at one point she felt she was going to die. It was coming to the end. She was in a wheelchair. She was completely paralysed. She was doubly incontinent by this point. To give hon. Members an idea of the kind of woman my mother was, she was an absolute titan. She was like Erin Brockovich, but with a bad perm, in the 1980s. She could lay claim to being able to spot talent, because she gave a job to the current Prime Minister, who worked for her for some time. He is often teary-eyed when I talk to him about her. My brothers live in different parts of the world and country, but I live 20 minutes from where I was born and where my mother lived. When she got to this stage, we all went back to be with her, because we believed that this was it—that she was going to be taken, that she was going to die. She did not die on that occasion, so my brother, who lives in France, went back home. Then, when it came to the point that a doctor made the call and said, “Your mom is about to die,” my brother could not come back—this was about four weeks later. So it was me who was with my mom when she died—not all of her children, and not all of her grandchildren. I am eternally grateful that I was there. This was a woman who had written every part of her funeral. She knew exactly what she wanted us to feel. She had planned, to the nth degree, what would happen after she was gone. The other day, I found a recipe for Christmas puddings and the PIN for her credit card—she was like, “Your dad might not be able to get money.” My mom had thought about everything, but she was not gifted with the ability to think about this. She would have taken the choice on that day, when my brothers were surrounding her. She did not die in terrible pain—I recognise what my hon. Friend the Member for West Lancashire (Ashley Dalton) is saying. She was not writhing. It was not awful. However, she should have been able to choose to have her family with her. I will vote for this Bill. I went to women’s liberation playgroup, which she set up with a load of women. She raised me to believe in a right to choose—my gosh, more than anything else in life. She would tell me what to do today. Many people have mentioned coercion. I am a scholar of coercion, and I say this to everybody today: do not rest on your laurels thinking that, if we do nothing, people today will not be coerced to death. That will literally happen today. The idea that if we just do nothing—
I am not going to, because Madam Deputy Speaker has been clear. The idea that if we do not pass the Bill today, we are going to walk out of here and women in our country will be any safer is an absolute myth. Doing nothing is not the same as acting.
If the primacy of this place is the most important point, why has the Bill’s promoter said that she will not allow amendments in this House at this stage?
Surprisingly, I will not try to persuade hon. Members how to vote today, because I think they know by now how they will vote and why. However, I feel I need to share my thoughts and views with my constituents, and to set out why I am voting the way I am. I say this because there is a significant change from how I voted previously. If hon. Members are influenced by my contribution, so be it. I will get right to the point. I previously voted for assisted dying. I recognised then, as I do now, the deep turmoil that family members experience when they know that their loved ones are dying, or see them die. The agonising distress or pain that they experience is something that no one wants for themselves or their loved ones. However, I cannot shake from my mind a conversation I had with someone some time ago about assisted dying. They had been diagnosed with HIV/AIDS before the time of advanced medication for this illness. Their body was breaking down, and they had been informed that their prognosis was bleak. They said that had assisted dying been an option for them then, they would have taken it. However, it was not an option, and they have since been stabilised on medication and are in full-time work. Although they do have side effects and feel tired, they are living a meaningful life, and, as Members can imagine, they are no longer an advocate for assisted dying. When I previously voted for assisted dying, the way I voted on the amendments to the Bill varied, as I was trying to navigate my way through this issue while ensuring that I was considered in my approach, but the question of inequality was always on my mind, and how this would impact poorer communities, isolated individuals, people with mental and physical disabilities, and those in controlling and coercive relationships; how this system would work in our society now, and how it would change in years to come; and, of course, how it would impact black and minority ethnic communities, who already experience deep inequalities in the health service, as shown by years of impact assessments and reports on the issue. As chair of the APPG on sickle cell and thalassaemia, I am constantly reminded of the health inequalities and suffering that people with this disorder continue to experience. They are constantly undermined and ignored, and their disorder is grossly lacking in research funding. Among the new evidence is the Government’s own equality impact assessment on the effect of assisted dying on the health service. This recent report suggests that people from ethnic minority backgrounds may be more susceptible to coercion due to structural pressures such as poverty, lower-quality care and domestic abuse. The impact assessment states that as a result of those pressures, ethnic minority people could disproportionately choose “to have an