Debate - Monday 29th April 2024
Show/HideAssisted Dying
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Tonia Antoniazzi (Gower) (Lab)
I beg to move,
That this House has considered e-petition 653593 relating to assisted dying.
It is an honour to serve under your chairship, Sir Robert.
It is no secret that I grew up as a Catholic and attended Catholic schools. One of the most engaging lessons was religious education, where topics such as abortion and assisted dying, or euthanasia as some may wish to call it, were hotly debated. I admired my teachers who, with firmly held views, always encouraged debate—that is how I remember it, anyway. I have taken, and still take, the same attitude in my work as a Member of Parliament. For this place to have integrity, we must disagree agreeably and have the skills to debate and amend legislation that we may not agree with. Assisted dying is one such subject.
There is no set definition of assisted dying so let me clarify at the outset that here we are referring to the involvement of healthcare professionals in the provision of lethal drugs intended to end a patient’s life at their voluntary request, subject to eligibility criteria and safeguards. That includes healthcare professionals prescribing lethal drugs for the patient to self-administer, and healthcare professionals administering lethal drugs.
The petition calls for the Government to allocate parliamentary time for assisted dying to be debated in the House of Commons and to give members of this House a vote on the issue. More than 207,000 people have signed the petition so far, 272 of them from my constituency of Gower. The petition remains open, so the numbers are probably ticking up as we speak.
The petition was started by Hanna Geissler, the health editor at the Daily Express, and is supported by Dame Esther Rantzen, who is named in the petition. Hanna and the Daily Express have been campaigning on the issue for about two years, but Dame Esther’s public comments marked a change in the public perception of assisted dying, leading them to launch this petition. I pay tribute to their dedication and tenacity.
As people across the House know, this is not the first time I have opened a debate on this topic on behalf of the Petitions Committee. In July 2022, this House considered e-petition 604383, which asked Parliament to legalise assisted dying for terminally ill, mentally competent adults; that petition had more than 155,000 signatures. The fact that, in less than two years, we have had two petitions debates on this subject clearly indicates to me and to others that this issue is one that our constituents are highly engaged in, and I have no doubt that Dame Esther Rantzen has contributed to the heightened awareness of assisted dying. By her own admission, made in our discussion, she did not realise that speaking out about her personal choice would have had the impact that it has.
Whatever our own views, we must recognise that public opinion on assisted dying has shifted in one direction. Polls by Dignity in Dying have shown overwhelming support for changes to the law, with safeguards in place. Membership of Dignitas held by UK citizens has increased to 1,900, with a 23% rise during 2023.
In preparation for this debate and the previous one, I met a wide range of voices on assisted dying. Before this debate, as well as speaking with Hanna and Dame Esther, I spoke with Dr Matthew Doré, the honorary secretary of the Association for Palliative Medicine of Great Britain and Ireland; Dr Andrew Green, the deputy chair of the British Medical Association’s medical ethics committee; and Jonathan Blay from the Royal College of General Practitioners. Such conversations are always welcome and challenge my stance in this debate. The more evidence and sunlight that we can bring to these debates, the better, and we must never dismiss concerns, but consider them fully.
Mr Alistair Carmichael (Orkney and Shetland) (LD)
Is not the truth of the matter that the debate will continue whether we have it here or not? My colleague Liam McArthur has a Bill going through the Scottish Parliament at the moment. Similar legislation is being considered in the Isle of Man and in the Channel Islands. This issue will have to be addressed. Either we do that in our own time, with our own measured, reasoned debate, or we risk having decisions made for us.
Tonia Antoniazzi
I fully accept the right hon. Gentleman’s point that the law is changing in other countries and in parts of the UK. It is important to consider that, and to look at what is done well and not so well. It is for us in this place to consider this matter fully when the opportunity arises.
“Choice” is a key word for Dame Esther and for many of those who have signed the petition. This is about having the choice to die under their own conditions, with dignity and without struggle.
Alex Davies-Jones (Pontypridd) (Lab)
My hon. Friend is making an excellent speech. I was here for the last debate that she introduced on the issue and I am pleased to see this debate overwhelmingly supported today. The fact of the matter is that people can have a good death if they can afford it and are physically able to fly to Switzerland. That is grossly unfair. This is completely out of reach for the vast majority of my constituents in Pontypridd and the vast majority of people in the United Kingdom, so it is absolutely right that we have the debate, because if people can afford it and are physically able to do so, they can have a good death.
Tonia Antoniazzi
I thank my hon. Friend for her intervention, particularly because she raises a very valid point about the cost of that option for those who can afford to travel, and the discrepancy that there is in our healthcare system.
Sir Edward Leigh (Gainsborough) (Con)
That was a perfectly valid intervention, but surely one way to approach this problem is for us to get much better palliative care in place throughout the country. Everybody should be entitled to a dignified death. On this point, under the law of double effect, it is perfectly proper for a qualified doctor to relieve pain with very large amounts of morphine as long as his or her primary purpose is not to kill the patient.
Tonia Antoniazzi
I really value that intervention, because two thirds of palliative care in the United Kingdom is actually funded by charities. It is a postcode lottery. Excellent palliative care is what I would hope to have, but I would like to have the choice to have assisted dying and palliative care. I will go on to discuss that further in my speech.
Caroline Lucas (Brighton, Pavilion) (Green)
On that point, will the hon. Member give way?
Tonia Antoniazzi
I will, but I am very aware of the time and the contributions that need to be made.
Caroline Lucas
I will be very brief; I am grateful to the hon. Member for giving way. Does she agree with me that, actually, assisted dying can be a catalyst for more resources to go into palliative care? That is exactly what we have seen under many Administrations around the world.
Tonia Antoniazzi
I thank the hon. Member for her intervention. She makes a valid point.
How your family remember you and those last, dying hours with them is also what worries people such as Esther Rantzen. So often, it is the struggle that sticks in the mind of family members when they lose a loved one.
One thing that we can agree on is that this choice must be the choice of the individual and one that is well informed. There are always intended and unintended consequences to any legislation, and it is perhaps naive to suggest that any change in the law would not have wider consequences in society, beyond the individual making the choice. Safeguarding is a huge issue among the voices who oppose a change in the law. In 2023, the Danish ethics council concluded that the existence of an offer of assisted dying would decisively change ideas about old age, quality of life and dying, and that there was too great a risk that it would become an expectation aimed at certain groups in society. How do we prevent vulnerable people from experiencing coercion at a time when they are afraid and ill? It is about conversations and decision making.
Sir Julian Lewis (New Forest East) (Con)
I am so grateful to the hon. Lady, for whom I have the highest regard, for allowing me to intervene. Can she explain one thing to me? I do understand the idea of safeguards against coercion, but this is where I have a problem with the notion of assisted suicide: how do we set a safeguard against the person themselves feeling that they have to accept that they will die by their own request rather than be a burden to others? We can protect them from the pressure of others. We cannot protect them from the pressures that they will put on themselves, even though they do not really want to die.
Tonia Antoniazzi
I thank the right hon. Gentleman for his intervention, because those are exactly the conversations that we need to be having. We need to see how this has worked in other countries, look at data, be specific and take our role as legislators seriously. We may fall on a different side of the debate, but we need to consider it and engage in the arguments. The work that has been done in this House by the Health and Social Care Committee reflects the importance of having the debate and taking the evidence. I hope that evidence will emerge if we get to debate the issue on the Floor of the House.
The Association for Palliative Medicine of Great Britain and Ireland and the Royal College of General Practitioners oppose any law changes, while the British Medical Association holds a neutral stance. I was very interested to see what the BMA had suggested. Unfortunately, I do not have time to go into that now, but everyone I spoke to agreed that no medical professional should be forced to assist patients to end their lives. That stance is an interesting one, which we should consider.
Dr Rupa Huq (Ealing Central and Acton) (Lab)
I am grateful to my hon. Friend, who is making an excellent speech. She has pointed out the opinion polls and the international examples—Switzerland, Spain, Portugal, Austria, the Netherlands, Belgium, Luxembourg and so on—and mentioned the BMA’s neutral stance. Does she agree that some of us are massively conflicted on this issue? When it comes to abortion I am very pro-choice, but last time we voted on this subject I actively abstained—voted yes and no—and was relieved that the status quo was upheld. Does my hon. Friend agree that some of us are relieved that there is no vote today? With the Hippocratic oath and other things, we are just massively torn on this one, despite the opinion polls.
Tonia Antoniazzi
I appreciate my hon. Friend’s contribution. I am going to make progress, because I said that I was going to speak for only 10 minutes, but she makes a very valid point, which will be noted. I thank her for it. This is not an easy debate to have.
In their response to the petition, the Government said:
“It remains the Government’s view that any change to the law in this sensitive area is a matter for Parliament to decide…If the will of Parliament is that the law on assisting suicide should change, the Government would not stand in its way, but would seek to ensure that the law could be enforced in the way that Parliament intended.”
There has not been a vote on this subject in Parliament since 2015, but that does not mean that this House is ignoring the issue. In February this year, the Health and Social Care Committee published its report on assisted dying, as I mentioned. The report did not make any recommendations on law changes; rather, the aim was for the report to serve as a basis for discussion and further debate in Parliament.
A common theme in the evidence submitted to the Committee’s inquiry was what many respondents called “a good death”. I want to make it abundantly clear that assisted dying should not be discussed as a replacement for palliative care; we must also have frank discussions about how palliative care can be improved, so that we can give people the most comfortable end of life possible. Last Monday, there was an engaging Backbench Business debate in the House on funding for hospices; in the interests of time, I recommend that Members and other interested people read it in Hansard. We have to think about some of the recommendations that the Health and Social Care Committee did make around palliative care. It recommended that the Government
“ensure universal coverage of palliative and end of life services”,
give a funding uplift to hospices that require assistance, commission research into how better to provide mental health support and guidance after a terminal diagnosis, and
“establish a national strategy for death literacy and support following a terminal diagnosis.”
That was a point raised by Dr Doré during our conversation. I was struck by the issue of funding. As I mentioned, about two thirds of the funding for palliative care comes from charitable organisations, and I really do not see how that is good enough.
Should the law on assisted dying change and any services be covered by state funding, what message would that send? Should Parliament vote in favour of a law change, there are important questions to consider, some of which I hope I have highlighted this evening. These questions are difficult, but as legislators it is our job to assess the evidence and to try to answer them. The topic of assisted dying is so broad that there are many areas I simply do not have time to cover, such as the current situation in the Crown jurisdictions, the pursuit of prosecutions for family members, or the many individual stories I have heard.
I have previously spoken about the death of my father, over 12 years ago. My family have been supporting my lovely mum, who has had a very tough year—since December, there have been a few times when we did not expect her to pull through. Many friends and colleagues in the House have offered prayers, and I have to say that my mother is our little Easter miracle—the Catholicness never leaves you—and she continues to make good progress. During this time, I have personally wanted to talk about death and consider how I want my death to be. The experience of being in a hospital where there is death all around makes you reflect. It seems harsh and even simplistic, but when such emotion and heartbreak is all around you, you just want your loved ones to be out of pain, however that looks.
We have been lucky that my mother has gotten better, although her life has changed greatly. In my personal view, if someone has a terminal diagnosis and is mentally sound, should they not have the choice to take themselves out of suffering? That is the choice Dame Esther Rantzen talks about. Whatever comes from today’s debate, I would like everyone to consider bringing up the subject of their death with their loved ones now, before it is too late, because two things are certain in this world: we are born, and then we die.
Several hon. Members rose—
Sir Robert Syms (in the Chair)
Order. As Members may have noticed, this is a popular debate. Please try to keep to three minutes or below. Normally you would be expected to be nailed to your seats until the wind-up speeches, but if somebody were to vacate their seat for other business, the Chair would be pragmatic.
Sir Peter Bottomley (Worthing West) (Con)
I thank the hon. Member for Gower (Tonia Antoniazzi) for her introduction to the debate.
When Frank Field spoke in one of the first major debates on euthanasia, he told the story of how Barbara Wootton, who founded the national assistance scheme, made him promise that were she in hospital with a terminal condition, he would empty her medicine cabinet and bring her all the things that together would make a poison so that she could end her own life. She lived perfectly conscious in hospital for six months and never did that.
On 22 October 2021, Frank Field had just come out of a hospice and was reported as saying that he had changed his mind: in the past he had been against euthanasia, assisted dying or medical assistance in death—however one wants to call it. He said that two-and-a-half years ago. When I saw him over the last months, he did not raise the issue at all, so I think people can understand that people’s views are not always as intense as they sometimes appear.
I am a great fan of Dame Esther and collaborated with her—at least, she manipulated me when I was a Minister in 1986, when we were campaigning for a really good policy on child restraints in cars. Were she to put the case for better hospice care, she would do it with the same verve that we have heard her speak with on the broadcasters in the last few days. I would like to go on and debate with her, if she were willing. I would ask how many people the campaigners thought would qualify under the kind of terms suggested in this petition.
