(5 years, 5 months ago)
Commons ChamberRead Hansard Text Read Debate Ministerial Extracts
Nick Boles (Grantham and Stamford) (Ind)
I beg to move,
That this House has considered the functioning of the existing law relating to assisted dying.
Six years ago this week, on a sunny July day like today, my father made a decision. At home in Devon, in the bed that he shared with my stepmother for more than 30 years, with his family around him, he took communion for the last time, said a few words of goodbye to each of us, and asked the district nurses to switch off the oxygen and make him comfortable. He could have clung on to life for several more days, but he was ready to go and, after talking it over with my stepmother, made his decision. A few hours later, he slipped away, with my brother by his side. This was the best of deaths: the saddest moments in our lives, filled with love and gratitude, and even joy.
A few months ago, Geoff Whaley made a similar decision. Cut from the same cloth as my dad, he was a gentleman of the old school, but Geoff had motor neurone disease and recognised that he was likely to suffer horribly in the final days and weeks of his life. He knew that his only chance of a good death was to arrange to go to Dignitas in Switzerland. Geoff was a determined and organised man, but there were some things that he physically could not do. He needed his wife Ann’s help. When someone tipped off social services about their plan, the police turned up at the Whaleys’ door and Ann was interviewed under caution. That caution remains on her record.
Thanks to the support of Ann and their daughter Sarah, Geoff died on his own terms, but several months earlier than he would have needed to had the same procedure been available here in the UK. Under Swiss law, none of the family was allowed to be present at his cremation. Yet Ann would describe herself as one of the lucky ones, because she and Geoff could afford the cost—the air fares, the hotels and the fees—of going to Dignitas. Every year, hundreds of other people in our country face the prospect of great suffering at the end of a terminal illness—suffering that cannot be alleviated by our wonderful palliative care nurses—and have no legal means of doing anything to stop it.
Susan Elan Jones (Clwyd South) (Lab)
I am most grateful to the hon. Gentleman for giving way during what is a heartfelt speech, but will he please answer the question of why he feels that the vast majority of disability organisations in this country remain opposed to assisted dying?
Nick Boles
I thank the hon. Lady for her question. It is incredibly important to understand all the concerns raised, perhaps especially those from such groups. What I think drives that very understandable concern is the fear that although a law might start off tightly constrained, there will be what people refer to as “the slippery slope”, and it might then be abused somehow: there might be situations in which people come under pressure to take their own lives when, in fact, they do not want to do so at all.
All I would say to the hon. Lady—I am happy to have further conversations with her about this—is that in jurisdictions such as Oregon, where for 20 years now there has been a law of the kind that was proposed here, there is no evidence of that slippery slope argument leading to people being put under pressure. If ever there were to be such a change of the law here, it would of course be essential to have safeguards that would prevent that and ensure that disabled people knew they had the same right to life as any of us, for as long as they wanted.
Nick Boles
I will give way to the hon. Member for West Ham (Lyn Brown) first.
Lyn Brown
This is an incredibly difficult debate for many of us; most of us will have personal stuff that informs our judgments about it. My mum died suddenly, riddled with cancer. I know that had this law been passed at that time, she would have spent her last months consumed by guilt and anxiety about when she should press that button. She would have worried about the pressure on me and my sister, about the cost of her care, and that people would have thought she was consuming resources that she should not consume. Sometimes when we have this debate, we do not consider collectively the pressure we would put on people by giving them that choice.
Nick Boles
The hon. Lady makes a very good point. All I would say is that the law could operate only with independent assessment—both by doctors and by a High Court judge, under the proposal in the most recent Bill—that would be clear that the person could not show any signs of coming to a decision under pressure or because they felt they were a burden.
Interestingly, talking to the Whaleys about Dignitas, I heard how the Dignitas doctors explained that if at any point Geoff had said anything like, “I think it is time to go. My family wants me to go; they are ready, we are here,” they would have sent them home. On no account would they allow somebody to go through with it if there was any indication that they might have changed their mind or that they might be prioritising other people’s feelings.
Several hon. Members rose—
Kate Green
I am very grateful to the hon. Gentleman. I thank him for the case that he is making. I support it, but I, too, recognise what a very difficult and sensitive issue this is.
In relation to disabled people and the concerns to which my hon. Friend the Member for Clwyd South (Susan Elan Jones) rightly alluded, it is true that most disability organisations—perhaps all that I have spoken to—oppose the legislation that the hon. Gentleman and I would like to see, but that is not true of every individual disabled person, and we should acknowledge that. Is it not the case therefore that what we need to ensure is that we build into any legislation excellent regulation, excellent audit and an equal commitment to investment in assisted living alongside the investment in assisted dying?
Nick Boles
I could not agree more with the hon. Lady. The truth is that this is not in any way an alternative to the best possible palliative care; it is a complement to the best possible palliative care. We want to ensure that all those who want to choose to live out their lives and die naturally—even through a horrific illness with horrific symptoms—are given every support to be able to make that decision. Unfortunately, we also know—and all the evidence suggests this—that there are some people for whom palliative care cannot help in those final moments, and it is of them that I am thinking.
What do we think of a law that criminalises otherwise law-abiding people, such as Ann Whaley, who are simply trying to act with love in accordance with their marriage vows and their conscience? What do we think of a law that forces people in the final months of a terminal illness to take desperate and even dangerous steps, which may cause even more suffering to themselves and to the people whom they love, in secret and without any safeguards or support? What do we think of a law that denies hundreds of innocent people dignity and control as their lives draw to a close and condemns them to extreme suffering instead? I will tell you what I think, Madam Deputy Speaker: it is a bad law and it should be changed.
However, the purpose of today’s debate is not to propose a new law on assisted dying, but to understand the effect of the current law on people suffering from terminal illnesses, on their families, on the doctors, nurses and carers looking after them, and on social workers and the police. It is only when we have fully understood all the different ways in which the current law impacts on the British people that we should consider returning to the question, last debated in 2015, of what kind of change in the law might be justified.
To that end, I have a request for my hon. Friend the Minister. We all understand and accept that laws such as these are matters of conscience and that it is for Parliament to initiate a change of the law, but Parliament’s ability to gather evidence is very limited. On behalf of those affected by such laws, and in honour of Geoff and Ann Whaley, I ask the Lord Chancellor and his boss, the Secretary of State for Justice, to initiate a formal call for evidence on the impact of our existing laws on assisted dying, so that Parliament can benefit from a comprehensive assessment of the facts when it next decides to debate and vote on a possible change in the law.
Sir Bernard Jenkin (Harwich and North Essex) (Con)
I am most grateful to the hon. Gentleman for giving way. I came into the Chamber in 2015 fully intending to vote for a change in the law. However, as I listened to the debate, although I was completely persuaded by the points that he is now making, I was unpersuaded that that was the right law or that the right people had been persuaded that it was the right law. What has changed between then and now that he thinks would bring the House to a different conclusion?
Nick Boles
I do not think that I have ever had a more intelligent set of interventions, so I thank the hon. Gentleman for another one. There has been change, but I do not want to pretend that the change has gone far enough, which is why we are not proposing, at this point, to bring forward a new set of legal measures.
Perhaps the most significant change is in the opinion of the medical profession. We have seen a number of royal colleges move from having a formal position of opposing assisted dying to having a position of being neutral about it, which reflects the fact that they will always have some members who are very much opposed to it, but they now have an increasing number of physicians who are in favour of it.
We have seen not so much a change as a consolidation of public opinion on this issue. In the latest opinion poll, which, frankly, is not very different from any of the opinion polls over the past couple of years, more than 80% of the British public support an assisted dying law for people in the final six months of a terminal illness, and well over 50% of people who declare that they have an active faith take that view. So although Church leaders, apart from the very honourable exception of the former Archbishop of Canterbury George Carey, are opposed, their flocks are actually finding that they, too, believe that a change in the law is justified.