assisted death to avoid financial hardship or escape abuse.” This relates to broader concerns regarding the availability and quality of social and palliative care, particularly for already disadvantaged communities. Earlier this year, up to 60% of hospices reported that they were having to make cuts to frontline services as a result of financial pressures. While the Government have increased funding for the sector, it is clear that far more work is needed before those in need of support at the end of life receive the dignified care and choice of treatment they deserve. Alongside that are the additional pressures on the broader health service and the legal sector resulting from this Bill; they reinforce my decision to vote against it. I implore the Government to invest in hospices and palliative care across the country, to make them the best they can be for all postcodes. Following my vote in favour of assisted dying, I had nightmares about dying and death for two nights. I had to wrestle with the knowledge that I was not entirely comfortable with the decision I had made. My conscience was not at peace, and I cannot again in good conscience vote for the Bill. In fact, I wish there was a Bill before this Chamber that we could have all got behind, as there is so much that needs to be done in our society. I decided that if the opportunity arose again, I would vote against assisted dying. I do not judge the conclusions that other hon. Members and hon. Friends reach, but I ask that we respect each other and act in a respectful way.
Will my hon. Friend be generous enough to give way on that point?
This is a very difficult moral and practical question, but for me it is fundamentally about whether we can act to relieve human suffering. We have heard a number of profoundly moving speeches in the debate, and I highlight in particular the speeches of my hon. Friends the Members for West Lancashire (Ashley Dalton) and for Filton and Bradley Stoke (Claire Hazelgrove). We are talking about people who fear or face unbearable pain, choking or gasping for breath, or loss of control at the end of their lives. Are they not vulnerable, too? For me, that is an important point. The question is, can we really look these people in the eye at the moment and say, “I’m very sorry, but I am not prepared to vote to support your being given the means to remove that fear”—not everyone will take advantage of the provision, but for them it is an assurance—“or to relieve that suffering, even though that is what you wish”? Are we going to say, “I’m sorry, but I will not give you the means of determining the manner of your passing from this world, surrounded by those whom you love”?
I will not give way because of the constraints of time. I do not think we can any longer justify the contradiction that is at the heart of this debate. We know that people with terminal illnesses are already killing themselves. That happens. It is not at all covered by the protections contained in the Bill that my hon. Friend the Member for Rochester and Strood (Lauren Edwards) has proposed. The biggest contradiction of all for me is the fact that there are those who travel abroad. We know that is happening, and I think it is a very uncomfortable fact for those who oppose the Bill for this reason: it is a gaping hole in the argument against the Bill. The truth is that the Crown Prosecution Service faced a terrible dilemma. It could see the number of people going to Switzerland, and it had to ask itself, “Are we actually going to prosecute mums, dads, spouses, lovers, friends, brothers and sisters for going with those whom they love to be with them at the end?” That is how the CPS came to draw up its guidelines. For me, they are full of common sense, because they say that in these circumstances, it is not in the public interest to prosecute someone. If we look at the figures, the vast majority of family members who have accompanied their loved ones to Switzerland have not—rightly, in my view—been prosecuted for what I would regard as a final act of love. Indeed, it would be an outrage to prosecute them. Despite those guidelines, some people are fearful, because they get questioned when they come back, and some have not gone to Switzerland with their loved ones, to hold their hands at the last, for fear of what might happen to them. The question I put to the House is this: if we have in effect legalised assisted dying for British citizens who have the money and means to do it abroad, and that is what we have done—I have heard no one in the debate criticise that—then why are we not prepared to provide the same means to people who are terminally ill to bring their lives to an end here in the United Kingdom? Coming to terms with our own mortality is about the final journey that we will make. We talk about awe and wonder; I never fully understood what awe and wonder meant until I was present at the death of those I loved most dearly. When the previous Bill was given its Second Reading, and the result was declared, there was this extraordinary moment—complete silence in the House. Why was that the case? Because we understood the significance of what we had just done and the consequence of the Bill that we would eventually vote to send to the other place. Today we are once again called on to make our choice. I have made mine. I will cast my vote to enable those who are terminally ill and who want to take control of the moment of their death, who want to be able to relieve their suffering, and who want to feel that they do not have to fear what is coming, to take that decision, if that is their choice. I urge the House not to deny those people that choice.