There are about 5,000 to 6,000 suicides a year in this country. Do people think we are talking about 100 people a year extra or 1,000? I put it to the people here that if we had a Dutch level of medical assistance in death, we would add 15,000 deaths a year—we would treble the number of existing suicides and, including the existing figure, take it up to four times.
People talk about the safeguards and conditions. There is a list of all the conditions and safeguards that other countries are taking away. It starts with, say, the people who cannot afford to go to Dignitas and expands to those who are depressed. All MPs and their staff know what it is like to try to help somebody who rings up or writes and says, “I’m going to do away with myself because of the condition I am in”, or says they will because of how they feel. We do not say, “We are in Westminster Hall debating making it easier for you to carry that out.” We say, “Can we talk? Can we pass you on to somebody else you can talk to? This help might make your life different and changed.”
I am at the sort of age that means that I am an orphan—my parents have died. My father died aged 93. After he came out of hospital having been badly shot up in the war, he did not spend another night in hospital for the rest of his life. He knew that he was dying. He had stopped eating and drinking. A few hours before he died he came out of unconsciousness and said, “Am I still alive?” When he was told yes, he said, “I’m so sorry”, and went back to sleep. He then died.
My mother died three days after a diagnosis. She had had the benefit of a wrong diagnosis six months before, so she lived her last six months happy rather than being mucked about in hospital. When she was told she would be dead within three days, she said, “Can we talk about the funeral?” My father said to my wife, “Look, Virginia, you are the Health Secretary—you are rather busy. Which day is convenient for you?” This was said in front of my mother—a perfectly normal conversation. I think conversations about death are ones we ought to have.
I conclude by telling the story of a member of my family who died last week. The hour-by-hour reports from those sitting with her in the care home, which had a hospice end-of-life service, and from those in my family would make a lot of people think twice before charging down a route that could lead to an increase in the number of suicides in this country by three times.
Sir George Howarth (Knowsley) (Lab)
It is a pleasure, Sir Robert, to serve under your chairmanship. I thank the Petitions Committee for enabling us to have this debate today.
I want to say quite openly that, after a great deal of thought, I have come to the same conclusion as that in the petition: the time has come to legislate to enable, with proper safeguards, assisted dying to take place. I do not want to get into the detail of what such a Bill might look like—that is for another day and another debate. I want to address the principle by referring to two arguments commonly used to oppose such legislation. The first concerns issues of faith and the second, which has been referred to, is about pressure being put on people to make a decision that they might not agree with when the time comes.
I will start with the issue of faith, which I approach with a great deal of trepidation. I certainly do not want to get caught up in any tangled theological debates, but as a Christian myself, I think that two important principles are involved. First is the argument that we are all—particularly those of us brought up in an Abrahamic faith—given free will. Our life is not mapped out before us; we have the free will to make choices at certain times in our lives. I also cannot imagine that the God I was brought up to respect as a Christian would want people to die in pain and suffering in a way that is, I think, unchristian.
The second argument is the one that has already been referred to—that at some point along the road to the end of their lives people will be put under pressure to make a decision that they either do not really want or that they do not want to be exercised when the time comes. I have thought a great deal about that argument and it seems to me that it is based on an unduly pessimistic view of human nature: that people will pressure their close relative or loved one to take such a decision purely on the grounds that it might serve them well financially—their motivation is venal, in other words—or because they want to avoid caring responsibilities in the later stages of their loved one’s life. I do not believe that that is how the majority of people take those decisions. I concede that some people might act in that way, but I think that the overwhelming majority will act as they act—out of love, rather than out of self-serving motives. The issue also comes back to the exercise of free will.
As I said at the outset, I think the time has come for us to make a decision about this issue. I am not being prescriptive about the clause-by-clause nature of what a Bill should do, because, as I also said earlier, this debate is not the occasion for that; Second Reading would be the appropriate occasion.
I conclude by saying to the Minister that I would like to think, not least because I will not be here after the next election, that before this Parliament concludes and before the next general election we will have the opportunity to vote, as a Parliament, on legislation on this issue that will take us forward. I do not expect her to give me any assurances in that regard today, but I hope that, as a member of the Government, she will use such influence as she has to bring about such a vote.
Several hon. Members rose—
Sir Robert Syms (in the Chair)
Order. May I remind Members about the three-minute time limit? I now call the Chairman of the Health and Social Care Committee, Steve Brine.
Steve Brine (Winchester) (Con)
Thank you, Sir Robert, for calling me to speak. The “Assisted Dying/Assisted Suicide” report by the Health and Social Care Committee —the Committee that I chair, as you said—has been tagged to this debate. It was published on 29 February and all Members of the House have received a copy of it from me. By complete coincidence, we received the Government’s response to the report just this morning; hon. Members can find that on the Committee’s website now.
Our report is a pretty big piece of work. It includes roundtables with people who have lived experience; we talked to health and care workers from across the NHS and social care, including people who on a daily basis provide care to people at the end of their lives; and we went on a number of visits, including to the US state of Oregon, where assisted dying has been legal for over 20 years, and to the Royal Trinity Hospice in Clapham. We received just shy of 68,000 responses to our online form, which is the largest number of responses of that type to any engagement from a House of Commons Committee. We held five evidence sessions with witnesses from across the world and received close to 500 written evidence submissions.
As we set out to conduct the inquiry, we were very clear that we did not want to weigh in on whether assisted dying should be legalised or whether the law should remain unchanged. That seems to have disappointed just about everybody, which tells me that we got things just about right and, more importantly, in line with the terms of reference that we published at the very start. All that has produced a weighty reference for MPs and peers to draw from in the future.
Our aspiration was for Parliament to have a broad and well researched basis for further consideration, whether sooner or later. Obviously, today’s debate makes it sooner, but I predict that this issue will come back again. We can be crystal clear that this debate is a general one, not a piece of draft legislation. I just implore the campaign groups that encourage people to contact their MPs about this debate to be clear and accurate about what it is. It is not fair to mislead people about what we are doing today. This is a general debate.
In their response to us this morning, including evidence that they gave us, the Government made it clear that they will not bring forward legislation in this area and that it was more possible that a change in law would be sought through a private Member’s Bill; that is indeed what has happened in other jurisdictions where assisted dying has become the law. In producing our report, it was very interesting to look at the international jurisdictions, although the evidence is quite limited about their track record on this issue. In the majority of jurisdictions that have it, this law has come in only quite recently.
As I said, we visited Oregon, and there has been such legislation there for two decades. Its legislation comes into the category whereby a person receives an established terminal diagnosis, which means that they are likely to die within a prescribed period—six months. In the Netherlands, however, the legislation applies a much wider set of criteria: the person seeking to access assisted dying can do so on the basis of “unbearable suffering”, subject to their own experience. That point was made by the right hon. Member for Knowsley (Sir George Howarth). I take the rather old-fashioned view that MPs should vote to change the law based on a clear and concise understanding of exactly what we are changing it to, but that is not the purpose of today’s debate.
We did not find any evidence that the quality of palliative and end-of-life care deteriorated after the introduction of assisted dying in those jurisdictions; in fact, there is some evidence to suggest that there has been an increase in the funding of palliative care services, which I think is interesting. I hope that colleagues follow up the point that some hon. Members have already made: there will probably be legislative changes elsewhere in the UK, and certainly in the Crown dependencies in the coming months. Ministers need to be ready to respond to that, whatever their intention for the law in England.
Three or so minutes is not enough time to set out much detail, but I hope colleagues will reference our report. In the time that I can be here today, I look forward to listening to them and the Minister.
Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to follow the Chair of the Health and Social Care Committee, having also travelled to take evidence over the last 18 months and really engaged with everything people have written to us about in sharing their opinions and life experiences. I really do commend the report to the House. We learned especially about the need to have a better death, and there are lots of opportunities for that, through improvements in palliative care and listening to clinicians about the extent to which that can be brought about. We also heard very clearly that if the law were to change, it would fundamentally change the relationship between the physician and the patient, and the House must take that into consideration.
Not only should there be more investment in palliative care, but we should push on with the opportunity for more research in that area. Of course, we should also address the social factors that are cited as reasons why people want to access palliative care. It is often about poor death literacy. Certainly, I am disappointed that the Government do not have a plan to improve that, so I urge them to consider it.
We must also look at the reasons why people have opted for end of life in other jurisdictions, as set out in the petition, including the loss of meaningful daily activities, the loss of dignity and incontinence. For many people, perhaps those with an impairment, that is their daily experience, and yet it would be wrong to say that that dehumanises them as individuals. We should move on from the embarrassment and inconvenience and look at how quality of life can be given to everyone, no matter their impairment.
Loneliness and isolation are also cited, but that is a societal failure that must be addressed. If we improve our NHS care, our social care and civil society, many of those reasons will be dismissed. The reason why we are debating this issue is not lost on me: the NHS is in tatters, social care is in a dire condition and so much funding has been withdrawn from civil society. There is much for the Government to do, and they must address those reasons in order to ensure that everyone has the opportunity for a good end-of-life experience.
I am worried about the person who says, “I’m just getting in the way. My children will have a better future without me. Perhaps the savings I have put aside could be better spent by them than on me.” It is not necessarily coercion, but the way that people feel in a society that changes the law. We have much to address, including the physical, psychological and spiritual needs of people in our country, and that must be our first consideration.
Sir David Davis (Haltemprice and Howden) (Con)
I am not a religious man, but I have always viewed life as sacred. For most of my life, I have been disinclined to accept the arguments of people who are in favour of assisted dying, but various events have changed my view in the past several years. Some time ago—a long time ago—my mother died of brain and lung cancer in considerable agony, pain and, I suspect, terror, too. I am pretty sure that the doctors in charge of her accelerated her demise. I am glad they did. It was a miserable, miserable time for her, and in my view it was a good thing for her to go more peacefully with an excess of morphine, if you want to put it that way.
I suspect that it was the unstated norm to do that in those days, and doctors took those decisions quite properly themselves. But I also suspect that that changed after the Shipman scandal. Dr Shipman killed hundreds of people, and doctors then became rather fearful of the legal consequences of doing what I have just described. That, in my view, alters the balance of this argument.
Later, Bishop Bill Westwood—some may remember him; he was probably the only Thatcherite bishop in history—became a constituent of mine. He also argued with me that we should change the law to allow assisted dying. I was surprised at that because of his faith. I thought that was really quite material.
And then, only a few months ago, one of my constituents talked to me about her father, who had motor neurone disease. He was terrified of getting to the end of his life and being unable to do anything about it, so he told her that he intended to end his life earlier than the inevitable outcome. He was a very wealthy man, and was able to afford a private jet to fly himself and his whole family to Dignitas in Switzerland and go through the process there to deliver what my constituent described as a beautiful death—certainly a painless death. I have come to the conclusion that as long as extremely strict controls are put in place so that no one feels pressurised to end their life, I am supportive of the legalisation of assisted dying.
But let us be clear: we must not make the same mistakes as other countries. I am thinking particularly of Canada and the Netherlands. In the Netherlands, for example, several people with autism and intellectual disabilities have brought on the end of their life, some of them before the age of 30. That is not acceptable. Similar weaknesses apply in Canada. We must ensure that safeguards are in place.
Given the time, Sir Robert, I will finish with these comments. There have been references to a private Member’s Bill. That is the wrong mechanism for this. A multi-day Second Reading and a many multi-day Report stage are required to take this through and get it right. Once we get it right, unless we are going to accept that we are stepping on a slippery slope, we have to make that the final decision as a Parliament.
I was a friend of Frank Field for 50 years. We were close friends and allies on all sorts of things over that time. Like me, he opposed this proposal for a long time and changed his mind at the end. I am honoured to follow him on that course.
Paul Blomfield (Sheffield Central) (Lab)
I have spoken in previous debates since 2012, the year after my father took his life alone and prematurely with terminal lung cancer. However, today’s debate is different, because I believe that we are finally on the brink of catching up with public opinion and bringing about law change—not in this Parliament, but in the next.
Since 2015, over a dozen jurisdictions around the world have introduced laws enabling choice at the end of life. Today, over 30 offer that choice, with protections, covering hundreds of millions of people. In the UK, the medical profession has dropped its opposition. Legislators in Scotland, Jersey and the Isle of Man are crafting laws that will give choice and protection. The Leader of the Opposition has committed to ensuring parliamentary time for proper consideration of a Bill in the next Parliament, and that commitment has been echoed by the Prime Minister. So law change will be debated soon, and we have the opportunity today to inform that debate to some degree. That is what the Health and Social Care Committee report did. I was pleased to be part of that report, and want to confine my remarks to it.
Our report starts by looking at the impact of the current law. So many of the 68,000 submissions we received set out powerfully how the current law is failing people, forcing loved ones with a terminal diagnosis to plan their death secretly and take their lives alone, often violently. I do understand why debate focuses on the consequences of change, but the evidence that we heard underlines the consequences of leaving the law unchanged. It forces those who wish not to end their lives but to shorten their deaths to act while they have the capacity, and too many die too soon.
