Terminally Ill Adults (End of Life) Bill
Will my hon. Friend be generous enough to give way on that point?
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Terminally Ill Adults (End of Life) Bill
Will the right hon. Member give way?
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Terminally Ill Adults (End of Life) Bill
Will my hon. Friend give way?
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Terminally Ill Adults (End of Life) Bill
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”?
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
Will the right hon. Lady give way?
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Terminally Ill Adults (End of Life) Bill
Will the hon. Gentleman give way?
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rose—
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
Will my hon. Friend give way briefly?
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Terminally Ill Adults (End of Life) Bill
Can I just say that there has not been one confirmed case of coercion in any of these jurisdiction anywhere in the world?
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
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.
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25th Anniversary of 9/11
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.
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Terminally Ill Adults (End of Life) Bill
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?
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Terminally Ill Adults (End of Life) Bill
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?
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Terminally Ill Adults (End of Life) Bill
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.
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Terminally Ill Adults (End of Life) Bill
Will my hon. Friend give way?
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Terminally Ill Adults (End of Life) Bill
This week, death has felt rather too close to home for me. My dad, John—my constituent, my great political hero and, indeed, my hero in life—had surgery for lung cancer, followed by a cardiac arrest the next day. Thanks to our wonderful NHS and its outstanding care, the CPR and treatment performed on him were successful. He is now in the process of recovery, to such an extent that I was able to have a detailed conversation with him at his bedside, in which he insisted that I come here to this place to speak and vote in this debate. My dad is determined to live. Nevertheless, he told me that if circumstances were different—if his condition was terminal, if he had six months left to live and if he had capacity to make that choice—he would want to have the option to choose an assisted death to give him dignity. Access to the choice of assisted dying, as tightly drawn in the Bill, enables the terminally ill adult who chooses it to live a good death. On Second Reading of the Bill previously brought forward by my hon. Friend the Member for Spen Valley (Kim Leadbeater), I said that my support was conditional on further safeguards being embedded in it, because too often control is taken away from disabled people.
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Terminally Ill Adults (End of Life) Bill
I will continue, if my hon. Friend does not mind. Clause 2(4) of the Bill before us today says: “For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both).” As a member of the previous Bill Committee, I worked for over 90 hours to ensure that all the changes that I requested were made, and they are now on the face of the Bill brought forward by my hon. Friend the Member for Rochester and Strood (Lauren Edwards). My amendments, including two new clauses, were unanimously supported by that Committee. The first, clause 48, establishes a disability advisory board made up of disabled people and our organisations in order to embed a long-term and iterative structure in law to report on the Bill’s implementation and its impact on disabled people. The second, clause 22, sets out provisions to put in place independent advocates for people with autism and mental health conditions, enabling them to effectively understand their options around end-of-life care. Further, I ensured that clause 8 provides for specific, up-to-date training for registered practitioners on reasonable adjustments and safeguards for autistic people and people with learning disabilities. I also secured an expanded duty in clause 28 to collect additional information about whether, immediately before death, the person seeking assistance has a disability—as defined under section 6 of the Equality Act 2010—other than a disability amounting to terminal illness, as defined in this Bill. Together, these measures create a solid foundation to enable disabled people to have a strong voice when advocating for themselves about their choices on end-of-life care and, importantly, to have a seat at the table so that they can scrutinise and monitor the implementation of this Bill. Spending nearly two years thinking about death in relation to this Bill has been life-changing for me, because the thing about considering choice in death, understanding what dignity in dying involves and what living a good death really means, is that it makes you think deeply about the meaning of living a good life, too: to love ferociously and to live passionately, experiencing every single moment as if suspended like a vignette woven from “Charlotte’s Web”. As E. B. White’s eponymous character points out: “After all, what’s a life, anyway? We’re born, we live a little while, we die.” Each of these stages of human life requires us to treat ourselves and fellow humans with dignity and to value ourselves, to enable us to feel and to perceive our own worth. This Bill not only anchors that dignity at the final stage but, in doing so, compels us to embed dignity in each and every other stage of our lives as well. This Bill lays a counterweight alongside the Government’s plans to improve the quality of and access to palliative care, to drive urgent reform on social care, and to build a new system that gives people the dignity, security and support they deserve. Driving quality in these areas together can and must be done contemporaneously. My friend, the incredible assisted dying campaigner Nathaniel Dye, passed away this year. He squeezed every single drop of joy out of life and taught me so much about why living a good death matters. In setting the bar high for dignity in death, we set the bar even higher for dignity in life.