As a practising surgeon who deals with bile duct cancer, I can reassure my hon. Friend that there is almost never a reason that someone should be in that state, with feculent vomiting, if they were treated appropriately and all the relevant palliative care measures were in place.
I speak on this matter as an active medical practitioner, a transplant surgeon and a cancer surgeon. Much of my clinical practice for the last 20 years has revolved around caring for unwell complex patients, many of whose illnesses flicker between the labels of “terminal illness” and “life-limiting illness”. It is some of that experience that I wish to bring to bear on this debate. Let me start off by acknowledging the varied experiences people have at the end of their life, or their loved ones’ lives. I have cared for and operated on thousands of patients in that position, and I have helped many, but I have often fallen short, and some of those stories have played vividly in my mind over the last few days. When they have, I have reflected on the fact that more often, when things have not gone right, it is not because of a failure, but rather an absence of universally available good-quality palliative and psychological care. Today, as a Member of this place and as a surgeon, my job is to help move this discussion beyond the emotive and the case study to level-headed analysis that will serve our society well, not only today but for decades to come. Having read this Bill again, and with the hindsight of ministerial experience in the Department of Health and Social Care, I am more convinced than ever that our social care and palliative care systems simply are not ready to meet the demands of this Bill—at least not equitably. The Bill, when taken from the laboratory of legislative text and dispatched to the bedside and the clinical frontier, will not serve its laudable aims of bringing choice and control over a pre-emptive, quick death, which is what many desire and expect from this legislation. While it will not fulfil those aims, it will expose millions: the quietly vulnerable. I think of constituents and patients of mine in Glasgow South West, more often than not women, who quietly concede to me, usually in the sanctity of a clinic room, that they do not wish to be a burden, and who have on many occasions asked me to end their life because they have suffered multi-generational financial strains and do not want their illness to hold back their children and their grandchildren. When you visit places like Govan and Pollok as a parliamentarian, as well as a doctor, you understand that as a society, we are only scratching the surface of understanding the full extent of coercive control in this country.
I commend the hon. Member for her powerful testimony. I know that she has personal experience of this matter. When you visit places like Govan and Pollok, you know what vulnerability looks like. Those people cannot send their voices down here via the mic, the TV studio or a billboard in Westminster tube station. We need to make sure that they do not feel the burden of making what some call an option, or a choice, their obligation or duty.
Not at the moment. It is on the foundational principles of the Bill that I primarily want to concentrate today. The first is the idea of a “six months to live” label. “Terminal illness” is a fast-changing medical diagnosis in the modern medical world, and it is becoming an increasingly meaningless term. Only yesterday evening, I was in the company of a professor of respiratory medicine who, with rightful satisfaction, told me that many of his stage 4 lung cancer patients who were designated with six months to live in 2023 are being managed as having a chronic disease in 2026. In my practice, if a patient comes to see me with stage 4 colon cancer that has spread to their liver, the advent of immunotherapy means that I have an equal chance of telling them they have six months to live or six years to live. Under this law, when I meet that kind of patient, it is unclear to me, with the Supreme Court precedents around consent, whether I should be offering them immunotherapy and an assisted death at the same sitting. A six-month prognosis will take a new and unhealthy salience in every clinical conversation. It will be a label some will desire, and others will want at all costs to avoid being placed on their clinical record. It will fundamentally change and undermine the candidness and sanctity of the patient-doctor conversation and relationship.