Our report drew heavily on the practical experience of jurisdictions that have legalised assisted dying. They take two routes, one based on terminal illness and the other on adding wider criteria, such as intolerable suffering. My remarks are based on those opting for terminal illness alone, because it is the approach of most countries and of previous legislation proposed here—and, I am sure, of the legislation that will be proposed in the next Parliament.
We listened hard to the concerns of those opposing law change. They fell into three areas, but our evidence provided reassurance on all three. We found that not a single jurisdiction that opted for assisted dying for terminal illness had extended it beyond that definition, so there is no slippery slope. We found no evidence of coercion in jurisdictions allowing assisted dying. That is not to say that coercion does not exist, but assisted dying laws seek to provide protection, in contrast to our current law. How do we know that the 650 people who take their own lives now are not coerced or did not take that decision because they felt themselves to be a burden? We talk rightly in this debate about safety, but it is the current law that is unsafe. Assisted dying laws are safer than blanket bans.
Andrew Selous (South West Bedfordshire) (Con)
I think it is right that Parliament looks at this issue early in the next Parliament—whether to leave things as they are or make changes. There is clearly public pressure for us to do so.
I was not able to get to the deaths of either of my parents —they both died in hospital before I was able to get there. But I was very involved at the time of my mother-in-law’s death just over two years ago. I was privileged to help my wife, her two brothers and my three children look after her in her final weeks. My biggest observation from the privilege of looking after her in her dying days was that the pain relief was much too slow to get hold of. I spent many Saturday mornings driving around North Yorkshire to GP surgeries to ask for her morphine prescription to be increased. That is simply not good enough in this country today. The thing about pain relief is that you have to get ahead of the curve; it is no good delivering it after the pain has built up. We urgently need to look at that.
Olivia Blake (Sheffield, Hallam) (Lab)
On the point about access to morphine, for some people it is simply not an option, as they have allergies to opiates. While uncommon, they do exist for many patients going through end-of-life care. Does the hon. Member share my concerns about that and think that it should be included in the debate?
Andrew Selous
I was not aware of that issue and I am grateful to the hon. Lady for putting it on the record.
A constituent wrote to me on Saturday about her sister, who she described as “begging” to put herself out of her misery before she died. Her death led to the nephew of my constituent taking his own life because he was so shocked by the death of his mother. None of us would want something like that to happen.
I have to say that I was deeply shocked by the remarks of the journalist Matthew Parris, who said in an article recently that he welcomes this being the thin end of the wedge, that he makes no apology for treating human beings as “units”, and that we should be making the cold calculus of inputs and outputs. I am appalled by that. I hope that every Member here is appalled by that type of discussion about our frail and elderly fellow citizens, who have a right to dignity and care until the very end of their lives. I will certainly fight back against that idea, and I want to call out what he said today in this debate.
I also think we need to look at the quality of life for people in their final days. I was sat next to one of my constituents this morning, who talked about how bored his 92-year-old father is in his dying days. That is an issue for us as well. Life should be full of stimulation. Life should provide things for people to live for, and we need to make sure that our elderly and those towards the end of their life are not bored and not lacking in stimulation such that they think they have nothing to live for.
I welcome the fact that Parliament will look at this issue. We have the commitment from the Prime Minister and from the Leader of the Opposition. There is definitely work to do on pain relief, which is not where it should be, but I want to end with a quote from Cicely Saunders, who founded the hospice movement:
“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.”
Rachel Hopkins (Luton South) (Lab)
I thank you for your chairship, Sir Robert, and I thank my hon. Friend the Member for Gower (Tonia Antoniazzi) for leading this important debate.
I am pleased to speak again on this issue to call for parliamentary time for assisted dying to be fully debated, and for MPs to have a vote on it. The blanket ban on assisted dying and on refusing terminally ill people the autonomy to make decisions at the end of their life forces them to suffer against their will while loved ones watch on helplessly. Some choose to avoid this fate and to seek assisted death abroad, but that comes at a substantial cost of some £15,000 to travel to Switzerland for that purpose, which highlights the systemic inequality where only those with the financial means have access to a choice over the timing and manner of their death. For the terminally ill, that should be a right, not a privilege.
That inequality forces many people who do not have other options to take their own life. Each year, up to 650 terminally ill individuals end their lives, with many more attempting to do so, often in secret and using unsafe methods at home. The lack of safeguards, regulation and oversight forces dying individuals to take matters into their own hands without adequate support for them or their families. As a humanist, I believe in individuals’ right to make informed choices about their own care and quality of life, and I do not believe that people should be forced into making horrible, lonely decisions to end their own life, something that the blanket ban on assisted dying in this country fails to recognise.
The legalisation of assisted dying for terminally ill, mentally competent adults must be introduced, with robust safeguards, to promote freedom of choice at the end of life. I reiterate: this is about choice. I agree that better pain management and much more support for palliative care are needed, but it is also about choice—if people wish to choose it. People deserve autonomy and compassion in their end-of-life decisions.
The public agree. Unwavering public support for assisted dying is exemplified by the 200,000-plus signatures on the petition calling for a parliamentary vote on this critical issue, and by the fact that reform is backed by the majority in every parliamentary constituency across Great Britain, including more than 60% of my constituents in Luton South.
I was encouraged to hear that the Leader of the Opposition has pledged to allow time for the next Parliament to consider assisted dying, if Labour were to form a Government. The public are counting on us as their elected representatives to ensure their right to freedom of choice at the end of life. As this is fundamentally an issue of dignity and compassion, we must use our power to alleviate the pain of thousands of suffering individuals and their families by ensuring a free vote in Parliament on assisted dying.
Siobhan Baillie (Stroud) (Con)
I feel a heaviness of heart about this debate, in part because of my faith and in part because of the weight of seriousness of the issue and of ensuring that I represent the constituents who have contacted me in droves about it. I have not had a surgery in some time when someone has not come in about it. In a public question-and-answer session, a gentleman broke down in tears thinking about the death of his wife, and the memory of a lady carefully walking me through her experience of the death of her sister, culminating in a trip to Dignitas, and her description of that place, has never left me.
I have to say that, over many years of being the Member of Parliament for Stroud, constituents’ experiences have steadily changed my views. Arguments about choice, compassion and the ability to plan are very powerful to me, although my constituents know that I am careful in how I vote and I would need to see the legislation in front of me before making a final decision.
Constituents on the opposite side of the debate have also contacted me in a very powerful and thoughtful way. I refer to the article by Josh Glancy in The Sunday Times this weekend which sets out a number of the arguments that my constituents have also made. I will use my brief time to give the Chamber some examples of the very thoughtful correspondence I have had. A gentleman wrote to me:
“This is extremely personal to me and my wife…who has an incurable blood cancer…at the age of just 55. Neither of us want her to suffer the gradual progression through incapacity, pain and death without her being able to choose her time of death with dignity, whereas at present the only choice might be to travel abroad and seek an exit prematurely”.
Another gentleman, in a lengthy and thoughtful correspondence, talked passionately about his mother, a working-class Liverpool woman who became a curator at Historic Royal Palaces. I liked the fact that he said:
“You would have loved her.”
He said that the weeks of her illness were rather life-affirming. His mum considered taking her own life, as her best friend had done following a terminal diagnosis, but she did not and,
“later told us she was glad she hadn’t, because she would’ve missed out on the experience of so much love and goodwill from friends, family and carers.”
Yet she went on to plead for death in the final weeks. It took 16 weeks for her to die, effectively from starvation. I mention this gentleman because he said:
“When my Mum was dying”—
This is hard; we all get such emails—
“I promised myself that at the very least, I would write this letter, so that my bitter disagreement with the law…would be known. Thank you for taking the time to read it.”
I agree with my right hon. Friend the Member for Haltemprice and Howden (Sir David Davis) that we need days of debate on this, with everybody involved. It has to be very well thought through.
Andy Slaughter (Hammersmith) (Lab)
I could refer Members to Hansard and my speeches in the three previous debates, and then sit down, which might be popular, but looking at those debates I realise that this is something to which some urgency now attaches. The last one was less than two years ago; the previous one, in this Chamber, was three years before that; and four years before that, in 2015, we had the last vote on the issue, when I was in the position of my hon. Friend the Member for Brentford and Isleworth (Ruth Cadbury), replying for the Opposition. I think I am right in saying that the previous vote was about 18 years before that. It is a matter that, partly due to public opinion, demands our attention, and I hope and trust that, certainly after an election, we may be in a position to legislate on it as soon as a year’s time, with the caveat that that will have to be a very serious and profound process.
Public opinion is leading on this. That does not mean that we have to follow public opinion, but there is a substantial change in the mood of the public and overwhelming support for some form of assisted dying, whereas the arguments and opinions have not greatly moved on over the last 10 years. For me, this is about one very simple question: that at the end of my life, it is not just my choice but my right to decide the manner and timing of my leaving it.
I hope first for a huge improvement in palliative care. I took part in the debate on hospice care in the main Chamber last week, and I pointed out that we have not had in-patient beds that are convenient for my constituents for six years. That should not be happening anywhere in the country.
In reality, I do not believe that anybody would say that their religion or their personal views should impact on my choice. The issue is whether there is undue pressure—by the state, the family or the person themselves in considering that act. We have many laws for dealing with coercive behaviour. We should have better palliative care. As a society, we should be able to reassure people that they are all valued as long as they want to be with us, even at the end of life and even, perhaps, in great pain and suffering. That should not be a barrier to those who wish to decide to leave because of great pain, because of great suffering and because the end of their life is near. As a society, we have to grasp that very difficult decision and move on.
Kit Malthouse (North West Hampshire) (Con)
I am grateful to you, Sir Robert. I am co-chair of the all-party parliamentary group on choice at the end of life, so it should come as no surprise that I support the aspiration of the petition.
Over the last 10 years of my involvement in the campaign in Parliament, I have become used to converts—very welcome converts—to the cause, but of course they almost always convert to the cause after they have been through the horrible experience of watching someone they love go through an awful, agonising and degrading death. When Esther Rantzen stepped forward and talked about the impact that her disease was having on her, as well as about her decisions for the future, it should come as no surprise that there was an outpouring of support from the British people, because for many people she was part of the family. She regularly appeared in their front rooms, with her smiley, sunny demeanour, on a Saturday afternoon. Now that she is facing a horrible death and, with money, has decided to make the choice, the British people have obviously stood up and listened to the fact that she is supporting the campaign for a change in the law.
The British people listened to such an extent that they now do not really understand why politicians tolerate or talk about three particular things. First, they do not understand how so many Members in this House can stand for the status quo when, as has already been stated, the status quo is appalling. We have hundreds of people taking their own lives in this country—thousands dying agonising, horrible deaths when they may wish to do something different. Of course, we also have business class, so it is even worse: if you have the money, you can have what the law denies to everybody else. It is an outrage, and it should change. Worse than that, many Members who would oppose me making the choice are quite happy for a doctor to do it for me, as we have already heard. They are quite happy for a doctor to give an extra squeeze on the morphine and take away my own agency, choice and rights about my life. The British people just do not understand how so many people can tolerate that.
Secondly, the British people do not understand this view that the country is teeming with granny killers—that all of us are just waiting to bump off a wealthy relative so we can pocket the cash, like we are some kind of nation of Jeremy Bambers, intent on remunerating ourselves. The vast majority of British people love their parents and grandparents. They want the best for them, and they agonise when they die. If you go to the funerals or see them greeting each other at airport terminals, you will see the love there. That is not to say that there should not be safeguards, but we have safeguards in lots of other areas, and we should in this, too.
Thirdly, the British people do not understand how people of a genuine religious faith can seek to impose their own morality on the rest of us. They have not done so on gay marriage. They did not do so on homosexuality, adultery, abortion or sex before marriage. Why on this issue should the British people be denied a choice, because of the—certainly legitimately held—religious convictions of others? If the law changes, as I hope it will, and assisted dying becomes available, in extremis, to me and others, people need to realise that it is not compulsory. You may not want it yourself, and you may not want it for your relatives, but please do not stop me having it.
Christine Jardine (Edinburgh West) (LD)
It is a pleasure to serve under your chairmanship, Sir Robert.
I was thinking today about all those evenings when I was allowed to sit with my parents and watch “That’s Life!”, and how I could never have envisaged this moment. With all the successful campaigns in which Dame Esther Rantzen has been involved in her astonishing career, there can surely be none that has touched a nerve with the British public in so widespread a way as this one. Her involvement with this petition, which 555 people signed in my constituency alone, shows me that there is a momentum among the British public: a desire to see a national debate on the subject and for their Parliament to reflect their view, which we see in so many opinion polls nowadays. It is not a party political issue, but for the record my party, which believes in the freedom, dignity and wellbeing of individuals, has long supported the idea of a free vote in Parliament and would welcome a free vote in the next Parliament for us all to make the choice.