I also agree with the hon. Gentleman that, before any further proposals come forward, we should study closely the experience in the state of Victoria in Australia, for example. As he will be aware, New Zealand recently passed on Second Reading an assisted dying law, and there is the much longer standing experience of Oregon as well as Canada more recently. We should study all those and look at the precise legal and medical safeguards used to try to devise something that avoids many of the risks that have been raised by other hon. Members.
Sir Peter Bottomley
I am grateful to the hon. Gentleman for his response to my hon. Friend the Member for Harwich and North Essex (Sir Bernard Jenkin). In the Netherlands, the number of physician-assisted deaths is 3.5%, which, in this country, would translate into 21,000 deaths a year. There are about 5,000 suicides a year in this country, of which about 400 are estimated to be people dying at their own hand because they have a terminal illness that they do not want to live with. How can one explain to anyone else the difference between that 300 or 400 and 21,000, which is four times the number of suicides that we have at the moment?
Nick Boles
I am grateful to the hon. Gentleman for raising that point, because it allows me to point out that the Netherlands law is a completely different law, and I would vote against it if anyone proposed it in the House of Commons. It is a law to enable people to commit suicide more or less whenever they want. That may work for the Dutch—I have nothing but respect for the Dutch people—but I could not vote for it, and I do not believe that it would get more than 100 votes in this House.
What we are proposing is something that has existed in the state of Oregon in the United States for 20 years, and it has never crept anywhere near being the kind of law that the hon. Gentleman is talking about. Yes, of course, there will be much more lax and liberal laws of assisted suicide in other jurisdictions. That is of no relevance at all to the question of whether, in the final six months of a terminal illness, a narrow assisted dying law, with legal and medical safeguards, can operate safely in the United Kingdom, as it does in Canada and in the state of Oregon. I am entirely confident that it can.
Jim Fitzpatrick (Poplar and Limehouse) (Lab)
Will the hon. Gentleman give way?
Nick Boles
I must wind up, because Madam Deputy Speaker has pointed out that there are many, many Members who wish to speak.
I am keen to hear from as many Members as possible during this debate. I will listen to all contributions with sincere respect, because this is a very difficult issue and one on which I myself have changed my mind since 2015. Before I sit down, I would just like to say a word on the role of religious faith in the debate about assisted dying.
I admire people who are blessed with religious belief. My own father was, and I envied him. Faith groups play a very positive role in our society and I salute them for it, but this country is a democracy, not a theocracy. When we make our laws, we must focus on men and women, not on God. Parliament was right to legislate to allow abortion for women in the early months of a pregnancy, despite the opposition of Church leaders. Parliament was right to legislate to extend the institution of marriage to gay people although most organised religions still consider homosexuality a sin. When Parliament next debates the reform of our laws on assisted dying, I hope that it is not religious doctrine, but humanity—our humanity as Members of Parliament and the humanity of all those suffering from terminal illnesses—that wins the day.
Several hon. Members rose—
Madam Deputy Speaker (Dame Rosie Winterton)
As colleagues can see, many Members wish to contribute to the debate. If everybody is to have the chance to speak, speeches will need to be kept to about six minutes.
Daniel Kawczynski (Shrewsbury and Atcham) (Con)
I will be very brief. I pay tribute to the hon. Member for Grantham and Stamford (Nick Boles) for the eloquent way in which he has introduced this very important debate. I just want to refer to him one of my constituents, Mr Noel Conway, who has campaigned on this issue for many years, both through the courts and the media. I had the privilege of visiting him and his wife at their beautiful Shropshire home, where I spent the afternoon finding out about his daily life and how his wife is caring for him. As I am sure hon. Members will realise, it was an extraordinarily emotional afternoon, especially when I found out about some of the very difficult conditions my constituent is living under and the constant care that he needs.
I spoke to Mr Conway about the possibility of him travelling to Switzerland, and his answer will stay with me forever; he said, “No, I am an Englishman and I want to die in England.” I think that is extremely important, because although some constituents have the wherewithal, financial means and opportunities to travel to Switzerland to take things into their own hands, that is not always the case for all our constituents bearing in mind financial restrictions, but also the fact that some people do not want to leave our country to be able to die. This is their home; this where their families live; and this is where they want to die.
I have always been a Roman Catholic—having been born in Poland, I come from a very strict Roman Catholic family—and my Christian belief is very important to me, but I have disagreed with my own Church on numerous issues. As the right hon. Gentleman alluded to, in our views, the Church is not always right. Having now been in a same-sex partnership very happily for the past eight years, I, too, agree that although we can respect the church and our Christian beliefs, perhaps the Church does not always get everything right when it comes to how human beings behave, interact and ultimately decide to die.
I am very grateful to the hon. Gentleman for bringing this debate to the Chamber. I have not decided how I will vote in future debates and my constituent Mr Conway knows that I have not yet decided, but I really appreciate that the hon. Gentleman has afforded us this opportunity to continue debating this matter until a consensus can be achieved.
Paul Blomfield (Sheffield Central) (Lab)
I thank the hon. Member for Grantham and Stamford (Nick Boles) for securing this debate, and for the thoughtful and powerful way in which he opened it. Like him, I will share a personal experience, although mine is not as positive.
It is, by a coincidence, the eighth anniversary to the day of my receiving a phone call here in Westminster that my father had been found dead in his garage. The previous night, he had tidied up his belongings, left small piles of money to settle the bills with the newsagent and others, and written final notes. He had then walked to the garage, connected a hosepipe from his car exhaust into the car, taken an overdose and switched on the engine. As hon. Members can see, I do not find this easy to talk about, even after eight years, but I have done so before and I will do so today, not least because I know that he would have wanted me to, as somebody who had always believed in a change in the law on assisted dying.
My father’s experience shows how the existing law does not simply fail people, but leads to premature deaths. Now, I know that some of those opposing a change argue—I respect my hon. Friend the Member for West Ham (Lyn Brown) for doing so—that it could lead to people taking their lives sooner than they would otherwise face their end. But my experience, and the experience of many others—I think that some of the statistics mentioned by the hon. Member for Worthing West (Sir Peter Bottomley) are understated—is that the existing law in itself encourages people to take their life sooner than they would otherwise do.
My father was 87. At that age, he had inevitably watched many of his friends go, often miserably. He talked in particular of one friend who had become confined to bed, doubly incontinent, and—having become both deaf and blind—unable to communicate with anybody. My father saw no point in that kind of life, and had always said that he would rather end things than face a degrading death. He was somebody who had made the most of his life: he had a tough east end upbringing in poverty, became an RAF pilot in the war and built a successful business career. He had his share of health problems, but faced them all positively. He was not afraid of pain, but he could not face the indignity of a lingering death, and I am sure that he made up his mind to take his life soon after receiving a terminal diagnosis of inoperable lung cancer. But he still died prematurely, and I am sure that what drove him to end his life at that point was the fear that if he did not act when he could and was still able to do so, he would lose the opportunity to act at all. He could not talk to me or his partner about it, because he would have made us complicit. The current law forced my father into a lonely decision and a lonely death.
Some people will say that we simply need to improve end-of-life care, and it is hugely important that we do. My father supported our local hospice and I raise funds for it. It does a great job, but no hospice can enable everybody to die with the dignity that they would want. Indeed, for my father, it was soon after his appointment with a palliative care nurse where together they talked about his last months that he took the decision to take his life. If the law had made it possible, he could have shared his plans with us, and knowing that he could, with support, go at the time of his choosing would have enabled him to stay longer. If the law had made it possible, he would have been able to say goodbye and go with his family around him, not in a carbon monoxide-filled garage. He, and many others like him, deserve better. We simply need to change the law.
I appreciate that there are those here whose personal beliefs—whose faith—makes my father’s choice unacceptable. I respect those beliefs. Live your life by them, but do not impose them on others. Let people have the choice at the end of their lives. Allow them dignity in dying as we would want them to have it in life.