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Terminally Ill Adults (End of Life) Bill
Will my hon. Friend give way?
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Terminally Ill Adults (End of Life) Bill
Will my hon. Friend give way?
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Terminally Ill Adults (End of Life) Bill
I thank my hon. Friend and constituency neighbour for giving way. This week we have seen evidence from Kingston University reinforcing that people with learning disabilities see advice from a doctor not as advice, but as a recommendation. We know from their experience during covid that they were five times more likely to have a “do not resuscitate” order placed on them. Does she share my view that those issues in the equality impact assessment reinforce the point that for people with learning disabilities, this legislation would remain unsafe?
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Terminally Ill Adults (End of Life) Bill
The Kingston University research that I referred to earlier shows that in the Netherlands, people with learning disabilities cited being coerced into an assisted death. Does my hon. Friend share my concerns about that?
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My hon. Friend talks about who makes our laws, and she has talked in articles that she has written about the primacy of this place. If the Bill goes forward, is she willing to accept amendments? She has brought forward a Bill that is exactly the same as the previous Bill, despite its sponsor in the House of Lords himself saying that there needed to be 77 amendments to make it safer.
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Terminally Ill Adults (End of Life) Bill
Is the hon. Lady not, like me, puzzled that the promoter brought back the same Bill, despite there being many amendments that the sponsor in the Lords agreed needed to be made and the promoter today acknowledged needed to be included?
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Terminally Ill Adults (End of Life) Bill
On a point of order, Madam Deputy Speaker, I have huge respect for the Minister, but she has said that she will not take any interventions. She is a very good Minister, and I trust that she will answer in detail the points that have been raised in the House today; having discussions with her and the Government after the debate is too late for today’s vote. I know she is a thorough and assiduous Minister and I am sure she will do her best to do that, but it is important to make that point to the House.
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Terminally Ill Adults (End of Life) Bill
Today I am going to share the most personal of stories publicly for the first time, and I ask for the kindness of colleagues in not intervening so that I can. Last October, my mum, Ruth Hazelgrove, chose to bring her late-stage terminal illness to an end, on her terms, at home, with dignity and with a strength that I can only try to imagine. Mum had just turned 61. She had endured significant health challenges for almost half her life. When mum was 32, she was diagnosed with a rare blood cancer, polycythaemia vera. Thankfully, she was able to see us grow up and meet her grandchildren. Mum loved life and laughter, and our family will remember her this way. In early 2024, mum was told that her condition had taken a significant turn. That autumn, while we debated the initial version of this Bill, her pain was excruciating. She had access to good palliative care, but what we learned the hardest of ways is that not all pain can be palliated. I will never forget seeing her writhing and screaming in pain, at points for weeks. None of us will. I know of no deity that would want that. Eventually, some medication helped her leave hospital, but it then became less effective over time. For mum, it was not a choice of life or death; it was a question of what kind of death she would have. She was clear that she did not want a painful or undignified death. She wanted peace. For us, it will always be a tremendous personal sadness that the current law meant that she could not tell us her plan, and we could not say goodbye to her—but more importantly than that, that she could not say goodbye at the end of her life, or be surrounded by her loved ones, which is what she would have wanted for her death. Instead, the harmful status quo meant that mum died alone, with photos of us around her. This was 11 months ago either today or tomorrow—we will never know whether she died late one evening or early the next morning, or whether we are ever marking the anniversary on the right day. This is the status quo. This needs to change. That is why our vote today and our work on this issue is so important now. People with terminal illnesses, and those who will be diagnosed with them soon, matter greatly. If we were again to leave this issue to another Parliament, it would be too late for other people with terminal illnesses who want this provision, but instead face the same impossible bind as my mum; they would continue to face it well into the 2030s, at best. An excruciating death or dying alone is simply not an acceptable bind for a human being. To allow choice does not impose an outcome, but to continue to restrict it does. In part of mum’s last note to us, which is why I am speaking today, she wrote, “I wish the Assisted Dying Bill would have come into force in my lifetime…Maybe there will be hope for others in the future.” Ultimately, is it not what Parliament is for to provide safeguards and freedom? I believe that we are here not to dictate how people live their lives and their deaths, but to enable safe individual choice. Today’s vote is on whether we should continue to work on this, or not at all. I ask right hon. and hon. Members to ask themselves if they feel that this impact of the status quo is right, is just. My hope, and I know my mum’s hope, is that her story can help us choose to end this harmful status quo and see terminally ill adults finally have true choice over their lives and their deaths.