I find myself in the strange position where my colleague Liam McArthur is currently steering a private Member’s Bill on this issue through the Scottish Parliament. If he is successful, I would hypothetically have a choice denied to so many other people in this room—a significant choice. Another Bill that is about to be introduced to the Scottish Parliament by a Conservative MSP is about improving palliative care. Liam and Miles Briggs are working together, because the two are not mutually exclusive. We should see it as a choice between assisted dying or palliative care not for us, but for the individuals affected. They should have the choice.
The time has come when we need to recognise that there is momentum; other parts of the UK will make decisions on this shortly. I must be honest with Members and say that I do not know what decision I would make. I saw my parents die very different deaths: my father suddenly from a heart attack when very young, and my mother very slowly of a horrible asbestos-related disease. I do not know what they would have wanted. I do not know what I would want, but I do know that I want everybody to have the choice that they want. The time has come when we should recognise this petition and what it asks us to do, and look at a very narrow form of agreement to assisted dying when someone has a terminal diagnosis and has made that decision at a time when they were mentally capable of doing it, and when a medical intervention is involved. Ultimately, they get to make the last, perhaps most important and most personal decision that they could make.
Matt Hancock (West Suffolk) (Ind)
We need an informed debate on this subject, and I believe we are starting to have the level of engagement and interest that means that now is the time to bring a vote to the Floor of the House. As Health Secretary asking questions about policy, I was surprised by the paucity of information and data on this question. I asked the Office for National Statistics to start collecting some of the data. One of the things it found is that the suicide rate among those who have a terminal illness is double the suicide rate in the rest of the population. So we know that suicide happens and is more prevalent—twice as prevalent—among those with a terminal illness. Of course, we also know that many of those suicides are lonely and earlier than they would have been if we had changed the law.
I have also been informed in this debate and in coming to a view on the subject myself by engagement with others. I pay tribute to the Health and Social Care Committee for its excellent report. I was influenced significantly by Sir Paul Cosford, the late medical director of Public Health England, who was a great man. He asked to speak to me while he was emeritus medical director, and he called to tell me that he had a terminal illness—it was cancer. He knew that there was a likelihood of a painful end, and he said, “As a medical doctor, I can of course prescribe myself morphine and I know what to do with it, but you and others do not have that choice.”
I was also deeply affected and persuaded by my constituent David Minns. Today I had the honour of meeting his son, Matt Minns. David, who has now died, was in the awful situation of having a disease that he had watched his own daughter die an incredibly painful death from. To those who say that palliative care needs to be better and can be enough, my response is: of course it needs to be better, and of course people give their careers to amazing palliative care, but the best palliative care in the world cannot prevent hugely painful deaths for some.
Yes, the safeguards are vital. Internationally, we can now see many countries, such as Australia, that have brought in a narrow and clear set of rules, but the people I want to have a choice are those facing a painful death when they know that death is coming. Of course there should be protections for people with disabilities and mental ill health, but we should ensure that all of us, when we know for certain that we are facing such pain at the end, have the choice to instead have a dignified and good death. I know that I would want that choice for myself.
Sir Stephen Timms (East Ham) (Lab)
I very much welcome the thoughtful and sensitive way in which my hon. Friend the Member for Gower (Tonia Antoniazzi) opened the debate. I agree with her and others that we need careful reflection on this subject.
The national health service is, rightfully, my party’s proudest achievement. It has delivered freedom from the fear of medical bills, which has blighted the lives of non-wealthy people since time immemorial. I think that changing the nature of the national health service, so that it ends people’s lives as well as sustains them, would be an absolutely fundamental change that we need to weigh very carefully indeed before introducing.
I understand the proposition that people with a diagnosis of terminal illness should be allowed help to die, but it is clear from what happens elsewhere that if that did happen, it would not remain subject to that narrow criterion. It would not end there. Indeed, the campaign to broaden the scope has already begun. Matthew Parris wrote in his column in The Times that we need assisted suicide because old people cost too much. He said:
“‘Your time is up’ will never be an order, but—yes, the objectors are right—may one day be the kind of unspoken hint that everybody understands. And that’s a good thing.”
I cannot see that that would be a good thing. It seems to me that legalising assisted dying would impose a terrible dilemma on frail people, elderly people and others when they are at the most vulnerable point in their lives, especially on conscientious frail people who do not want to die but do not want to be a burden. I do not think that there is any way to avoid imposing that dilemma. The national health service should be there to protect those people.
It is reported that in Oregon since 2017, over half the applicants for assisted dying have applied not because they want to die but because they feel that that they are a burden. The next time we have a Government committed to austerity, the temptation to cut health service costs by allowing people to choose to end their lives in a wider set of circumstances, instead of funding their care, would, I fear, be irresistible. Indeed, in Canada, the Government publish how much they save by ending people’s lives rather than continuing to care for them.
Sir George Howarth
I will be brief. Does my right hon. Friend accept that his argument reflects a very bleak view of how assisted dying would work in practice?
Sir Stephen Timms
I very much agree with my right hon. Friend that it is a bleak view, but it is supported by what we have seen happening elsewhere around the world. Unfortunately, I think it would happen here as well.
The argument I want to set out is that this road is not one that those of us who subscribe to the founding principles of Nye Bevan’s health service should be willing to go down.
Fiona Bruce (Congleton) (Con)
It is a pleasure to follow the right hon. Member for East Ham (Sir Stephen Timms). I agree with what he said. Assisted dying is a complex subject, and if we are to make any progress in discussing it we need careful reflection and informed debate. It is reasonable that reference to statistics should be made, but we need to be careful in our use of them. What people understand by the term “assisted dying” makes a difference.
In 2021 a Survation poll asked more than 1,000 members of the public what they thought the term meant. Only four in 10 correctly understood it to mean providing lethal drugs to those with less than six months to live to end their life. The same proportion incorrectly thought that it meant giving people who are dying the right to stop life-prolonging treatment, which is already legal in the UK. Worryingly, one in 10 said that the term referred to the provision of hospice-type care for people who are dying. So six in 10 people did not understand what “assisted dying” actually means. We need to ensure that our constituents are fully informed about what assisted dying means, so that they do not “run there blindly”, as Josh Glancy warns in his thoughtful article in The Sunday Times yesterday, which was movingly referred to by my hon. Friend the Member for Stroud (Siobhan Baillie).
Let us consider a recent Dignity in Dying poll, which concluded that 75% of Brits supported assisted dying. That had fallen from 84% in a 2019 Populus poll. But how strong is the supposed support? That recent poll found that only four in 10 of those polled wanted their MP to vote in favour of assisted dying. It seems that out of the initial 75%, almost half did not support the cause enough to want the law to change. To proclaim that nearly eight in 10 Brits want assisted dying cannot be accepted as a fair representation.
A more committed and thorough approach to understanding what our constituents think might lead us to reflect on a 2014 ComRes poll, which found that the proportion of people who supported assisted dying stood at seven out of 10 when initially asked, but fell dramatically to four in 10 when presented with the full picture of the arguments against assisted dying, and so equipped to make a more informed decision. I recall that in the 2015 debate, several colleagues had entered the Chamber without a firm view on assisted dying, but after they heard the arguments and implications of changing the law on assisted dying and what it would mean for this country, they firmly voted against it.
Caroline Lucas (Brighton, Pavilion) (Green)
I welcome this much needed debate. I want to make three points. The first is to reiterate my point about inequality. The current blanket ban on assisted dying does not just rob dying people of any meaningful choice, but it perpetuates inequality. We have heard about the £15,000 that it costs to go to Dignitas. People often have to go alone, as the law prevents assistance from their loved ones, as we know, so that they might face prosecution when they return. People go much earlier than they need to because they have to be well enough to make the journey, so they die too soon.
For those who cannot afford to travel abroad, the choices are fewer. They might be subject to a lottery of compassionate but illegal co-operation from their healthcare providers. Others might feel forced to take things into their own hands in violent and lonely ways. Some choose to hasten their deaths, with the support of doctors, by refusing food and water. Rather than keeping people safe, we are inadvertently permitting assisted dying in a way that lacks any regulation or oversight, or indeed compassion.
Safeguards are important. I know some people have concerns about how, for example, assisted dying could inadvertently reinforce the discrimination that people with disabilities already face, so I want to be clear that resourcing and enabling disabled people to live dignified, full and long lives must be an absolute priority for us all, irrespective of our views on assisted dying. I want to be clear, too, that the proposals being considered are explicitly and purposefully for terminally ill, mentally competent adults. In other words, disabled people without a terminal prognosis would be deemed ineligible for an assisted death at the first stage.
The current law does not eradicate demand for assisted dying. It just drives the practice overseas, or behind closed doors where there are no safeguards in place to protect people. In fact, introducing a strictly safeguarded law with tight restrictions is the best way to protect those who are at risk of pressure to hasten their deaths against their wishes.
It is wrong to think that current practices in end of life care do not already demand the medical profession to be alert to the possibility of coercive control. A change in the law could strengthen doctors’ skills in that area and enhance our understanding of and ability to protect against it. For example, we could have in place mandated training so that doctors recognise even more easily the signs of coercion and, critically, we could create a specific criminal offence for the act of coercing a person into an assisted death.
Some have argued that more resources for palliative care are the answer, and of course I want to see that, but even the best palliative care cannot help everyone. We have seen growing evidence from places such as France and Queensland in Australia that the introduction of assisted dying can be a powerful catalyst to improve palliative care.
Palliative care and the hospice movement need more funding, but that does not take away from the importance of giving people choice at the end of life. I am proud that the Green party will commit to supporting a change in the law in our manifesto for the next general election. I hope very much that other parties will do the same.
Mr Tobias Ellwood (Bournemouth East) (Con)
I invite Members to look around. Westminster Hall is packed; extra seating has been brought in. I will wager—with apologies to my right hon. Friend the Secretary of State for Work and Pensions—that there are more colleagues here than there are in the main Chamber. This is a big day.
As chair of the APPG on bereavement support, I very much welcome this debate and I congratulate Esther Rantzen and the whole of the Dignity in Dying campaign on bringing this issue to our attention today. We rightly call this place the mother of all Parliaments and we are a proud global exemplar of how policy is debated, advanced and so on, but on this issue the people have had to nudge us in Parliament by way of the petition that brings us all here today. However, I do believe that we are starting to do justice to it by the quality of this debate, in which I am pleased to participate.
We must now have the courage to take this issue further, because the legislation is out of date. Under the Suicide Act 1961, anyone involved in assisting another person’s death could be subject to a 14-year custodial sentence. The world has changed since 1961. First, medicines significantly extend life, so we keep people alive longer, but their quality of life is not necessarily the same; and of course, as we are illustrating here today, attitudes are changing. A poll suggests that 77% of people in Bournemouth are supportive of changing the law.
Since the establishment of Dignitas in Switzerland in 1998, some Britons have chosen to travel to Zurich and pay £10,000 to £15,000 in order to say goodbye to their loved ones on the family’s terms, and I understand that for the last decade, the Crown Prosecution Service has not charged anyone for assisted dying. The law as it stands is not working; it is not enforced. The UK Parliament has not kept up with the contemporary thinking in Britain, or, as we have heard, with other countries—France, New Zealand, Australia, Spain, Austria, Holland, Chile, Colombia, Ecuador and, of course, Switzerland. The world’s position is changing and modernising, and we must do the same here.
The current system fails on three counts. First, with a terminal illness, there is the potential to experience pain and mental hardship as the body slows and loses strength. Secondly, it obliges families and loved ones to witness that deterioration, causing its own stress. Finally, as I heard from members of Dignity in Dying just an hour ago, there is the added anxiety of not knowing for sure whether there will be a knock on the door from the Crown Prosecution Service. We can and must do better.
Debates come and go in Parliament—policy is discussed, and it is all written up in Hansard—but occasionally there are big days when the public are watching and we remember where we are and what is said. Today is one of those days. Let us make today’s debate count. Let this be the start of a process that gives real choice to those who are terminally ill. It is time to change the law, with Government legislation.
Ian Paisley (North Antrim) (DUP)
The Guardian is not known for its conservative zeal on any campaigning issue, but in a brilliant article on 7 April, Sonia Sodha outlined some things that I think should be compulsory reading for anyone engaging in this debate. She deals with the issue of coercion and she comments to the effect that we are in a day and age when coercive control is the norm for many in relationships. She blows a hole through the notion that we are in a free society to make these decisions. Many in our society are in fact not free at all. They are coerced, subject to conditioning and influenced by what becomes wrongly called the new cultural norm in our society.
One third of suicides of females in the United Kingdom are related to intimate partner abuse—just think about that. We have all read the stories, seen the court reports and heard from our constituents about coercive and abusive control of females in our society: “I hate you”; “You’re not worthy of my love”; “Your children hate you”; “Are you still alive?” We know what that does to people and what it drives them to do. It controls them and creates a very ugly environment for them to live in. That type of abuse is all too prevalent in our society. The elderly are similarly abused: “Mum had a good life, you know”; “You know, they’re done, really”; “It’s going to be very costly to keep them in this health service.” All that pressure builds.