Crispin Blunt (Reigate) (Con)
I have been engaged in this issue since the very early days when I arrived in this Parliament in 1997, guided, along with many other right hon. and hon. Members, by the experience within my own wider family.
By 2040, nearly one in seven people is projected to be aged over 75, so we will be engaged in supporting an ageing population who will lead fuller lives, working longer, by adapting the workplace and ensuring that individuals can reskill throughout their life. But people will be living with chronic conditions, and multiple morbidities and cognitive impairments will become more common within our population. I have no doubt that our innovative and caring society will solve, or certainly ameliorate, these conditions, but the hard truth is that more of us will have to grapple with surviving with the pain and indignity of crippling progressive infirmity in later life.
If we do not change the law, even more people than the current one every eight days may travel to Switzerland for an assisted death—and, of course, there are all those people who do not have the means to travel and all those travelling to Switzerland early so that they can exercise the autonomy available to them there. I do appreciate the views not only of right hon. and hon. Members but of the public who express concerns over assisted dying. It is of course a controversial subject. However, the injustice and the tyranny of having no escape from pain and indignity that our law continues to impose on a growing number of our fellow citizens will not go away until we address it. In Oregon, since 1997, a total of 1,127 patients have died from ingesting these medications. Not only does the yearly figure barely rise above the 0.003% mark, but only 64% of those who have received prescriptions for the medications since 1997 have actually taken them.
When we discuss this emotional topic, the most grotesque characteristics of greedy, overbearing relatives are conjured up in some hypothetical dark fantasy, but these arguments about a slippery slope or the vulnerability of people simply ignore the fact that this applies only to terminally ill people. When the Assisted Dying Bill came to this House in 2015, its terms would require two doctors to sign off on the fact that the person would be dead within six months and the process to be overseen by a High Court judge. How many more measures would opponents of this principle want to satisfy them? The difficult truth is that for many, it is none. This is about the imposition of a faith-based view of the sanctity of life overriding any sensible application of personal autonomy for people in dreadful and terminal strife.
Crispin Blunt
No, I will not. I might want to pick up on the example the hon. Lady gave later in my remarks.
That personal autonomy on any individual application of universal human rights includes the freedom to control and direct one’s own life and, in this case, death. Yet again, despite a poll in March of more than 5,000 people showing that 84% of Britons wanted a change in the law on assisted dying, they have to contend with the moral certainties of those who are not suffering extreme pain and who are taking these decisions on their behalf—us. We have a responsibility to discuss this issue in an honest, compassionate and evidence-based manner, and we have a swathe of evidence available to us.
The whole Oregon experience entirely supports that this is a practical, sensible, humane and decent measure. Over two decades later, the opinion of the people has not changed one iota. This Parliament, in not facing up to its responsibilities, is party to increasing tyranny, pain and despair.
Ultimately, this is about potential control. Just as people exercise control over how they live, they should be able to exercise control over how they die. In reality, the vast majority of people will never take this choice, even when faced with it. With strong safeguards, Oregon, Washington state, Montana and Vermont have had no documented reported cases of abuse. Why, when the evidence is clear, do we deny everyone the comfort of some personal control over the end of their life?
To return to the point made by the hon. Lady, I wonder what her mother’s view was, because under the law, she could not exercise her autonomy. I am utterly certain that the hon. Lady would have wanted, with all the generosity in the world, to ensure that her mother had the full support available to her. Well, that just might not have been the view of her mother, in the pain and difficulty that she was facing. Why was she not allowed the opportunity to make that decision?
Lyn Brown
The hon. Gentleman is absolutely right; she would have argued that she should have had the right to take her own life, but let me put one statistic to him. He mentioned Washington state—51% of the people who took the tablets there said that their reason for doing so was that they were a burden to the people they loved. That is the exact reason that my mother would have done the same. We must weigh the evidence properly.
Crispin Blunt
The evidence is there to be weighed by two doctors and a High Court judge, and the hon. Lady’s mother and other people in those circumstances would have had the right to exercise their autonomy. It is that autonomy and that control that we are choosing to suppress. Sadly, for now, it remains that we have a cruel, outdated law that forces people to die earlier by traveling to Switzerland while they are fit enough to travel, or to suffer pain, indignity and degradation that we would never impose on a suffering animal.
Carolyn Harris (Swansea East) (Lab)
I regularly visit Ty Olwen, a fantastic hospice in my constituency, which is staffed by the most wonderful clinicians and volunteers. Ty Olwen is a beautiful, peaceful haven, providing dignified, loving and intensive palliative care for patients, as well as comfort for their loved ones. I am full of admiration for the work they do and the care they give, but sometimes that may not be the choice of the person who has been diagnosed with a terminal illness. Imagine for just one minute being given that diagnosis. Imagine, in time, knowing each day that you will never feel this good again and that eventually all your future holds is more discomfort, more fear and possibly a slow and painful death.
While I wholeheartedly believe that life is sacred—I have a faith, and it is my faith that gives me strength— I am a huge advocate of quality of life over quantity and for an individual’s right to make their own choices. I cannot say 100% which path I would choose if I was given that diagnosis, but I know for a fact that I would want to be able to make that choice, and I would want the same for loved ones.
I appreciate that assisted dying is an emotive and contentious issue that splits opinion in this House and across society, but when someone makes the decision to end their life with assistance while they are still physically able to do so and of sound mind, they will do so after much research, thoroughly discussing it with their family and considering the consequences.
As it stands, a UK citizen travels to Switzerland to end their life every eight days. I believe that if the law allowed assisted dying in this country, enabling people to choose to die surrounded by their loved ones in a familiar environment, that would bring comfort and solace to many people.
Under the Suicide Act 1961, while suicide itself is not a criminal offence, the act of encouraging or assisting someone else’s suicide is, leaving doctors and families facing prosecutions and up to 14 years in prison. There are many people who would, and do, choose to continue with their suffering, sometimes dying a painful and undignified death, rather than risk those consequences for their families.
Bambos Charalambous (Enfield, Southgate) (Lab)
My hon. Friend is making an excellent speech, and I agree with much of it. Does she agree that there need to be various safeguards and that the law is outdated, and this may be a subject for the Law Commission to look into?
Carolyn Harris
I entirely agree with my hon. Friend, and we have to make sure that the right safeguards are in place.
A few years ago, I met a woman who had recently travelled to Switzerland with her terminally ill husband to end his life. She supported his decision to end his suffering on his own terms, and she watched the man she loved die a peaceful, respectable and comfortable death. She then returned home alone, where she was questioned by the police for facilitating his final journey. I watched this woman struggling to cope with the fear of prosecution on top of the grief that was already eating away at her.
I understand the concerns surrounding assisted dying, and the need to ensure that the decision is voluntary and one that has been expressed repeatedly over a period of time. As in most things, I still believe people should be given a choice. Palliative care is wonderful and it is the right choice for some, but for others assisted dying is their preference. The point is that everybody should have the right to control their own life, and ultimately their own death.
Antoinette Sandbach (Eddisbury) (Con)
It is a pleasure to follow the hon. Member for Swansea East (Carolyn Harris). I thank the hon. Member for Grantham and Stamford (Nick Boles) for bringing forward this debate, because I am on something of a journey in relation to my approach to this issue. That approach has largely been shaped by speaking to the family of a constituent who, in July 2017, went to Dignitas in Switzerland, where she ended her life. Her mother and sister came to see me, and their experience echoes that of the hon. Member for Sheffield Central (Paul Blomfield). I pay tribute to him for his bravery in outlining his experience with his father.
Anna, my constituent’s sister, said:
“To get to Dignitas in Switzerland Jemima had to be able to single-handedly plan, pay for and travel across the UK until she was outside its legal jurisdiction, all without any family support. In accompanying Jemima to Dignitas, I knew that my family and I were going to be subjected to a police investigation on our return from Switzerland. At the worst possible time, when we were grieving the loss of our loved one.