I am grateful to my hon. Friend for mentioning the Scottish context. We voted down such legislation on Third Reading, when we understood the impacts and the wider societal ramifications. I have to be honest. When I am asked to prognosticate on whether someone has six months to live, I am as often wrong as I am right. It is no longer a good enough marker for the DWP to use in discharging benefits for life-limiting conditions, and I do not see why it should be a good enough marker for prescribing death. There is another paradox in this legislation: someone like me could write a prescription to induce death with less regulatory oversight than is on me when I have to remove a kidney to give life through transplantation. Of course, I sympathise with and endorse the desire of many colleagues who support this Bill to relieve suffering. To be clear, we have many tools to do this, and we must bust some myths today. Clinical discretion, for instance, means that there is no maximum dose of morphine, so I can give my patients whatever they need, in the setting in which they need it. But this Bill is less about relieving suffering and more about bypassing its possibility, and I understand that. The Bill is in many ways advocating for death as prophylaxis. Under the definition in this Bill, death must be induced by medical prescription. It will be the only medical prescription that I will be able to write as a doctor but not administer, because the burden of administration falls to the patient, and the weight of expectation falls on the patient. We must discuss the mechanisms by which death will occur: muscle paralysis, slowing of the heart rate, sedation, and the possibility that paralysis will take hold before sedation does. Death will not be an event; it will still be a process. In 15% of cases, it will be subject to some form of complication, such as vomiting or seizures, and it will not always achieve its goal. I wish I could give hon. Members more information about the complication profile, but despite this procedure being prevalent in other jurisdictions across the world, the data continues to be woefully lacking. Alongside that, the 14-day cooling off period means that the patient must remain lucid in that time. There have been cases elsewhere in the world where patients have denied themselves palliative care and pain relief to remain lucid in order to consent to their death. I am therefore of the opinion that the foundational elements of this Bill will create the allure of choice and control, but not the agency to pursue either. Turning to safeguards, much is made of the provision requiring two doctors to assess eligibility, but the trouble is that neither has to know the patient well, or go to any great lengths to exclude the likelihood of coercion. Doctors are trained to do many things, but assessing and picking up on coercion is not one of them. In fact, consultant psychiatrists with PhDs in coercion, like the hon. Member for Runnymede and Weybridge (Dr Spencer), whom I hope we will hear from soon, have said in written testimony presented in court that they would find it difficult to exclude coercive controlling behaviour. I came into medicine, and into Parliament, to act with compassion, and to provide dignity to those we serve. I believe that is why we are all here. Compassion and kindness is not the preserve of one those on one side of the argument or another, but for me, compassion and kindness also calls to courage—the courage to be honest with patient and constituent alike. We need the compassion and honesty to say that the Bill will not fulfil its aims; it will disappoint many who crave total agency and control, and it will expose and disenfranchise further the vulnerable in our society. We need the compassion and honesty to say that our NHS, while a great institution, is not, in its current form and state, ready. It is not safe for this conversation or for this Bill in this moment.
I thank my hon. Friend for giving way, and for making an incredibly strong speech. I was part of the Bill Committee, and we gave about 200 hours of assessment to this Bill, which is much more than most Government Bills get. Indeed, the Lords had an enormous amount of time to consider it, too. Saying that there has not been enough scrutiny is simply wrong.
Does my hon. Friend acknowledge that, even with excellent palliative care, there are very similar rates of people demanding assisted dying? In fact, even in 2010, when we had probably the best palliative care in the world, people still went to Dignitas or took their own lives.
Can I just say that there has not been one confirmed case of coercion in any of these jurisdiction anywhere in the world?