All those people who tell us that there is no coercion, anti-disability prejudice, emotional abuse or financial abuse in this society are wrong: there is, and all those factors influence people to say, “Maybe I should end my life.”
Wera Hobhouse (Bath) (LD)
Can the hon. Gentleman explain whether a doctor who diagnoses a terminal illness is part of that manipulative coercion?
Ian Paisley
That is actually a brilliant point, because I want to turn to the issue of safeguards. Some Members have said, “There are going to be brilliant safeguards,” yet every single one of them has told me and this House over the years how rubbish and useless the law is—how it has failed here and is deficient there. Yet they say we are going to come up with the best, most brilliant, most wonderful law on this matter that no one has ever seen before—on this occasion, we will achieve it. The very same people who tell us that we will have safeguards tell us every single day that they cannot create those sorts of safeguards.
Look at what happened in Canada. It was said in 2016 that its legislation would have a very narrow scope, but that narrow scope has turned into discussions about disability, sick children and chronic mental illness. Those are all now within the purview of the Canadian law, but of course they were never supposed to be.
I think we are doing a huge disservice to palliative care and to the doctors and nurses who care, give their life to this and want to see compassion at the end of life. I believe, as some Members have said, that there should be a national conversation about this issue. It should be a long debate, because we really need to get into the weeds of the matter, but to think that because some people have signed a petition, suddenly this nation is ready to make the health service the service that will result in the end of people’s lives is folly, and we should avoid it.
Dr Thérèse Coffey (Suffolk Coastal) (Con)
Living with terminal illness is distressing and difficult for the person involved and for their family and friends. The cases we regularly hear about are truly moving and evoke the highest degree of compassion. When and how someone passes from this life is challenging and a very emotional topic.
When I raised this issue in Parliament back in 2011, I expressed my concern about how the practice of withholding water and food in order to accelerate someone’s death had been deemed lawful in court, although I was relieved that after the Neuberger review that was effectively stopped across the country. Assisting or encouraging suicide is a criminal offence under section 2 of the 1961 Act. That Act was updated by the Coroners and Justice Act 2009, and there was an attempt then to change the law to make assisted suicide legal in this country.
I was not in the House at the time of the 2009 Act’s passage, but fortunately that attempt failed. What did come, though, were guidelines for the Crown Prosecution Service, put in place by the then Director of Public Prosecutions—now the Leader of His Majesty’s Opposition —which seem to have stood the test of time. Back in March 2012, when this House debated those rules, it voted against the proposal to make them statutory guidance while adding its support for palliative care and hospital provision.
There has been a lot of talk about how somebody comes to the end of their life, but there is an overwhelming difference between clinicians knowingly giving medication to help accelerate someone’s death—mindfully setting out to kill—and giving something that may help deal with the pain. However, I think such ethical issues need to be considered as stand-alone Bills. Unfortunately, there are too many attempts to make quite significant changes to ethical issues through Government Bills that are often rushed through, and so significant changes happen with very little debate, if any at all.
On 11 December 2015, 330 MPs voted against changing the law, which is three quarters of the MPs who voted that day. That was not an insignificant debate, and 70% of the House participated in that Division. Since then, no Member of Parliament has come forward with a Bill for the House to consider, either through the ballot or by presenting a Bill. While I know that a lot of constituents would like a change in the law, I still think that the House would not make one. We have seen the issues that have put doubt into people’s minds.
Many Members have talked about the experiences of other countries. The evidence of the acceleration that has happened around the world shows exactly why we should not change the law. In Washington state in 2009, a quarter of people applied because they thought they were a burden. That rose to 59%.
Fiona Bruce
Is my right hon. Friend aware that, at the same time that this country’s Parliament voted against legalising assisted suicide, a different decision was made in Canada? In 2016, the first year of medically assisted deaths, 1,000 people chose to have one. By 2022, more than 13,000 people had availed themselves of that law, representing a 30% year-on-year increase.
Dr Coffey
My hon. Friend points out how this starts to increase quite significantly. It was also in Canada that a distinguished Paralympian who was looking for help with their disability was offered assisted dying as an alternative to adaptation of their home.
There has been a lot of discussion today about elderly people, but we are not just talking about elderly people. We are talking about vulnerable people. We are talking about people with disability. We are talking about people who could be taken advantage of to end their lives early and who may have that element of being considered a burden. People in this House have put forward the view of Matthew Parris that it is perfectly rational to say that you are a burden, and that you should potentially end your life. No one should feel such a burden on their family, their friends and society that they should end their life early.
While I will upset some of my constituents, I hold a different view from them on this matter, as I have done consistently, and I will continue to want to leave the law as it stands.
Damien Egan (Kingswood) (Lab)
I thank my hon. Friend the Member for Gower (Tonia Antoniazzi) for her introduction. I feel privileged to follow so many compelling and thoughtful contributions.
We do not have to speak to many people before we hear painful stories of the torturous and brutal deaths that people’s loved ones have had to endure, often through extreme pain. I always thought that I would be one of those people who said that a form of assisted death would not be for me or something I would encourage for loved ones. This weekend, I talked to a lot of people about this debate, and my nan—a very wise woman—shared the story of her mum, who died of breast cancer at 61 and had a very difficult death. That made me feel that what I thought before was naive. Yesterday, on a very different visit, a woman from a local “save our green spaces” group said to me that we do not treat our pets in the same way that we do people, and let them have such cruel deaths. I did not have an answer for that, which made me feel that surely we can do better.
As we move forward in this debate, I would like to add my voice to the call for us to exercise caution. With over 400 million people around the world living in countries and jurisdictions that have introduced a form of assisted dying, there is much to learn from. I do not yet know the ins and outs of parliamentary procedure, but it is something that needs considerable thought and time. On one extreme, I was taken aback by examples from the Netherlands of people ending their lives due to mental illness. I worry about assisted dying being seen as an alternative to palliative care, about people feeling like a burden on their families, and of course about coercion.
[Mrs Pauline Latham in the Chair]
However, I bring Members back to the example of Oregon, where legislation has existed for 27 years, and has not actually been extended. Assisted dying is limited with strict safeguards: people must have a terminal illness, life expectancy of less than six months, and there must be cooling-off periods. Interestingly, a third of people who start that route never take end-of-life drugs, but they are reassured that they have that choice, if needed. It would need interrogating, but in 2019, the executive director of Disability Rights Oregon said that they had not received a complaint about coercion of disabled people. It has come with very good palliative care, and more than 90% of those who died under Oregon’s Death with Dignity Act 1997 were enrolled in hospice care—
Sir Desmond Swayne (New Forest West) (Con)
A couple of years ago, on the near continent, a young woman of 23 years was euthanised, having suffered from post-traumatic stress disorder since 2016. Although physically uninjured, she had witnessed school friends being blown to smithereens in the bombing of Brussels airport. I put it to Members that if we use assisted dying as a therapy to end suffering for which other therapies exist, we will have made a profound transformation in assisted dying, changing it from being a means of ending suffering in death, to a means of ending suffering in life. I suggest that the trajectory is in that direction, as it has been in all those jurisdictions that have introduced it.
I debated this subject against Baroness Meacher at Durham University, at the time when she had a Bill in the House of Lords. She was determined to constrain the debate to all the provisions she had made in the Bill on safeguarding, diagnosis, the number of doctors giving assent and all the rest, but she was completely hijacked by her seconder, who was a psychiatrist representing an organisation called My Death, My Decision. They were determined that this was a therapy—a provision; a service—that should be available to absolutely everyone.
I only want to make one further point, aside from the fact that I accept we have not voted on this for three Parliaments. We should determine what our position is; I would welcome a vote, but we should be careful what we wish for. Oregon has just released its statistics for last year. By far, the largest cohort of applicants for the service—52%—are those who say they wanted it because they did not want to be a burden, far exceeding those who wanted it to avoid pain in death. There is a profound danger that what begins as a choice will end as an expectation, and so proceeding, we will end up with what Matthew Parris has said, and then it is not much of a jump to “Logan’s Run”. If you do not know what that is, Mrs Latham, google it.
Jim Shannon (Strangford) (DUP)
It is a real pleasure to speak in this very poignant debate as the DUP spokesperson on health. The issue is of great importance and must be in line with our obligations to uphold and protect the sanctity of life. I will say clearly that I am a Christian and I have a Christian faith; that faith is what drives me and it is why I am here to represent my people. And I represent the thousands of my constituents who are opposed to assisted suicide.
Introducing so-called “assisted dying” would fundamentally and irreversibly change the relationship between doctors and patients, and how we think about healthcare. The duty of a doctor is to save life, not end it. It is there in the words of the Hippocratic oath—to “do no harm” and not to:
“administer a poison to anybody when asked to do so”.
Even the modernised versions of the Hippocratic oath, which all doctors must take, clearly state:
“I shall never intentionally cause harm to my patients, and will have the utmost respect for human life.”
So, that is very clear from the doctors’ point of view and it is what I want to speak about.
I have been struck by the fear felt by those over 70 who are found to have cancer—
Sir George Howarth
Does the hon. Gentleman not accept that “harm” to human life can involve someone existing in pain and acute distress?
Jim Shannon
I thank the right hon. Gentleman for his intervention, but I will give him the example of a lady over 70 who has cancer and of those people who have to apologise for waiting for treatment to fight their cancer. This lady is 72. She says that she really wants to fight the cancer if they will give her the chance—those are her words. However, she says that she felt guilty for taking resources and guilty for wanting to continue to live her life and help her daughter to raise her child. So, imagine the conversation about introducing assisted suicide. That would only increase the fears of vulnerable people and further damage the important trust between doctor and patient.
The Isle of Man statistics are very clear; I do not have time to refer to them. The Royal College of GPs continues to oppose assisted suicide, after the results of a consultation. The British Medical Association did the same. It was said that
“When the votes were analysed by the BMA, it was found that majorities of members whose work brought them into close and regular contact with terminally ill patients, including palliative medicine doctors, geriatricians and GPs, were opposed to legalisation, while respondents who had voted for legal change contained a majority of retired doctors, medical students and those in branches of medicine which involve little or no contact with terminally or otherwise incurably ill patients.”
Ian Paisley
I thank my hon. Friend for giving way. Regarding safeguards, we are told that one of the ideas for future legislation is that two doctors and a judge will ensure that there are plenty of safeguards. Does he agree that our courts have so far been utterly useless in finding family abuse in many situations and so they do not offer a safeguard at all?
Jim Shannon
I thank my hon. Friend for his intervention and he is absolutely right; again, he iterates the issue. I will give two examples. In Belgium, courts have ruled that doctors have an obligation to make effective referrals even if they themselves are unwilling to take part in assisted dying. Canada is the very same. My goodness! The right hon. Member for New Forest West (Sir Desmond Swayne), who spoke before me, made the point very clearly that in other words there is a duty to inform patients that an assisted death is an option. That should never ever be the case.
It is not too hard to see how, in such a context, vulnerable people may feel that they ought to end their life early to avoid being a burden or because of medical advice. Assisted suicide can never be just about one person and their own choices. It would irreversibly transform the role of the NHS and the patient-doctor dynamic.
I will finish by saying that we must not allow this change of law to happen. The duty of doctors in society as a whole is to care for the vulnerable and therefore we must continue to resist attempts to introduce assisted suicide. As lawmakers in this House, we must err on the side of caution to ensure that the option of assisted dying does not lead to pressure on those who are older, vulnerable and feeling that the best thing for them to do would be to go quietly, to save people money and to save putting pressure on the NHS, when instead they could have 10 more years to live a full life, enriching the lives of their family and their community.
This is a very serious debate; we all know that and we have different opinions. But I am clearly on the side of supporting people to have a longer life and assisted suicide is not something that I can ever support.
Danny Kruger (Devizes) (Con)
I greatly respect the campaigners who are proposing a change in the law and the people who signed the petition. Nevertheless, it is not the case that the majority of the public support what is euphemistically called “assisted dying”. When the details of the proposed law change are explained to people, a majority of people oppose a change in the law. Crucially and most importantly, the doctors who work with the dying—people in palliative care and geriatric care, and GPs—overwhelmingly oppose a change in the law, because they know what we are talking about. Nor is it the case that in countries that have legalised assisted dying—
Paul Blomfield
When the BMA consulted its members, more doctors supported a change in the law than opposed it.
Danny Kruger
The BMA has decided to be neutral on this matter. Most of the doctors who supported a change in the law are do not work with the dying and the elderly. I accept that a majority of doctors have now accepted a change in the overall position. What I am talking about is people who know what they are talking about—I say that with great respect to the hon. Gentleman, who I understand has a lot of knowledge of this topic, as well. My point is that while there might be overall polls that suggest public support, in fact, when professionals, members of the public and MPs get the chance to look at this closely, they end up opposing a change in the law, and for good reason.
Palliative care services do not rise in countries that have legalised assisted dying compared with countries that have not; they flatline. Of course, all palliative care services are going up because the population is ageing, but they decline in countries that have legalised assisted suicide.