Jemima interpreted the UK laws as best she could so that she didn’t implicate us in her death but she was still terrified that we would be prosecuted on our return. Jemima was also really concerned that her degenerative diseases would deteriorate to the point where she would not be able to either plan the journey or to physically get to Switzerland under her own steam.
So Jemima made the decision to have an assisted suicide years before she needed to. The UK Government literally stole years of my sister’s life. I know if she had been able to exercise her ‘right to die’ in the UK, she would have chosen to stay with us for many more years to come.”
I think those are very powerful words.
Those who wish to end their lives now must leave the UK alone, despite their ill health, or leave with relatives who will face suspicion and investigation when they return home. This imposes a legal complexity that requires ordinary people, at a time of great stress, to understand and interpret complex areas of law and how it is enforced by the police, often without professional legal advice, because of the terms of the Suicide Act, as outlined by the hon. Member for Swansea East. I would like to focus on that for a moment. In the case of this constituent, I had to write to Cheshire police to ask what its approach was and how it enforced the law. The lack of clarity from police forces is deeply troubling, and although I was pleased that it said it would enhance constable training and update its website, I am deeply concerned that that guidance is still not online. That means there is a postcode lottery in this country regarding how a local police force will enforce the law, which makes an already complex legal picture even more difficult to navigate. Whether or not we change the law, the police must respond to these cases far more sensitively and be more transparent about how they handle them.
My constituent and her family were put through months of hell, waiting for an investigation to conclude. To face such scrutiny after a heart-rending loss is difficult, but for the police to then make a family spend month after month reliving their loss does not serve the interests of the family, the public or justice. Despite all that, my constituent had the resources to go to Switzerland and plan her own death.
Bob Stewart (Beckenham) (Con)
My hon. Friend says that her constituent had the resources to go to Switzerland and end her life. Does she know how much it costs to go to Dignitas? The whole package, plus recovery of the body, must be an eye-watering amount.
Antoinette Sandbach
Dignity in Dying estimates the average cost of a trip to Dignitas to be around £10,000, which is a substantial amount. Only one third of UK families have that much in savings, so under our current system, with its manifest cruelties, that option is inaccessible to two thirds of the country on financial grounds alone.
This week Jemima’s mother told me:
“I have become increasingly sure that under certain circumstances and with the right safeguards, a person should have the right to choose to end their life in this country. I know Jemima would have been with us for longer if she had been able to take that choice at home.”
Alongside her heartfelt plea for reform, and those of others, there must be two key criteria for any future proposals. First, assisted dying must be made available under certain circumstances, and there must be appropriate safeguards for patients, families, medical professionals and those who need to enforce the law. It is a difficult area, but I hope that Jemima’s story will help build a consensus that will allow us to take this issue forward, and that we will not continue to block future changes to the law.
Sir Vince Cable (Twickenham) (LD)
I thank the hon. Member for Grantham and Stamford (Nick Boles), my right hon. Friend the Member for North Norfolk (Norman Lamb) and others for giving us the opportunity to debate this subject. Members have spoken movingly and from experience about their views.
I am someone whose views have radically changed. Until recently I was a vehement opponent of assisted dying, but I have changed my views and think I should explain why. That change is partly based on an understanding of why I was previously opposed to it, which was due to my own personal experiences. Two of those experiences were relevant, and I think they will resonate with many Members of the House.
One experience concerned my elderly mother who descended, as many do, into confusion and dementia, compounded by mental illness and depression. One week she would say, “Please, please end my life. I am a burden. I want to go”, but a few weeks later she would be enjoying the simple pleasures of life. I could see all too clearly that under a permissive system of assisted dying, people like my late mother would be extremely vulnerable.
My conviction at that time that assisted dying was the wrong route was compounded by my experience with my late wife, who contracted breast cancer and had a very long illness. She eventually died at home with good palliative care, surrounded by a loving family. She was vehemently opposed to assisted dying and wanted to live her life to the full. I guess that I took the view that that was her choice but should also be everybody’s choice.
I came to realise, however, that there are very different situations we need to understand. One thing on my conscience is that in my 20 years as an MP, two constituents came to see me to request help and political support for a campaign in the High Court to be allowed to die through assisted dying and, although I expressed sympathy, as one would expect, I declined to support their campaign. I was very wrong to do so. Both suffered from motor neurone disease, and I think many of us know of such cases. One has surfaced today: a man called Richard Selley in Perth, in Scotland, who is fighting for the right to assisted dying. I think we all know the nature of this condition. Although some people live with it, Professor Hawking being a famous example, in most cases it involves the physical degeneration of all bodily functions combined with absolute clarity of mind and very great suffering. It seems to me that we should consider the position of those living with it and similar conditions.
The argument that is deployed against doing so is that hard cases make bad law. That was quite well summarised by Lord Sumption, who gave the Reith lectures a few years ago, when he said assisted dying should be criminalised but that the criminal law should be broken. That is a somewhat strange way of putting it, but essentially what I think he was saying was that we should keep the law but turn a blind eye to exceptions and treat them compassionately.
I have thought about that argument, but it seems to me that the evidence is very strongly against it for a variety of reasons. However sensitive the Director of Public Prosecutions or the police might be—I am sure they are; the 2015 guidance is very humane—the sheer process of going through a criminal investigation and a caution is deeply traumatic, and probably the most difficult period of any person’s life. It is probably also difficult for the police who have to implement it.
We can all see from the evidence that the law simply is not working: from the fact that 300 people over the past decade have been through the pain—and, indeed, the expense—of the Dignitas solution, and the fact that about 300 people a year are killing themselves, often without medical support and in very painful circumstances. The hon. Member for Sheffield Central (Paul Blomfield) gave a very moving example, which I think showed the extent to which the law as it currently stands does not work.
When we put that together with the change in public opinion and the change in the views of the various medical bodies that would have to administer this and would be faced with the awesome responsibility of authorising assisted dying, I think the evidence is now very strongly in favour of a change to the law. I hope that when the opportunity arises, we will progress beyond the theoretical discussion to the practicalities of how we introduce humane legislation with proper safeguards.
Martin Vickers (Cleethorpes) (Con)
Thank you, Madam Deputy Speaker, for giving me the opportunity to speak in this important debate. I congratulate my hon. Friend the Member for Grantham and Stamford (Nick Boles) on initiating yet a further discussion on this subject. We have heard some passionate contributions, and very moving ones, including that by the hon. Member for Sheffield Central (Paul Blomfield), who delivered his speech with great dignity; I congratulate him on that.
We discuss a wide range of matters in this House, from rather mundane ones, such as those which we were discussing before this debate, to those that affect life and death. Nothing, of course, can be more important than issues that affect life and death.
I am not a lawyer; nor do I claim any particular insight. Indeed, I see through a glass darkly. I have an uneasy feeling, which I know is shared by some hon. Members, that we as a society are moving towards a situation in which assisted dying is legitimised, and I recognise that many would support that, as we have heard this afternoon. For myself, I believe life to be sacred and God-given, and I readily acknowledge that that is a view that is not universally accepted. However, I am sure we can all agree that life is uniquely precious, and that we should do all we can to preserve it, and I do not in any way question the motives of those, be they Members of this House or members of the public at large, who take a different view. Many will have reached those conclusions having witnessed the slow, painful death of a loved one.
I believe that any move to lay out a statutory framework is a further step, however small, towards an acceptance that assisted dying is in some way given the seal of approval. Some things are best left in the grey area.
We are today discussing the functioning of the current law, and it is perhaps an argument to say that it is not as clear as some desire, but surely the question is whether we can give clarity to such a complex matter—can we, as the Legislature, frame an Act of Parliament to cover all the complexities—or is it better, in cases that are presented to the prosecuting authorities or the courts, to leave it to them to consider the unique circumstances that each case presents?