May I praise the House for some fantastic speeches all round, including from my hon. Friends the Members for West Lancashire (Ashley Dalton) and for Filton and Bradley Stoke (Claire Hazelgrove), and indeed just now from my hon. Friend the Member for Penistone and Stocksbridge (Dr Tidball) and the hon. Member for Runnymede and Weybridge (Dr Spencer)? I am proud of our House and the way in which we have debated this matter. I have been involved in delivering palliative care and end-of-life care—they are actually quite different—for over 34 years and I continue to do so as a GP. Given the time, I will cut my speech short, but I want to say that this is really about choice. Choice exists for people in France, in Spain, in the Netherlands, in Belgium, in Australia, in the US and in Canada, and indeed in Jersey and the Isle of Man. It also exists for people in this country if they have got 15 grand. However, we do not give access to it at the moment. To all the doubters, I say that this is the safest assisted dying Bill in the world—full stop. That is a fact, because it has got so many safeguards: many more than the ones in Australia or any other place.
No, I will carry on if that is okay. It is a great thing to offer end-of-life care and palliative care. In 2010, the UK system for palliative care was at the level of the best in the world, yet still people went to Dignitas. Still, 600 people who were suffering from terminal diagnosis killed themselves. Indeed, in Oregon, 92% of patients who opted for assisted dying were receiving good palliative care. They are different things.
I am going to carry on; I will be very brief. There has been a lot of concern—quite rightly—about disabled people and people from black and Asian minorities and whether they will be harshly dealt with. In fact, the evidence from other jurisdictions is that these people do not go for assisted dying—it is actually a white, middle-class, able-bodied thing—so in a way we have the opposite problem to deal with. Let me also say, to answer a point made earlier, that studies done in California showed that where people with terminal illness and depression were treated for their depression, it made no difference to their choice on assisted dying. Assisted dying is different because, as my hon. Friend the Member for Bury St Edmunds and Stowmarket (Dr Prinsley) said, it is a choice not between life and death, but between someone’s death from natural causes and death under their own control. I say to all hon. Members that we have a choice to make in five or ten minutes, but we must give other people that choice. Is it our right to deny those people that choice? I will end my remarks as Madam Deputy Speaker is giving me some black looks.
The hon. Gentleman mentioned the loss of emergency workers in that brutal attack, and we celebrate and salute their courage. But we now know, since the attack, that more firefighters have died as a result of their work on the site than died on the day of the attack itself. When we remember those who died that day, we also have to think about the legacy of the attack, including those firefighters who have been lost.
I thank my hon. Friend for giving way; she is being very generous with interventions. Is she willing to share with the House what, if any, amendments the Lords made, besides the two she has mentioned, that she thinks should have been added to the Bill, and, if so, why they were not?
Does the hon. Member acknowledge that the handful of peers she refers to include the former presidents of the British Medical Association and Royal College of Psychiatrists, a leading professor of palliative medicine, a former chief executive of NHS England, two former Attorney Generals and the former president of the family division of the High Court?
I have cared for patients with advanced cancers of the head and neck, and I have seen patients at the end of their life. It is that experience above all that convinces me that we must introduce this humane and dignified option to assist those who are dying, so that they can die in peace at a time of their choosing and avoid the loss of autonomy and dignity that so many people fear. I fear it; perhaps other hon. Members also fear it, for none of us can know when we will die until we are dying ourselves. This is not a measure that chooses between life and death; it chooses between death and death, between dying and dying. That is the truth of the matter. I did not always think like this, but I have seen the limits of even the most skilful palliative care. I have seen the look in the eyes of the patient reconciled to the end of their days, and the pleading expression of the poor soul who wants to put an end to suffering. That is what we are debating—suffering. Assisted dying is complementary to palliative care; it is not an alternative. Others will say that assisted dying is unconscionable, and I respect that. I am asking the House to vote to support choice; that is all I am asking. We voted for the Bill before, and hon. Members in the other place sought to prevent its passage, but we are not misled or deceived by such a parliamentary device, and neither are the public, who will not forget this moment. I urge Members across the House to support choice. That is all I am asking.