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Will the right hon. Lady give way?
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I thank the right hon. Lady very much for giving way and for sharing that really difficult story. Does she not agree that the current system has no safeguards at all against coercion, and that is exactly why we need this Bill?
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Will my hon. Friend give way?
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The last time this House considered this Bill on Second Reading, I was keeping a secret. While hon. and right hon. Members were debating the issue, I was grappling with my own terminal diagnosis. I was told that I have stage 4 incurable metastatic breast cancer. I was overwhelmed with grief, fear and anxiety; I was scared of what was to come, and fearful of how it would impact my family and my loved ones. I was scared that I was going to get really poorly and thinking, “How will I cope? How will my family cope? How will I be cared for? How will I afford it? How badly will it hurt? How long will it last?” When you hear those words, depression, anxiety, grief, fear, shame and guilt come in bounds. Suicide risk is highest immediately after diagnosis, and it usually falls quickly, within three to six months. I would be lying if I said that when thinking about all that was to come, I did not consider that it might be fairer and easier on everyone if I just got the dying over with as soon as possible. Having treatable depression, however, will not exclude anyone from an assisted death under this Bill, and depression is common among people with terminal illness, but it is often treatable. Clinicians are trained to prevent suicide in people suffering from depression, but where would the line be drawn? This Bill makes no provision to support this difficult transition, or to create safeguards around it. A person can also be suicidal and have unmet mental health needs prior to developing a terminal illness, and then ask the state to kill them without any assessment of their psychological health, just an assessment of their mental capacity—because mental capacity and mental health are not the same thing. The Royal College of Psychiatrists recommends a holistic, multidisciplinary assessment of every applicant. The three-person panel at the end of the assessment process provided for by this Bill is not what most NHS clinicians recognise as a multidisciplinary team; it certainly does not allow for meaningful multidisciplinary decision making. The assessment needs to happen at the beginning of the process, not the end, and each team member should be independently assessing the patient in person. That is not what is included in this Bill. I do not know how long I will live. I will be on treatment for life, however long or short that may be. At the moment, I live between scans, in nine to 12-week blocks of time. The last scan might have shown that the disease is stable, but the next scan might show that it is growing again. If the disease is stable, the drug is working and we can carry on. Eventually, the drug will stop working, the cancer will grow, and we will have to try another drug and see if that works. At some point, we will either run out of drugs to try, or I will be too poorly to tolerate them—then I die. It could be months. It could be years. No one really knows. Prognosis is notoriously difficult to predict. Palliative care professionals and oncologists tell me that while they can more or less give me an indication of when I will die when I am a few days or weeks off, anything beyond that is the flip of a coin. The six-month prognosis in this Bill is something no one can ever be really sure of. What the palliative care professionals have told me is that palliative care can help me when I die. In the campaign around this Bill, though, it seems to me that it is being implied that a person with a terminal illness will have a dreadful, painful death unless they have access to assisted dying. That is simply not true; palliative care in the UK is excellent. Far too many people do not have access to the palliative care they need, but the idea that it is not possible to alleviate pain and discomfort is false. People have been terrorised—I have been terrorised—with tales of people vomiting up their own faeces, as though this is commonplace during death. It is vanishingly rare. Bowel obstructions are more common, but they are treatable. I know—I have had one. It is nothing short of