Both my parents died of cancer and suffered in their final months. I well remember the telephone call from a specialist who, having received the results of the tests on my father, said, “We must hope that God is merciful and does not allow him to suffer for too long”. Although he did suffer, it was not for too long. In fact, he lived for a further six months after I received that fateful call. In his final weeks, which he spent in St Andrew’s hospice in Grimsby, I saw what comfort could be offered through palliative care. No longer did he suffer the periods of pain that he had had in earlier weeks—and that happened as long ago as 1988. Through my visits to St Andrew’s since, and to Lindsey Lodge hospice near Scunthorpe, both of which serve my constituency, I have seen the advances that have been made in the years since. Sadly, my mother died in hospital on the day that she was to be transferred to St Andrew’s.
In the case of both my parents, it is probably true that their passing was hastened by drugs, such as morphine, and no doubt others would argue that it would have been better had they been given the opportunity to shorten their lives by a few weeks or months, but I firmly believe it is better that the situation is left as it is. If one is old, frail, weak and seriously ill, one needs help, support and compassion—not the added worry and the nagging doubt over whether everything possible is being done to preserve one’s life.
Crispin Blunt
I congratulate my hon. Friend. He is making an extremely good argument so far, except that it does not address the wider benefit that comes from a change in the law here, which is about the knowledge that you have that control available to you as you enter a period when you might be contemplating these very difficult decisions. That is the principal benefit that would come from a change in the law. By leaving a grey area in the law, we deny nearly all of us the benefit of knowing that we have that control at the end of our life.
Martin Vickers
I thank my hon. Friend for his intervention and acknowledge that that is a deeply held view for him and many others, but I am afraid it is not one that I share.
Lyn Brown
I am grateful to the hon. Gentleman for giving way because, counter to that, there is the issue of vulnerability, which we have not really come to in this debate. On Friday an elderly couple came to me, terrified for their daughter, who was in a very expensive care facility. Their grandsons, who they love dearly, wanted to take that woman out of that expensive care facility because it was costing too much of their inheritance. We cannot have this debate in a vacuum; we need to understand people’s vulnerabilities—the vulnerabilities of my constituents’ daughter, the vulnerabilities of my mum, and the vulnerabilities of the constituent of whom the hon. Member for Eddisbury (Antoinette Sandbach) spoke, who ended her life. We must understand that this issue is a reality, and not just dodge the subject.
Martin Vickers
I thank the hon. Lady for that intervention. As I mentioned earlier, every situation is different and I think the complexity of framing a law that covers everything is beyond us, to be honest.
Susan Elan Jones
I am conscious that the late Lord Walton of Detchant spoke passionately on this subject. He was a great neuroscientist, but he was also president of the Muscular Dystrophy Campaign, one of the great disability organisations. He spoke and wrote at length on the issue of vulnerability: it is a massively difficult ethical issue, but it has to be considered.
Martin Vickers
I thank the hon. Lady for that intervention and I share those views.
Having spoken of the work of the hospice movement, I will take the opportunity to pay tribute to all those who work in, volunteer for and generously support the hospice movement, with a special mention for St Andrew’s in Grimsby, which is marking its 40th anniversary this year.
We all have to cope with the loss of loved ones, and such experiences raise—in the mind of any right-thinking person—the question of how to minimise suffering. If someone has previously indicated their wish to hasten their death, I acknowledge that it is extremely difficult, and a major moral dilemma, to say to them, “Sorry, that’s not possible.” However, I believe that any move to legalise assisted dying would be yet another step that lessened the value that we as a society place on human life.
The relationship between doctor and patient is crucial, and it could be compromised if the patient was anything other than 100% certain that the doctor was striving to maintain life. When we are old, weak and seriously ill, we need compassion and support, not the nagging doubt—
Sir Bernard Jenkin
I do not think this debate is about the sanctity of life, because the people who did not support the Bill last time believe it is legitimate to end a life early; the question is how to legalise it. It is not a moral question. On the point about the medical profession, plenty of evidence shows that people are acting in the grey area that my hon. Friend describes, leaving them with the questions he mentioned. That is not the issue either. The question is whether we can safely change the law in a way that does not create new or worse dangers.
Martin Vickers
I recognise what my hon. Friend says, but I do not think it is possible to change the law and cover all the varying circumstances. I regret the fact that many in the medical profession are moving towards support for assisted dying. The views of the public vary considerably at various times, and can be influenced by headlines, but I hoped that the medical profession would take a different view. Mention has been made of motor neurone disease, and I recognise the unique difficulties of that condition because I had an aunt who died from the disease.
I will finish shortly as I appreciate that I have taken interventions. I have a final question. Is the abortion law working as originally intended? I would argue that that is not case. A change in this law would open the door to a very different thing. Transparency is something we seek in many areas, such as financial dealings, but in this area I suggest that the grey area should remain.
Madam Deputy Speaker (Dame Rosie Winterton)
I am anxious to ensure that everyone is able to contribute, and I urge colleagues to be considerate to each other. I am now going to apply the six-minute limit.
Tonia Antoniazzi (Gower) (Lab)
I have made just a few notes for my speech, because this is a very important debate.
I picked up a couple of emails earlier from constituents. Some wished me to speak in favour of a change in the law, while others wished me to oppose it. I wanted to stand up today and explain why I would vote in favour of assisted dying if legislation were to be introduced in the House, because I grew up as a Catholic, I was educated in a good Catholic school, and I feel very strongly that when something becomes a religious issue we must be very careful about how we use our language, particularly when the issue involves life and death.
The debate is very pertinent to me, because I have a kind of counter-argument. My father died on 22 December 2011, and this choice was taken away from him. It was not like the situation described by my hon. Friend the Member for Sheffield Central (Paul Blomfield), whose father, having known that he was dying, sadly and tragically took his own life.
I feel very strongly about people being in hospital and being told that they will be fine and they are keeping going, given that in this case the decision was not a decision made by the patient and the doctor. That doctor took away our family’s choice, and the opportunity —not the choice, but the opportunity—to discuss with my father how he would end his life. He would not have been in favour of assisted dying—I can tell you that with my hand on my heart—but the information was kept from him, and from the family, that his medication was to be withdrawn, and he was to die a very painful and horrible death in a hospital bed just before Christmas because it was at the convenience of the hospital.
This is a mega decision, and one that each individual has the right to make, because we should have that choice; we should be able to choose how we end our lives. The choice was taken away from my father and from the family, and I will never forgive the clinician for that.
I believe that charities should play a greater part in this discussion, because talking about dying and death is a huge taboo in our society. The need to improve knowledge and understanding of death is key to the debate. Amazing work is done by people like Kathryn Mannix, a palliative care consultant in Wales. It is very important for these options to be available to us, and for us to be able to have the necessary conversations. There are many flippant conversations with my friends and family—“If anything is going to happen to me, you know what to do; I will have my savings, and I will have my paracetamol”—but we should not be having such conversations. It is our duty as Members of Parliament to ensure that there is legislation that enables people to decide how they want to end their lives.
I pay tribute to the people who are in the Public Gallery today, because they include many families who have either been in this situation or are in this situation currently. We need to remember that their journey is real, and we need to know that we must have this discussion. I will not use any religion, or my Catholic upbringing, as a reason for the discussion not to happen, or for a change in the law not to come about.
We have talked about the law in New Zealand, and, indeed, across the world. Let me also pay tribute to a good friend of mine, Louisa Wall, a Member of Parliament from Auckland in New Zealand. She too is in the Gallery today, and she has a great interest in the debate.
I hope that we will see that legislation, and I just wanted to explain to my constituents, and to everyone, how I would intend to vote.
Fiona Bruce (Congleton) (Con)
Let us look at some of the reasons given by those advocating a change in this law. They say the current law is not working and point to cases such as that of Ann Whaley—a case surely deserving of our compassion, but one that contradicts their arguments for change. It shows that our current law is working.