Paul Blomfield
Has the hon. Gentleman not read the Select Committee report? We looked at every single jurisdiction. There was no evidence that palliative care declined in countries that adopted assisted dying. There was only evidence that it had opened a debate that had led to an increase and improvement in palliative care.
Danny Kruger
The point I just made is not that it declines, but that it does not increase compared with countries where assisted dying is not legal. Often, the increase and investment in palliative care is actually because there is more spending on assisted dying, which has now been legalised in those countries. I am very happy to take up this point offline, because it is very important, and I recognise the Select Committee looked closely at it in its report. However, there is an important point about the investment in palliative care in countries that have assisted dying and those that do not.
I am not sure whether this point was in the report, but what does go up in countries that have legalised assisted suicide is suicide itself in the general population. The fact is that suicide is contagious. Suicides among people who would not be eligible for assisted suicide increase in countries that have legalised it. I am afraid that is understandable when we consider that the Government have told society that some people would be better off dead. We have policies in this country to prevent suicide—we want to stop people committing suicide. It is important that we recognise the potential implication of a change in the law for others.
As that suggests, this is a profoundly moral question. I recognise that there are people with deeply held beliefs on both sides. There is a quasi-religious belief in the notion of autonomy and choice as the only moral question in this debate, and I have heard that suggested. It is important to acknowledge that the people with the least agency and autonomy—the vulnerable, the disabled, the mentally ill, the frail, the lonely—are the ones who suffer in every country where the law has been changed. It is not surprising that every country that legalises assisted suicide starts with very tight restrictions, and then the scope and the access expands. I will demonstrate that offline after the debate, because it is true.
Paul Blomfield
We looked at this in detail as a Select Committee. Not a single jurisdiction that has defined its law in terms of terminal illness has chosen to broaden it.
Danny Kruger
The definition of terminal illness is incredibly difficult, and people can always find a doctor to demonstrate it. That has happened in Oregon, in Canada and other countries. Again, let me take this up offline. [Interruption.] I respect position of the hon. Member for Sheffield Central, but I stand on the point that the scope, access and eligibility expand, and of course it does, because expansion is implicit in the principle.
Robin Millar (Aberconwy) (Con)
I note from the Health and Social Care Committee’s “Assisted Dying/Assisted Suicide” report that:
“Wherever the boundaries are set, evidence from other jurisdictions shows that the boundaries are eroded and criteria expanded, with concomitant escalation in numbers, most markedly seen in Canada.”
Does my hon. Friend agree that that is the concern he is trying to express?
Danny Kruger
I am very grateful to my hon. Friend. These things are very contentious, and there are issues around definition. But I stand on the principle that there is implicit expansion in the scope of any law. [Interruption.] Am I being given extra time for the interventions I am taking?
Danny Kruger
Then I will not take one now.
Baroness Campbell, herself a wheelchair user, said that:
“The existing law…rests on a natural frontier”,
namely that we do not kill people. She asked:
“What the proponents of 'assisted dying' want is to replace that clear and bright line with an arbitrary and permeable one…If terminal illness, why not chronic and progressive conditions? And, if chronic and progressive conditions, why not seriously disabled people?”
It is impossible to make distinctions between those terms. That is why the law always has the scope for its own expansion within it. That is why we should oppose the change.
Carla Lockhart (Upper Bann) (DUP)
I am grateful to speak on this important issue, and it is an honour to follow the hon. Member for Devizes (Danny Kruger).
The supporters of the petition want to alleviate suffering at the end of life. That is a commendable motivation, and something we can all agree on. However, making it legal for doctors to help people to kill themselves is simply not the answer. It is so important that we are all clear about what we are talking about today: we are dealing with assisted suicide, not assisted dying. We need to be clear, because politicians and the public need to know what they are being asked to consider. We are all in favour of helping people in their dying moments, comforting them and relieving their pain, but that is categorically different from bringing in a law that says that killing yourself is an acceptable thing to do.
Like many today, I find this topic emotional to deal with. On 11 June last year, my dad passed away aged 66, having suffered from cancer for almost five years. Loved beyond measure, my dad had great faith and never feared dying because he knew he was going to his heavenly home, but his cancer was absolutely horrendous. It was a thief, and it caused him immense pain and suffering, particularly in the last years of his life, but despite the suffering my dad knew there was an appointed time for him—for his home-calling—and that it was not for him or any other to decide on that time.
The palliative and cancer care that my dad received was exceptional. With further investment, such care could be even better. I speak today not as someone who has not experienced a loved one’s suffering from terminal illness—I know the journey, but I also know the one thing that these people do not need is the law telling them that their lives are not worth living or that they are costing too much. We need to tell such people that they are valued, that they are important, and that we care for them—no matter the cost. We must put our money where our mouth is and ensure that all those who need it can access high-quality, specialised palliative care.
Wera Hobhouse
I thank the hon. Lady for sharing her story, which I understand is very personal. Does she not accept, though, that the choice her father made would never be taken away from him by changing the law? The choice for some would be to end their life, but the choice for those happy to continue their life until it came to an end would never be taken away from them.
Carla Lockhart
As we have heard and as I will go on in my speech to say, when the law is introduced it is expanded and the potential safeguards are not safeguards at all—it is a slippery slope. By investing in social care, by continuing to be a world leader in palliative care, and by being a society that respects life and upholds the dignity of the elderly and of people with disabilities, we can give hope to the hopeless and create a society where assisted suicide is not needed.
The consequences of introducing assisted suicide are not a matter for speculation. The practice has been implemented in other countries not unlike ours, and when assisted suicide is permitted, it is a slippery slope. Whenever assisted suicide has been legalised, however tight the initial safeguards and however sincere the assurances that it will be a narrowly defined law for rare cases, the practice has rapidly expanded.
Carla Lockhart
I am going to make progress. In Canada, it took only five years from the 2016 introduction of assisted suicide for those whose death was “reasonably foreseeable” to be expanded to the ill-defined “serious and incurable illnesses” criteria in 2021. In Oregon, in the US, people have been given assisted deaths because of diabetes, hernias, arthritis and anorexia, with the “terminal illness” interpretation now wide and wieldy. In the Netherlands and Belgium, child euthanasia has been legalised, as well as euthanasia for mental illness and dementia.
I conclude by quoting the national Danish Council of Ethics. Having considered the issue in detail, including examining the evidence from supposedly safe places such as Oregon, it concluded:
“The only thing that will be able to protect the lives…of those who are most vulnerable in society will be a ban without exception.”
It is time to invest in better palliative care and support those who go over and above to support those in their dying hour. Leave the law as it is. We must resist this change.
Simon Jupp (East Devon) (Con)
It is a pleasure to serve under your chairship, Mrs Latham.
Five hundred and eighty-one people in my constituency have signed this petition—make that 582, as I want to put on the record for the first time my support for the principle of assisted dying. I recognise the arguments on both sides, but my personal view is deeply held. It was strengthened recently when I strolled around Sidmouth, where I live.
An older gentleman was tending to his garden, when he decided to strike up a conversation. He explained that the garden was his wife’s pride and joy. She was now in a local care home, so it was his turn to do some pruning. At this point, I could see that he wanted to cry. In a very British way, he apologised, but went on to explain why he felt so emotional. His dear wife, the love of his life, is terminally ill, has no quality of life and lives in constant pain. She cannot leave her bed. He visits her every day, and every single day she tells him that she does not want to be here any more. It was clearly breaking his heart. The gentleman suddenly straightened up, looked me square in the eye and asked me if I supported assisted dying. The look of relief when I said yes was palpable. We shared an emotional moment together. I will never forget that conversation.
As I continued my stroll, one thought rang constantly in my head: “My view shouldn’t matter.” Assisted dying, with appropriate safeguards, should be the law now. Who is any of us to deny people that ultimate freedom, that choice to end the pain? The blanket ban on assisted dying forces people to suffer against their wishes. The only legal solution involves going abroad at enormous expense, which is out of reach for most people. Dignity in dying should not be available just to the privileged few.
Assisted dying does not replace palliative care and end-of-life services, as we have heard today. Someone approaching the end of their life or living with serious illness should be provided with the care and treatment they need to maximise their quality of life and minimise any suffering or distress. In my view, assisted dying should be an additional choice that terminally ill, mentally competent adults with six months or less to live should be able to make because they want more control over the manner and timing of their death.
Currently, there are terminally ill people in constant pain who are living against their wishes. That is cruel. If I was terminally ill, was in unbearable agony and had no quality of life, I would want a choice. Whatever happens next truly frightens me, but I want there to be that freedom: a decision in my hands, and no one else’s. Suffering should not be inevitable. I hope to one day vote in favour of a policy that ends a cruel reality for far too many people.
Sarah Dyke (Somerton and Frome) (LD)
It is an honour to serve with you in the Chair, Mrs Latham. I thank the hon. Member for Gower (Tonia Antoniazzi) for bringing forward this important debate. I also thank the petitioners, including 645 in Somerton and Frome, and everyone who reached out to me ahead of the debate. Your experiences have touched me deeply, as have the experiences of hon. Members here.
One constituent wrote to me about her son, Jonathan, who died in a hospice at the age of 46. His family told me that the tragedy of his death was made so much worse by the lack of provision for assisted dying. Jonathan’s mother, Denise, gave me a quote that I think sums up today’s debate very well:
“It’s not about ending life, it’s about shortening death”.
I want to mention Dorothy House, which offers free palliative care and end-of-life care across much of my constituency. It remains neutral on this issue, but shared its ethos with me earlier today:
“Dorothy House has a vision of a society where death is a part of life”.
I cannot thank Dorothy House enough for the support that it provided me and my partner while we were caring for my partner’s mother in her final few months, as she was dying of cancer. Having cared and watched this strong, independent and dignified woman fade away in considerable pain, unable to have the dignified death that she wanted, will forever haunt me.
The UK public have stated that they would support provisions to make assisted dying legal in the UK. Research carried out in January this year by Dorothy House, which gathered 401 responses, showed that 69% of respondents would support the law being changed to allow assisted dying for someone suffering from a terminal illness. The findings are backed up by a recent Opinium poll for Dignity in Dying, which showed that 75% of people in the UK support assisted dying. The analysis showed that there is majority support for assisted dying in every constituency in the country. In the new constituency of Glastonbury and Somerton, 80% of people support the change, which is the third highest level of support in the country.
I am committed to championing the freedom, dignity and wellbeing of individuals, and respecting their right to freedom of conscience, but the issue is complex and divisive—hence why it is vital that any legislation that provides for medical assistance to die in particular circumstances is subject to rigorous safeguards and regulations. That is also why it is important that this topic is debated fully in Parliament, and that any new legislation is robustly scrutinised. I hope that we can be reassured today that we will see progress over forthcoming parliamentary Sessions.
Duncan Baker (North Norfolk) (Con)
This debate will always provoke many feelings and emotions—ones that, no matter what side of the argument one is on, we should respect. Whatever one’s views—I have heard nothing today that has convinced me otherwise—we cannot argue on one’s personal sovereignty. An individual has the right to choose, and they should have the dignity to choose how to end their suffering, provided that there are the right safeguards.
Often in this place it is said that if you speak with a level of passion about a subject that you care about, the speech will resonate more. I lost my stepfather—my dad—suddenly in July 2019. It was just five months before I was elected to this place. He was well-known all over north Norfolk, and I know that my dad would have been proud of the accomplishment that saw me to this place, which he sadly never got to witness. He was the inspiration for my foray into local politics. He never imagined that I would get here, but without him I would not have risen through those ranks in local politics just to serve that community.
My stepfather had a heart attack on Good Friday 2019. In his usual style, he just dismissed it—it was just one of those things—but actually he needed a quadruple heart bypass. Just weeks later, he suffered a sudden, unexpected and dreadfully debilitating stroke. Just a few days later, he passed peacefully, back in his own home, in his own bed and looking out into his own gardens, where he wanted to be. We were lucky—I say that because my stepfather always knew that he did not want to suffer for years on end if this sort of eventuality ever happened to him. He had a vision for what he wanted and how he wanted to die, and he had a living will that the doctors in the hospital adhered to and respected.
This was a proud man, rooted in his community, who spent 45 years building up his own business in the town that was his home. He did not want to be pushed around in a wheelchair and fed by somebody else, or for his grandchildren to be sat on his knee and him not even to recognise them any more. If he had a condition, a stroke or any other terminal illness, he would rather not be here. I know that I speak for millions of people around the country who would also want the dignity and respect to pass peacefully if they so chose.
I am lucky that one of my constituents, Zoe Marley, has come here today all the way from north Norfolk. She has been a tower of strength in her determination to see a change in the law. Zoe lost her mother and her husband in a couple of years, both to painful terminal cancers, and they both assisted themselves to die after a battle with their cancer. I thank her for all her determination on assisted dying.
Lia Nici (Great Grimsby) (Con)
I commend the petitioners for allowing us to have this debate, because many, many of my constituents believe that we should be pro-choice in specific ways and not in the current no-choice situation of most people. People who do not have the means to go to Switzerland have no choice but to suffer in pain or try to have secret, illegal conversations with medical people who make it difficult for everybody to be able to endure and allow them to have a good-quality death.