irresponsible to scaremonger people like me into believing our deaths will be horrific when all the evidence suggests that, with access to good palliative care, deaths are, on the whole, gentle. The answer is not to terrify people and their families. It is to sort out palliative care and social care first, because none of this takes place in a vacuum. Until we can say that everyone who needs it has access to high-quality palliative care, we are offering nobody a choice. A terrible death or an assisted death is not a choice; it is a threat. While I speak today from the position of someone with a terminal illness, I am acutely aware that this is not about me. This debate is also not about an abstract concept or a position of principle. The question that will be put at the end of this debate will not be, “That this House has considered the question of assisted dying.” It will not even be, “That this House agrees with the principle of assisted dying.” The question will be, “That the Bill be now read a Second time”—this Bill, not the Bill it might have been, not the Bill that Members might have hoped it would be, and not the Bill it could be. This Bill is the only thing before us today. Incidentally, there is absolutely nothing before us about the House of Lords. That is not the question we are being asked. Whatever hon. or right hon. Members think about the principle of assisted dying, surely our first and foremost responsibility is to write law that is safe and workable. Not one of the professional bodies that would be tasked with delivering the Bill is willing to attest that it is, as it stands, safe or workable. The Royal College of Psychiatrists, the Association for Palliative Medicine and the Royal College of Physicians all say that the Bill is seriously inadequate. They are not opposed to assisted dying in principle, but they cannot support this Bill. Instead of bringing a Bill identical to the last, so that the Parliament Acts can be used and the Bill can be forced unamended on to the statute book, why did the proposers not spend the summer working with the royal medical colleges, the professional bodies and organisations to build a Bill that they could support? If they had done that, it would have been difficult for anyone opposed to the principle to argue against the Bill. But they did not do that. This is not about sides. This House is not a debating society; it is about making the law. While we may be campaigners out there, in here we are all legislators. It is our responsibility not to pick a side and dig in, but to work together to build the best laws that we can, and that is never truer than with a private Member’s Bill on a matter of conscience.
- Hansard source
Terminally Ill Adults (End of Life) Bill
No, I will not. This Bill does not protect the most vulnerable. It does not mitigate against the poor, the old, people with disabilities, or black and minority ethnic people being disproportionately affected. It does not protect people who are mentally ill. It does not recognise that not everyone has the same level of agency, control or influence over their decision making. The clinicians we would ask to deliver this Bill are saying that it is not even workable—that there is every expectation that it would not even work for the terminally ill people who want an assisted death either. And there would be no stopping it. Auto-commencement means that if the Bill is passed by the Commons and pushed through via the Parliament Acts, it has to happen on the stroke of four years after being passed. Even if the Government or the NHS are not ready, even if there is no funding, even if palliative care is still broken, and even if it is known to be dangerous, flawed or unworkable, then it is still happening, ready or not. This is not a last-chance saloon. This debate has been going on for years. It is not a once-in-a-generation opportunity; it could come back again in the next Parliament. My days may be numbered, but that does not mean that I want this Chamber to rush through bad law, just so I might have a chance to see it or use it. This matter is of huge importance. If hon. and right hon. Members have any doubt that the exact Bill before us today is not the best it could be—if it is anything less than excellent, well thought-out and robustly drafted legislation that protects the vulnerable and recognises the expertise of our world-class clinicians—and that it is not the Bill that I and other terminally ill people deserve, then I urge them to vote no or to abstain.