No prosecution was proceeded with in Ann’s case. I understand how unpleasant it must have been for her to be interviewed under caution, but the CPS approaches such cases on the basis that if someone is in some way involved with the suicide of another person, yet has compassionate rather than self-interested motives, it is highly unlikely that they will be taken to court. Indeed, there have been only three successful such prosecutions in England and Wales in the last 10 years, and during that period just 148 cases were referred to the CPS.
The small number of cases and rarity of prosecutions indicate that our law is an effective deterrent to those with malicious or self-interested motives and protects against the very real danger of the abuse of the disabled, sick, frail or elderly and the danger that they could feel pressured into ending their own lives.
Why change this? Proponents of change argue, as we have heard from the hon. Member for Grantham and Stamford (Nick Boles), for a very focused, very limited, legal change on assisted dying, but it would not stop there.
Nick Boles
Is it not the case that it has stopped there in Oregon for 20 years?
Fiona Bruce
In fact, that is not the case: in Oregon now there are clear public pressures for a widening of the law there.
Nick Boles
But the law has not changed in Oregon; it has remained exactly the same for 20 years.
Fiona Bruce
Let me turn then to the case of Canada, whose law in this area was also cited by the hon. Gentleman as an example we should follow. Just a few days ago, a clinical director from Canada came to this place and made a presentation. I was privileged enough to chair the meeting; it was called “ ‘Assisted dying’ in Canada? A cautionary tale.” To clarify, at about the same time as this House rejected assisted suicide here, in Canada there was a court case that decriminalised assisted suicide on the basis that it should be up to capable adults who clearly consent to the termination of life and are suffering intolerably from a grievous and irredeemable medical condition.
What the clinical director told us was startling. She told us of grave problems now being encountered in that country in connection with the practice of assisted suicide. She told us that in fact medical assistance in dying, or MAID as it is called there, involves in 99% of cases euthanasia, not assisted suicide. She told us of funding allocated to palliative care previously now being diverted for these purposes; of assessments being done on a very rudimentary basis, including even by telephone; of safeguards such as the 10-day reflection period being regularly shortened; and of MAID being used for non-terminal illnesses, even in a case of arthritis. There are now even proposals for it to be extended to so-called mature minors.
The suggested need for two clinicians to give consent is apparently being effectively flouted, too: all anyone has to do if they cannot find one of the clinicians from the first two approached to give consent is approach another and another until one who will give consent is obtained. Conscientious objection by practitioners is not statutorily provided for, so practitioners are feeling increasingly obligated to undertake this. In Canada the safeguards simply are not working, and I was interested to hear Baroness Meacher, the chair of Dignity in Dying, stand up at the end of that meeting and say, “We don’t want that in this country.”
Those advocating change argue that legal opinion has changed, but it has not. In the most recent court case—that of Noel Conway, who has been mentioned here today—arguments for a change in our current law were rejected not just by three judges of the divisional court, but by three judges of the Court of Appeal, and three judges of the Supreme Court, our highest court, then declined permission for a further appeal.
Advocates of change have wrongly and selectively argued that in a Reith lecture this year the former Justice of the Supreme Court, Lord Sumption, called for a change in this law. He did not. In fact, if his speech is read in context and comprehensively, it is clear that he said the very opposite. He did no more than state a fundamental principle of the criminal law—namely, that it is there to protect society by prohibiting acts regarded as unacceptable, and that one such act is encouraging or assisting suicide. He said that
“we need to have a law against it in order to prevent abuse”.
Yes, he referred to what he called the “untidy compromise”, which recognises that, as with other criminal laws, there can be exceptional circumstances where a person breaks the law for altruistic reasons, and that in such cases prosecution may not be warranted, but there is a world of difference between not prosecuting in such situations and licensing acts in advance.
Next, those arguing for change say that medical opinion is shifting. On what basis? A recent Royal College of Physicians poll of its members is mired in controversy. The RCP was, before the poll, opposed to any change in the law. However, this poll unprecedentedly required a super-majority of 60% of those voting to maintain the status quo. How strange! Bizarrely, the RCP’s council is now arguing that the result of this poll justifies a change in the college’s stance, despite the result of the poll showing that the highest number of those members voting—43.4%—opposed any change in the law and that the lowest number—25%—thought that the RCP should be neutral. Yet, strangely, the RCP has chosen to adopt a neutral stance. It is no wonder that the poll has been the subject of a referral to the Charity Commission for investigation. And for what? As Baroness Finlay said in another place, “neutrality adds nothing”. Let us also note that, within that vote, more than 80% of palliative care physicians wanted the RCP to remain opposed to change.
The fact that the British Medical Association and the Royal College of General Practitioners are set to consult their members is neither a surprise nor an indication of a change in their position. Professional membership consultations can be expected every few years. Indeed, the RCGP said five years ago that it would do this about now. It is to be hoped that both the BMA and the RCGP will reaffirm their opposition to any change in the law.
Finally, the proponents for change argue that public opinion is shifting, but it all depends on the question people are asked. That is the problem with the 80% figure that the hon. Member for Grantham and Stamford cited. The more deeply we probe this issue and the more aware people are of the implications of change, the more concerned people become. I can quote from another poll from February this year indicating that more than half the public say that
“some people would feel pressurised into accepting help to take their own life so as not to be a burden on others”
if assisted suicide were legal. Only 25% disagreed with that.
Norman Lamb (North Norfolk) (LD)
It was a pleasure to join the hon. Member for Grantham and Stamford (Nick Boles) in applying for this debate. I want to use my time to tell the stories of two constituents. The first is Vonnie Daykin, who has come to Parliament today to hear the debate. She has talked about how she witnessed her uncle and her father die of Parkinson’s and her mother die of motor neurone disease. She says that her mother went through living hell, but ultimately had no choice and was forced to suffer “until the bitter end”.
I also want to spend a little time quoting my constituent, Zoe Marley. Her words deserve to be heard in Parliament, so if I may, I will quote from an email that she sent me. She says:
“In January 2018 my mum Judith Marley was diagnosed with an aggressive cancer…She had nursed her own mother with cancer and had seen numerous ‘bad’ deaths. From the outset, she announced that she would not let the cancer do its worst, but would formulate a plan to escape the terror. No matter how marvellous the palliative care, she didn’t want it.”
That is her right, incidentally.
“She was a very private person; her death should have been a private affair instead of the circus that it became. On a warm July afternoon in 2018, she took a framed picture of her mum, a bottle of Drambuie and approximately 70 sleeping pills into the garden and in this most cherished place, she proceeded to attempt to take her life.”
After some considerable time, her daughter found her there; she had not died and then started to come round. Zoe was then placed into an impossibly invidious position, not knowing whether to call an ambulance. Her mother had already given her lasting power of attorney and did not want resuscitation—her legal right. Ultimately, however, because of the impossible situation that her daughter was in, she had to call an ambulance. Zoe says:
“Her wishes to stay at home and not be admitted to hospital were my priority as her LPA. But was I technically assisting her suicide? My lack of action could be considered supporting a suicide. I was terrified of the consequences of my inactivity. We waited but no change, the day was cooling down and I wanted her to be comfortable.”
In the end, an ambulance was called, and a doctor also attended.
Zoe writes:
“The doctor was unsympathetic. He said he had spoken to an on-call psychiatrist and that he was within his rights to call the police so they could take her to hospital. He was threatening and arrogant, telling me if Mum died there would be a police investigation and she would have a full autopsy. It all made me sick to my stomach. All this time my beautiful Mum laid outside while my daughter held her hand. I had somehow found myself embroiled with a medical team that had no understanding of how to interpret the law. The doctor called the police and three officers arrived. I have never had the police come to my door. It was demeaning and frightening. Once again I showed them my Mum’s paperwork and begged them to bring her inside. They seemed unsure of what to do, the expression ‘grey area’ was used a lot.”
To answer the point of the hon. Member for Cleethorpes (Martin Vickers), grey areas cause enormous distress, as in this case. Zoe continues:
“After much confusion they insisted they take Mum to hospital. I was now indignant and focused on what Mum wanted. I made it very clear I would obstruct them. I felt everyone was ‘trying to cover their backs’ which meant disregarding my Mum’s wishes.