My good friend and colleague Debbie Woodward asked me to fight for assisted dying. Debbie had terminal cancer; tumours meant that she could not swallow or digest food any more. She was as bright as a button, determined, passionate and an excellent local councillor who we lost too soon.
In the last week I met Debbie before she died, I said to her, as many people do when they are with their friends, “What can I do to help? Is there anything you need?” She said, “Yes. You are in just the right place. I need you to fight for assisted dying.” She texted me the things that she wanted me to say:
“I believe we should fight for euthanasia for certain illnesses. I have Signet Ring Cell Carcinoma (had to be jewellery related with me) they also sometimes refer to Goblet cell Carcinoma. Not really sure why they give them the names they do, because when I see the pictures, I see no resemblance to either. I wish I had more time, I have not done all I want to do yet.”
In her last week, Debbie was in a lot of pain but she knew what she wanted. The last thing she said to me was:
“You asked me what you can do for me. Please support assisted dying. Give people who have terrible illnesses like me the choice as to when and how to die.”
Chloe Smith (Norwich North) (Con)
I am grateful to be called and to have been able to attend the statement in the main Chamber earlier. We last debated this issue nearly a decade ago—in 2015. The Commons vote failed to reflect public opinion then, but MPs could do so now. It is my view that we should have a thorough and fresh debate, especially as other places increasingly have experiences to share about how assisted dying laws can work well, as we have heard from the Health and Social Care Committee. It is notable that none of the 31 countries that have put these laws in place has repealed them.
I speak in favour of the proposition, and I am very pleased that the petitioners have brought it to us. I voted as such in 2015, and I will make the same arguments now. I was in the minority on that day, but I hope that there will shortly be a majority for the proposition. I believe that terminally ill people who are mentally sound and near the end of their life should not suffer unbearably against their will. They should have the option of requesting medical help to end their lives with dignity through a safe and compassionate system with strict criteria and safeguards. It is their life, their death and their choice—not anybody else’s. Under the core proposal, it is not only a choice; it is also not compulsory.
Without such a provision in our law, too many people are taking matters into their own hands with absolutely tragic consequences. People are forced to take often hidden, undignified and desperate action. They should be able to have an open conversation with their doctor instead. It is not okay that they have to refuse food or be able to afford to go to Switzerland.
The problems in our law are twofold: it is not just that it forces honest people to go underground, but that it is not currently neutral. This debate is about a choice that has already been taken in law. We are not starting from neutral ground, but we have to apply our best work to it as legislators. The main problem with that lack of neutrality is that it is heartbreaking to make carers risk a charge on top of their grief. One constituent said to me:
“In the 21st century we should be having an adult debate about this. We should protect family members or friends who risk prosecution for assisting.”
Another added:
“This is a subject that as a caring and civilised country we can no longer ignore. I hope this issue can finally be addressed in Parliament.”
I agree with my constituent: we should bring these quite awful ethical choices into the light, and give people dignity and support. People are suffering cruelly, and I hope the next generation of MPs will take courage.
Nick Fletcher (Don Valley) (Con)
On 7 May, surrounded by her family, Shanti Di Corte was euthanised. She was 23 years old. Six years earlier, on 22 March 2016, Shanti had been at Brussels airport when terrorists set off bombs. Her assisted death has been added to the number killed in that atrocity. She suffered immensely with PTSD.
At 2 pm on Friday 26 February 2018, 29-year-old Aurelia Brouwers was allowed to end her life on account of psychiatric illness. Zoraya ter Beek has chosen euthanasia because of crippling depression; she is 28, and she is scheduled to die in May. Does anybody here want to be part of a decision that allows a young person to schedule their death? I do not.
In the Netherlands, euthanasia now accounts for 5% of all deaths. I cannot support a policy that takes life, because life is God-given and precious. The thought of killing someone just because they are old or in poor health makes me feel desperate for the state of our society. It also makes me see how naive our society is becoming—naive that, if this policy ever came into force, it would remain tightly controlled.
As we have seen in other countries, assisted dying starts with the terminally ill, but too often the scope is widened to include disabled individuals and, as with the three women I mentioned, individuals with mental health issues. How many among our population are struggling with their mental health at present but will no doubt, after a relatively short period of time, be back to having a good and meaningful life once more? Yet sadly, if we follow the example of these countries, we will be ending the lives of young people in their 20s and 30s. To anyone who thinks this would never happen on their watch and that it would only ever be for the terminally ill, I am sorry to be the bearer of bad news, but you are wrong.
None of us will be in this place forever. We will not be able to control where this legislation ends, but we will have been the ones who started it, and therefore, we will be forever culpable. We cannot and should not start on this journey. As I stated at the beginning, I cannot support the Bill, because I believe that life is precious—far too precious. It is God-given, and only He should ever take it away.
Robin Millar (Aberconwy) (Con)
First, I give my thanks to the hon. Member for Gower (Tonia Antoniazzi) for introducing the debate on behalf of those who signed the petition. It is really important that we represent the people who write to us, and like many colleagues here, I have had lots of emails and letters on this subject.
I want to make two points. My first would be a note of caution. As parliamentarians, it is our job not only to represent those with a voice—those who are motivated, interested, engaged and who grab our attention. Our job is also to represent those without a voice—those who are vulnerable, who cannot speak or who speak with a very quiet voice. It is our duty to represent their interests and consider their situations as well. That is an important balance we must bring to this debate, and I make no apology for that. I want to commend the hon. Member for Gower for bringing that balance to her opening remarks. If we are to have these debates, it is important that they are done in the right way. The tone she set was very helpful, so I thank her for that. I also thank the Health and Social Care Committee for its report, which I found very helpful, with the facts it presented and the approach it took. I commend it to all to read, as there are many good and useful points in it.
There is very little time available, so I will finish with my second point. Some might characterise this as a slippery slope or the thin end of a wedge, and I, too, was appalled at what Matthew Parris wrote. I found the way in which he wrote and presented it to be crude, and unnecessarily so in such a debate. However, I want to speak about the issue of normalising. The point has been made in other places that suicide rates in countries where this legislation is introduced go up, and it is that normalising that I am particularly concerned about. In Scotland, the Assisted Dying for Terminally Ill Adults (Scotland) Bill includes a definition of terminal illness, which could be seen to include things like type 1 diabetes or rheumatoid arthritis. To quote the Health and Social Care Committee’s report again, it states on page 45:
“Wherever the boundaries are set, evidence from other jurisdictions shows that the boundaries are eroded and criteria expanded”.
Chloe Smith
I was following these arguments very carefully earlier. The citation my hon. Friend makes is a quote from a campaign group rather than a finding of the Committee.
Robin Millar
I thank my right hon. Friend for that. It stands as it is, and I refer every interested reader to the context of the quote.
Robin Millar
I will give way to the hon. Member for Sheffield Central (Paul Blomfield) and then to the hon. Member for Strangford (Jim Shannon).
Paul Blomfield
I think it is necessary to have accuracy in this debate. I refer the hon. Gentleman to paragraph 7 on page 96 in which the Select Committee says:
“We also conclude that jurisdictions which have introduced AD/AS on the basis of terminal illness have not changed the law to include eligibility on the basis of ‘unbearable suffering’.”
Jim Shannon
To add to the hon. Member’s concerns over what is coming out of Scotland, it has been suggested that even young girls with anorexia could find themselves in a position where they might feel constrained to do this. I make this very important point. The health service saved the life of one of my constituents. When she was in difficult times, she went to St Thomas’ Hospital across the way and they saved her life. It could very well have been the other way round.
Robin Millar
That speaks to my concern about normalisation. If we introduce legislation that says, “It is acceptable to end life for a wider range of conditions”—the evidence before us in Scotland is that that interpretation is correct—we risk normalising suicide as a prescription.
Dr Coffey
My hon. Friend is making a perfect point in terms of clause 2 of the proposed Bill going through the Scottish Parliament at the moment. There is no mention of 12 months and no mention of a person dying at a particular time. It is simply about aspects of a condition from which someone is not able to recover and could reasonably expect a premature death. The worry that we have is the interpretation of the law. It has undoubtedly expanded around the world such that we have seen an increase in the number of people with assisted suicide.
Robin Millar
I thank my right hon. Friend for her intervention. I will conclude with this: we must never get to a point where assisted dying is seen as a prescription. We must never get to a point where we see death as a treatment.
Mrs Pauline Latham (in the Chair)
The wind-ups will now begin. I call Ruth Cadbury.
Ruth Cadbury (Brentford and Isleworth) (Lab)
It is a pleasure to serve under your chairship, Mrs Latham, and an honour to speak for the official Opposition in this e-petition debate that calls on the Government to allocate parliamentary time for a debate and a vote on assisted dying. The debate follows the campaign by Dignity in Dying, the Daily Express and Dame Esther Rantzen, and the petition signed by more than 200,000 UK residents, including over 200 of my own constituents.
I thank my hon. Friend the Member for Gower (Tonia Antoniazzi) for her considered opening speech. I also thank members of the Select Committee for the work that they have done in informing this debate.
I should start by making my own view clear. I support reforming the law in favour of assisted dying. I voted for reform in the private Member’s Bill debate in 2015 and I have spoken in previous debates on the subject in this Chamber.
Today we have heard powerful, deeply held views from many right hon. and hon. Members, some supporting change, some not, and some still with an open mind. This has been a truly cross-party debate in the very best traditions of this House. As I speak from the Opposition Front Bench, I can reiterate that both the Leader of the Opposition and the shadow Secretary of State for Health and Social Care have said that, if elected, a future Labour Government would provide parliamentary time and a vote on changing the law.
The process in issues of conscience means that it would be for a Member of Parliament rather than the Government to introduce the change in law. It would be debated and refined on a cross-party basis with each Member free to speak and vote according to their own conscience. Any Government must ensure that any proposal carries with it proper and strong safeguards. It damages the cause if such reforms are rushed through with inadequate consideration. If any reforms do not recognise the concerns that many people have, including those who support reform in principle, we will not receive the consensus that any change must have.
The right hon. Member for Haltemprice and Howden (Sir David Davis) addressed the concern that in Canada and the Netherlands, issues of cognitive impairment or mental illness might be reasons for people to consider assisted dying. We must listen to those concerns. We must also listen to those who are or who represent the elderly, people with disabilities and those who face life-changing conditions.
Steve Brine
There has been a lot of talk about Canada today, so I just want to place something on the record. It is true that Canada did extend the MAID—medical assistance in dying—provisions to include those who are suffering from a mental illness. However, on 29 February this year, Bill C-62, as they name them there, received Royal Assent, postponing that eligibility until 17 March 2027. My point is that lawmakers can change the law; that is what we are here for. The slippery slope argument is often made, but actually, the slippery slope would have to be engendered by politicians and by this Parliament.
Ruth Cadbury
I thank the Chair of the Select Committee for that very helpful contribution.
Ruth Cadbury
I want to crack on so that both the Government and the mover of the debate can have their chance.
We have heard concerns about vulnerable adults nearing the end of their life who could be at risk of pressure from either family members who feel incapable, for whatever reason, of providing care and support for a terminally ill person, or, as eloquently touched on by my right hon. Friend the Member for Knowsley (Sir George Howarth), those with even worse motives. If reform is offered, it is essential that there is a plan for robust and effective safeguards against those issues.
Matthew Parris’s article has been referenced by the hon. Member for South West Bedfordshire (Andrew Selous) and my right hon. Friend the Member for East Ham (Sir Stephen Timms). Unlike the hon. Member for North Antrim (Ian Paisley) and the right hon. Member for New Forest West (Sir Desmond Swayne), I believe that the article is not a reason for doing nothing—I hope I have got my negatives right. Change must be backed by evidence. Safeguards must be backed by evidence that they work, so we must learn from international experiences and look at how reform has played out in other jurisdictions that have implemented such a law change.
I want to address palliative care and hospices, which is an issue I had hoped to speak about in the Chamber last week as I recently visited the Shooting Star hospice used by my constituents. We know that we need to improve palliative care in this country. The Chair of the Select Committee, the hon. Member for Winchester (Steve Brine), said that a law change in other jurisdictions has led to significant improvements in palliative care in those countries. My hon. Friend the Member for York Central (Rachael Maskell) addressed the issues of loneliness and poor social care. It is so essential that everyone, whatever their choices, has a good end of life experience. Irrespective of what happens with the law on assisted dying and what choices we take, we must improve end of life care in this country.
I was moved by the hon. Member for South West Bedfordshire, who described the difficulty in getting adequate morphine for his mother-in-law as she was nearing her end. As the former Secretary of State for Health, the right hon. Member for West Suffolk (Matt Hancock), said, even the best palliative care cannot remove the trauma and terrible pain of some health conditions. The issue of choice has been mentioned many times by Members. I will paraphrase the right hon. Member for North West Hampshire (Kit Malthouse), who said, “Please don’t impose the choices of others upon me.” The hon. Member for Brighton, Pavilion (Caroline Lucas) and others have addressed the fact that going to Dignitas is expensive and out of reach for many, and those who do go are not able to have close family with them because that would risk police investigation, as Esther Rantzen mentioned this morning on the radio.
My hon. Friend the Member for Kingswood (Damien Egan) said that, in Oregon, a third of those who initially choose the option of assisted dying do not actually take that route. Again, they have the choice at the end. The issue about choice was described most profoundly when the hon. Member for Great Grimsby (Lia Nici) read out her friend’s letter and described what her friend had said to her in her last painful weeks. That really came home to me in a very moving way. We have had other considered and thoughtful contributions from a number of Members, which I do not have time to list, but I thank them, and I listened carefully.
To conclude, only by reforming the law, and introducing safeguards to address the concerns that hon. Members have raised today, can we move the law forward—a law that is about personal freedom and morality. As the Supreme Court has decided, only Parliament can make the change. I want to restate our clear commitment that a future Labour Government would make time for a private Member’s Bill so that Parliament can have the final say through a free vote following a full debate and a process of amendments. This place is at its best when it rises to the occasion and takes a cross-party, consensual and evidence-based approach to issues, and that is the approach that we need on this vital issue.
The Parliamentary Under-Secretary of State for Justice (Laura Farris)
I thank the hon. Member for Gower (Tonia Antoniazzi) for opening the debate, and I thank the Petitions Committee and the 200,000 people who signed the petition. I pay particular tribute to Hanna Geissler and to Dame Esther Rantzen for the way that they have articulated their own very moving cases.
It has been a privilege to listen to this debate. I will say at the outset that it calls into conflict two fundamental values—the right to individual autonomy and the sanctity of life. It was genuinely a privilege to hear voices on both sides of the debate, even when the disagreement was profound, acknowledging the moral difficulties and challenges that we face on this as parliamentarians.
Before turning to individual questions, I will set out the Government’s position. Our view remains that any relaxation of the law is an issue of conscience for individual parliamentarians, rather than one for Government policy. In the tradition of all conscience matters where the Government maintain a neutral stance, that is typically achieved through a private Member’s Bill.
As others have observed, the last occasion when the House of Commons debated legislative proposals on this subject was in September 2015. Then, just under nine years ago, the Assisted Dying (No. 2) Bill was rejected on Second Reading, as my right hon. Friend the Member for Suffolk Coastal (Dr Coffey) pointed out, by 330 votes to 118. However, this is not an area where opinion is static, and nor is the composition of Parliament a static thing. It was because of the growing strength of feeling on this issue that the last debate on this subject took place in this Chamber, less than two years ago, on 4 July 2022. I recall that because I was there, and it too resulted from an e-petition, calling for a change in the law, that also attracted many signatures.
Mr Ellwood
My hon. Friend eloquently summarises the difficulties on both sides of the debate, but it has also been expressed today that perhaps there is not the sense of faith that a private Member’s Bill would do justice to the details that we have been discussing in depth here today. How we get around that, I do not know, but I am now of the mind—I did not come here thinking this—that this needs to be done in Government time, so that it can go through the full Committee process, and so that we can do our job. We have illustrated that we can do that here today, but I do not think that tacking this on through a private Member’s Bill is the process that we should be pursuing.
Laura Farris
I do not for a moment disagree that this is a subject that would require extensive time in the House. Everybody knows that we are now in the months leading up to a general election, and there is significant Government legislation already planned. However, with those caveats in mind, I hope that I can address more of the substance of the debate, which is what this is really about. I should add that, if it becomes the clearly expressed will of Parliament to amend or change the criminal law to enable some form of assisted dying, then, of course, as the Prime Minister has made clear, the Government will ensure that the legislation is delivered in a way that is legally effective. However, it is within the context of the Government’s neutral position that I wanted to set out and summarise the contours of this debate.
I could pay tribute to so many speakers, so hon. Members will forgive me, I hope, if I whittle the list down to a few. I will start with the hon. Member for Sheffield Central (Paul Blomfield), who talked about his father, and then talked about constituents. Similar points were made by my hon. Friend the Member for Stroud (Siobhan Baillie), who is no longer in her place. They talked about people with terminal diagnoses making the decision to take their own lives in circumstances that were premature because they anticipated reaching a point where they would no longer be able to do that.
The former Health Secretary, the right hon. Member for West Suffolk (Matt Hancock), said that, when he looked at the data, he saw that people with terminal diagnoses were twice as likely to commit suicide. The point was made powerfully by myright hon. Friend the Member for North West Hampshire (Kit Malthouse), and also by my right hon. Friend the Member for Haltemprice and Howden (Sir David Davis), that we cannot disregard the fact that there is another route already taken by those with means: when they are at an early stage and have the resources, they can go to the Dignitas clinic. My right hon. Friend the Member for North West Hampshire called it “business class”, and we cannot ignore that.
It is also true to say, as many have observed, that the view of the medical profession has shifted or is shifting, with the BMA moving from a position of opposition to one of neutrality. In a “Moral Maze” programme on assisted dying for Radio 4, Michael Buerk said that he had recently chaired a series of medical conferences where doctors tried to reach an agreed position on assisted dying. The majority of doctors there said that they had not gone into the profession to kill people, but at the same time thought that they might choose assisted dying for themselves. The moral ambiguity was not lost on them.
Jane Hunt (Loughborough) (Con)
Having been diagnosed with bowel cancer last year, I know that doctors already provide an option. They provide an option of whether to have the operation or not, which is why I asked, “Will I die if I don’t have this operation?” When the doctor said, “Yes,” I said, “Well, I want to live, so let’s get on with it.” When moving into chemotherapy, they also provide the option of whether to have it or not. Why not have that last control where, if someone is terminal, they have that option of whether to die or not?
Laura Farris
May I say that I did not actually know that my hon. Friend had had that diagnosis. I am so sorry to hear that.
I will just repeat that although those from the medical profession said that they did not wish to be tasked with assisted dying, they also thought that they might want assisted dying for themselves. They recognised that was a morally inconsistent position to take, which was a point echoed by the hon. Member for Ealing Central and Acton (Dr Huq). We must recognise that this tension exists in the medical profession.
There were also counter-arguments elegantly expressed by my hon. Friends the Members for Aberconwy (Robin Millar), for Devizes (Danny Kruger), for Don Valley (Nick Fletcher) and for Congleton (Fiona Bruce), my right hon. Friend the Member for Suffolk Coastal and the hon. Member for North Antrim (Ian Paisley), to name a few. One of them more or less echoed the decision that was reached by the divisional court in the Noel Conway case in 2017, which said that section 2 of the Suicide Act 1961 served to
“reinforce a moral view regarding the sanctity of life”
and
“to promote relations of full trust and confidence between doctors and their patients”.
That position was echoed by the right hon. Member for East Ham (Sir Stephen Timms) and the hon. Member for Strangford (Jim Shannon). As parliamentarians, we cannot duck the difficult issues that this question engages.
Kit Malthouse
The Minister has talked about the medical profession and the various arguments for and against, but she is a distinguished member of the legal profession. One of the things that many people suffering with terminal diseases find so confusing is that the law as it stands is inconsistent and a mess. We have a situation where it is technically illegal to accompany somebody to Switzerland, but upon return, the Crown Prosecution Service has a policy of not prosecuting. We have the example of Mavis Eccleston, who agreed a suicide pact with her elderly husband, but survived. She was prosecuted in court, effectively for murder, but was acquitted, having gone through this dreadful experience. The current law is a mess, and I wondered if we could have the Minister’s professional view on that.
Mrs Pauline Latham (in the Chair)
Order. There is a Division in the House. The sitting is suspended for fifteen minutes.
Laura Farris
I was about to respond to the intervention from my right hon. Friend the Member for North West Hampshire about consistency in the law. Yes, I agree that consistency is a good thing.
I want to touch on four arguments made by Members who hold an opposing view on this issue. The example was given of Canada, where the law was changed, and the Chair of the Select Committee, my hon. Friend the Member for Winchester, made the point that no change had been implemented; but it is true to say that in 2016, when the Canadian medical assistance in dying legislation was introduced, the threshold was whether the individual suffered from a grievous and irremediable medical condition, where death was reasonably foreseeable. What has been delayed but none the less agreed is removal of the requirement that death be foreseeable. Canada is also mulling over whether the Act should apply to circumstances in which there is no physical disease at all—in other words, where the condition is mental.
Laura Farris
I think I have not got very much time, so I am going to crack on; I am sorry.
Laura Farris
Well, I have been told I do not.
The other issue is evolution of the wider principle. What if a right to die evolves, perhaps slowly and imperceptibly at first, into a duty to die? My hon. Friend the Member for Aberconwy put it beautifully. Once we have allowed people to rationalise the quality of their life, how do we avoid it becoming incumbent on them to do so? There are also the hard cases: some of the cases described in the Chamber today are heartrending and sound clearcut, but we cannot ignore the difficult ones. One in particular jumped out at me in relation to something that the hon. Member for Gower said: the case in Belgium of Nathalie Huygens, who ended her life because of the extreme psychological suffering that she experienced after she was raped. The hon. Lady—I mean this very respectfully—said we should give people the choice to take themselves out of suffering, but that is exactly what Nathalie Huygens would have argued she was doing. We cannot ignore these difficult cases.
Kit Malthouse
I am very grateful to the Minister for giving way and I appreciate the point that she is making. However, around the world, different countries have legislation to deal with abortion, and there are different time limits and different attitudes to it. For example, in Canada, it is technically legal to have an abortion up to the point of birth. The fact that other countries have different rules, or indeed different cultural nuances around this or any other issue, surely does not mean that we should not have and design our own framework for the same purpose.
Laura Farris
I am not presenting any particular argument; I am reflecting the arguments that were made. I accept that we would not be in any legislative straitjacket, but these are the concerns raised by Members and they deserve to be ventilated in my summing up.
The final issue was manipulation or coercion. The hon. Member for North Antrim made the point very powerfully. I was listening carefully to what the right hon. Member for Knowsley (Sir George Howarth) and my right hon. Friend the Member for North West Hampshire both said: that a majority of people are well meaning and love their relatives, but implicit in that is that a minority do not. Some people live in dysfunctional families, or may not have loved ones; we must consider the consequences or the potential risks for them, too.
My right hon. Friend the Member for New Forest East (Sir Julian Lewis) and, I think, the hon. Member for York Central (Rachael Maskell) talked about the subtle coercion that a person might experience from being made to feel a sense of guilt at the cost that their illness is imposing on family members, not just in terms of money but in terms of stress and time; they could feel that they are becoming a burden. It is right, necessary and incumbent on us as parliamentarians to contemplate and recognise the enormity of the proposition, given the moral and ethical and medical issues that it engages.
I thank the Health and Social Care Committee for its excellent report. One of the Committee’s recommendations is that the Government consider how to respond to potential changes in other jurisdictions in the UK and the Crown dependencies. Of course, should they move on this issue, we will work closely with them to consider the practical implications for England and Wales.
Finally, I emphasise that end of life and palliative care is of the utmost importance. In the Health and Care Act 2022, the Government added palliative care services to the list of services that an integrated care board must commission. Our response to the Health and Social Care Committee’s report was published today. The report’s recommendation 5 was a request for a national strategy for death literacy. I do not think that we went that far, but I reassure the Committee that the Government have committed to including palliative and end of life care in wider strategies.
To conclude, I thank everyone who has spoken and assure the House that the Government will reflect carefully on everything that has been said today. In the meantime, I thank all hon. Members for their sincere and heartfelt contributions to the debate.
Tonia Antoniazzi
I thank the Minister, who has rightly set out a measured response to the petition. Obviously, it is difficult for her to commit to a debate on the Floor of the House, because there is an impending general election and much business to do, so I hope that an incoming Labour Government will have that opportunity.
I also thank the petitioners, the petition’s creator, Hanna, and Dame Esther Rantzen. Today has shown our ability to come to this place with a range of strongly held views and have a debate in an informed manner. I thank the hon. Member for Strangford (Jim Shannon), who has sent me a note commenting on the balanced tone of my introduction to this debate on assisted suicide. His comments mean the world. Haven’t we done a sterling job in this House today? That is what we are here for, and that is why we are voted in. I feel strongly about that, as I have said before.
The hon. Member for Aberconwy (Robin Millar) talked about the voiceless and the people who do not have a voice in this debate. I am very good friends with the Paralympian Baroness Tanni Grey-Thompson and Baroness Ilora Finlay, who hold different views on this matter. They are well informed and well spoken and have been in the media on the matter. That does not mean that this House cannot give any potential legislation the sunlight that it deserves. It is incumbent on us to do so. We do so from a place of privilege, because we are elected to this House.
On that note, I thank everybody. I thank the petitioners and campaigners, and I thank you, Mrs Latham, for chairing the debate.
Question put and agreed to.
Resolved,
That this House has considered e-petition 653593 relating to assisted dying.