Finally sanity prevailed, they contacted the A&E manager at our local hospital who realised even if they brought her in, the LPA would stop them from treating her. So finally at 3 am they brought Mum inside.”
Moving on a month, Zoe writes that the
“symptoms from the brain metastasis made their ugly appearance… The pain in her head was unbearable and the constant vomiting made keeping pain medication down almost impossible…
On Friday the 17th of August, Mum had had enough. She knew only torture lay ahead! That evening she took all the morphine and sleeping pills available to her and by Saturday morning she was dead.
That morning I called an ambulance. My family and I myself felt broken and traumatised. But our ordeal wasn’t over. I was questioned by the police all morning. I was heartbroken, the mental and physical torture I had to witness was now followed by a police interrogation.”
Can we in all conscience put families through this awful trauma? That is the reality of the grey area that currently exists in our law. It is the individual, not the state, who should decide, in a period of terminal illness, whether they want to bring their life to an end. That is why the law should change.
Sir Peter Bottomley (Worthing West) (Con)
The number for the Samaritans is 116 123. If anyone thinks they need help or is contemplating suicide, other than in some of the circumstances that we have heard about, they should think about calling up, sending an email to jo@samaritans.org, visiting a branch, or writing to them.
It is obvious that a lot of people in many countries around the world want to end their lives because of depression or mental pressures, and people ought to start a debate like this by talking about that.
We then ought to get on to what was said by my hon. Friend the Member for Grantham and Stamford (Nick Boles), who stated that this was not about changing the law. However, it was fairly plain from his speech and that of my hon. Friend the Member for Reigate (Crispin Blunt) that they are talking about changing the law, and that was confirmed by the speech we just heard from the right hon. Member for North Norfolk (Norman Lamb).
I have experience of some of these issues. My brother’s life support was switched off after an accident, and my mother died six hours early because of pain control. My father clearly told me he would never go into a hospice. He said he would go to bed and make sure he did not wake up in the morning. I asked when that would be, and he said, “When I stop playing golf.” The third time he gave up golf and put his clubs in my car, I rang my sister and told her what was happening. She told me he had said the same thing about when he stopped playing music.
A year later, I discussed with my father whether he might ever think of going into a home, and he said he would—he never did—and that he had thought about what he would take. He said he might take three CDs with him, because he might want to play music, but he had not actually played any music for six months.
My father’s story echoes what the right hon. Member for Birkenhead (Frank Field) said in an early debate on this subject about 20 years ago. Barbara Wootton, the founder of the national assistance service, had made him swear that, if she were in hospital and asked for drugs, he would go and get them from her bathroom cabinet and give them to her. She was in hospital for six months in awkward circumstances, but she never asked.
I spoke earlier of the equivalent of 21,000 people having assisted deaths or euthanasia in the Netherlands. In Switzerland, where Dignitas provides a service for some people, the rate is under half of that in the Netherlands and, I think, Belgium—that needs checking.
Some people say we might have an initial peak but that a second order, polynomial best-fit trend line will show that, in time, the rate of increase slows and the overall rate levels off. That may be so, but what is also so is that 15 jurisdictions in the past two years have decided against changing the law, and 96% of jurisdictions around the world do not have laws that go further than ours.
Of course there are difficult cases, but we should not use hard cases to justify a change that can lead—not will lead, but can lead—to a major change. Nobody in the Netherlands said in 2002 they were anticipating 5,000 assisted suicides or euthanasia cases a year. They did not say it. People may say that because Oregon has not changed further, things there will never change, but in Oregon they are having the same debates about euthanasia as we are having about assisted dying.
There is a whole series of expressions: medical aid in dying, physician-assisted suicide, physician-assisted death, aid in dying, death with dignity, right to die, compassionate death, end-of-life choice, medical assistance at the end of life and advanced care directives, and the like. I understand all that, and I have taken part in more of these debates than anyone else in the Chamber because I have been here longer—I am probably nearer my death than other Members are—but what I want to say to colleagues is that we should not build on individual cases.
Our first lodger was the first person I knew with motor neurone disease. In the days, weeks, months and years before he died, he never once suggested that he wanted to end his life. A constituent of mine—she has authorised me to give her name, but I will not—says that her family has Huntington disease, and most of us know what that involves, and she asked me to oppose this, so I shall.
Steve McCabe (Birmingham, Selly Oak) (Lab)
I am glad the House has a chance to think about this again. I also remember Rob Marris’s Bill, which I voted against not because I was not sympathetic to the issues but because there was a lot of division among people in my constituency. The question of safeguards came up repeatedly, as I recall.
What has changed since then, as the Assisted Dying Coalition points out, is that the numbers going to Switzerland have virtually doubled. Parliament now finds itself in a position where we can decide to intervene and change the law, or we can accept random prosecutions, interviews under caution and denying assistance to people who seek it.
Contrary to what the hon. Member for Congleton (Fiona Bruce) said, I think we can draw much better conclusions about safeguards on the basis of Canada’s experience. In Canada, assistance is not available to non-residents, and that discourages suicide tourism. Assistance is not available to minors; it is not available to people who have a history of mental illness; and it is not available on the grounds of mental illness, long-term disability or any curable condition. The safeguards include ensuring that none of the legal witnesses or physicians involved has any legal or financial interest in the outcomes of the patient. Consent must be repeatedly expressed, not implied, and consent can be revoked at any time and in any manner. To receive a medically assisted death, patients must be experiencing intolerable suffering and must sign a written request expressing their wish to die. As we have heard, two independent witnesses are required. I would say that those are quite strong safeguards.
We have also heard that the view of the medical profession in this country has changed; I think the hon. Member for Grantham and Stamford (Nick Boles) referred to the Royal College of Physicians, and I know that there will be a poll of the British Medical Association and the Royal College of General Practitioners.
Earlier this year, I had the opportunity to listen to tetraplegic Paul Lamb, who spoke at a humanist event in the House, and I was very moved by the case that this very rational and sane man made. Traditionally, the argument for changing the law is based on the Oregon model, as we have heard, and it generally refers to people who have six months left to live; that was the case with the Marris Bill. I have some difficulty with that, if we are to look at the matter again, because I think there is a problem with being precise about life expectancy. In addition, such a narrow position would not help someone such as Paul Lamb. Paul has been living with his condition for 29 years. He is in intolerable pain that can sometimes only be controlled with very strong medication, which blurs his consciousness and limits his life experiences. He wants the right to choose, if he reaches a stage where he has no quality of life.
We need to focus on quality of life, capacity for life and the rational, sound judgment of a person who makes such a decision. Life expectancy in itself does not tell us anything about suffering. We should be considering assisted dying both in the context of terminal illness and in the context of suffering and a lack of meaningful life. That is especially true when we are talking about progressive conditions, conditions such as locked-in syndrome or intolerable suffering.
Some people have strong views about this subject, and they are influenced by their Church or religious community. Those organisations encourage people to contact MPs, and I understand that it is always going to be like that, but the Supreme Court did ask this place to consider the case for changing the law, and the Court recognised that that was a decision that only Parliament could make. Having listened to Paul Lamb and thought about it again, I think that we should be wondering whether things have moved on since 2015. The poll that was released by the My Death, My Decision group shows that the level of support for a change in the law is now about 88%. I think that is significant, and I am surprised that people would want to ignore that.
Of course, as the hon. Member for Grantham and Stamford said, we are a democracy. It is our job to wrestle with these decisions, not to rely on the fears of particular groups. It is our job to make sure that we get the safeguards right. It seems to me that the choice is simple. We cannot stop assisted dying; we can only prevent legal assisted dying, which would be open, transparent and open to change and challenge.
Karin Smyth (Bristol South) (Lab)
Ten years ago, I worked with some excellent doctors, nurses, patients and carers who were trying to improve clinicians’ communication skills to help patients gain a better understanding of long-term conditions and diseases—how to live with their disease and how to die with it. As my hon. Friend the Member for Gower (Tonia Antoniazzi) said, not all clinicians are equipped with the skills necessary to have those conversations. I learned particularly about how lonely it is for people who are dying—it is often nobody’s role to talk about dying—and no one has exemplified that today more than my hon. Friend the Member for Sheffield Central (Paul Blomfield). It is a very lonely place. I learned that people do not have the control and choice that they otherwise have in their lives, and I learned how hard is for clinicians to support people. It really opened my eyes and made me determined to change the law even before I came into this place.
It is a pleasure to work with the hon. Member for Grantham and Stamford (Nick Boles) as co-chair of the all-party group. In that capacity, it was my absolute pleasure to welcome and host Geoffrey and Ann Whaley when they came to talk to MPs in February. I welcome Ann to the Chamber, as well as all the other families who have come here to listen to this very measured debate.
When the campaigners, who are very passionate on this subject, come to see me, I talk to them about how to talk to their own MPs, and the first thing I say to them is, “Try to look at the MP in front of you as a human being.” We know in this place and in this time in our politics that lots of people do not think we are human beings, and it is difficult, but we are human beings. I say to those campaigners, “You do not know what those human beings you are talking to have experienced in their lives or are currently experiencing in their lives. Please bear that in mind when you start to talk to us.”
We are here as human beings, but we are also here as legislators, and legislation is what we are trying to encourage with this debate. Through the all-party group, we are trying to help all of us human beings, with all our failings, prejudices and experiences, to understand the law as it operates, how it affects people and what we need to do to take our responsibility to change that. I am clear that the law needs to change, but I understand that many people have not got to that place. We want to try to help people. In particular, we want to try to get evidence. The call is not just to trade facts and figures, but to collect evidence. I really hope that we can help to move forward on that today.
The story of Geoffrey and Ann really did horrify me, although it is not the first time I have heard it. We have two committed, loving people being treated as criminals for carrying out what was an act of love and compassion. We should also think about the impact on people like those in our police services. Think about the poor police officers who were sent round as this lovely family were trying to manage a terrible situation. Think about the time taken out of their duties and the trauma for them as individuals. That is not acceptable; it is us abrogating our responsibility.
Geoffrey died comfortably at Dignitas only a week after he came to Parliament. He was clear that he was dying before he was ready, and he was terrified about the police investigation. As the hon. Member for Grantham and Stamford said, he was a strong man. When he talked to us, the only time his voice faltered was when he talked about that knock on the door, because he was so worried about the impact on his family. He was clear about the hurdles that needed to be jumped to make the decision that he wanted to make, but he was also clear that he did not expect MPs just to change the law. He had high standards for us as MPs. He expected us to collect evidence and to challenge the evidence, and to do so very carefully. He was, as the hon. Gentleman said, cut from some old cloth. He expected us to do a diligent job.
Bob Stewart
It seems to me that the law is grossly unfair. If someone has the resources—we have talked about £10,000—they can go to an alien place and die, with a few family around, and their body can be brought back. But they have to have the money to do it. Currently, our law is not fair, because it differentiates between people who have the resources to end their life when they want to, without the pain and the indignity, and those who cannot afford it, who are the vast majority. That is wrong, and that is where the law has to change.
Karin Smyth
I am grateful to the hon. Gentleman for his intervention. He must have seen the next point in my speech, because it is exactly that. Geoffrey and Ann’s story has been the prompt for this debate, but they are not the only family to go through this process. More than 400 Britons have died at Dignitas, and one Briton is dying in Switzerland every eight days. Every person who dies leaves behind a loved one facing the risk of prosecution. He is absolutely right: they have parted with more than £10,000. The family were very open with us that they could afford that, but most of my constituents in Bristol South absolutely cannot afford anywhere near that sort of money. This is a cross-party debate, and people have their individual views, but for me, as a socialist, it is eminently wrong that people who have resources can have that choice and those who do not cannot. That is one of the many reasons why I think we need to change.
The vast majority of people in this country who are dying of a terminal illness can expect a comfortable, dignified and pain-free life. The palliative care service is amazing, and I have worked with many clinicians over time, but they cannot alleviate all symptoms.
I just want to add that a third of patients in Oregon who request assisted dying do not use it. The autonomy that is granted by the choice is very comforting. Autonomy, choice and dignity are important. We must do better with our laws. Our law is outdated, unpopular and uncompassionate. It is time to look at the undue suffering that the blanket ban on assisted dying is causing people at the end of their life, because compassion is not a crime.
Christine Jardine (Edinburgh West) (LD)
This is undoubtedly a hugely emotive and controversial subject, but I thank the hon. Member for Grantham and Stamford (Nick Boles) and my right hon. Friend the Member for North Norfolk (Norman Lamb) for giving us the opportunity to discuss it. I am convinced that I have not just a right, but a duty to work for changes in the law that will make it possible for people to have the individual right to choose their own time and manner of death. I am talking about people who, otherwise, will face a situation that will soon be very painful and that will also cause a great deal of stress to their family members. I have been lucky: I have not had to go through the sort of experience that we have heard about from other Members of the House.
Two years ago, I had a conversation with my husband about a friend who, we had just heard, had been given a terminal diagnosis. It was January. We said, “This year will be difficult. Christmas will be difficult. We will have to think about how to deal with it, but it will not be easy for him or for his family.” The irony of that conversation has never left me, because neither my husband nor the friend actually lived until Christmas, but the difference was that my husband died very suddenly. Our friend went through a long, painful, lingering death. If there had been a way that he could have been spared that, I would have wanted him to be offered that choice. There is also an irony in the fact that had I had the choice for my husband, I would have chosen the death that he had, rather than the one that our friend had.
The last piece of the ironic jigsaw is that, in this House, if we do make a decision on a change in the law, it will be a free vote, because we will regard how we vote on that law as a matter of conscience. Yet we have never taken up the challenge of giving that same choice, that same freedom of conscience, to the people who actually deserve it. If we are to take up that challenge—and I think we should—it will not be easy and it will not happen quickly. We will have to spend time on it. It will be extremely difficult for us all because we will have to examine our consciences and take into account the views not just of those who feel it is a necessary change, but of those who find it difficult for religious or other moral reasons. But we have a duty to do that.
Like probably every other Member here, I have received numerous letters from constituents this week, asking me to speak up for the change because they have been through experiences like the ones we have heard about so movingly today, and they want and need this change. We would sometimes do well to remember, as I am sure most of us do, that we are here to represent those people. We are told by Dignity in Dying, and in every other poll that has ever been done, that the majority of the public out there—84% at the last time of asking—believe that it is time for a change.
I saw the reports on television this morning about people who are currently facing this decision. They know that death is not far away, and would like to choose the manner of their dying. They would like to have what they believe is a good death. It is our duty to do whatever we can, for however long it takes, to ensure that they have that choice.
Jim Fitzpatrick (Poplar and Limehouse) (Lab)
I am grateful for the opportunity to contribute to this debate; I thank the Backbench Business Committee for the time, and congratulate the hon. Member for Grantham and Stamford (Nick Boles) and the right hon. Member for North Norfolk (Norman Lamb) on securing it. I am also pleased to follow the hon. Member for Edinburgh West (Christine Jardine).
My starting point is the last debate on this matter on 11 September 2015—Second Reading of the Assisted Dying (No. 2) Bill, which was sponsored by the former Member for Wolverhampton South West, Rob Marris, and was moved in the other place by the noble Lord Falconer. I do not often quote myself, but I am going to do so in this case. In fact, I think this is the first time that I have ever quoted me. I said on that occasion:
“There are three key issues here…it is about having the right to choose; secondly, it is about the need to protect the vulnerable against…pressure…thirdly, it is about treating every citizen with the same degree of respect and dignity…On the right to choose, this—I should declare an interest—is personal.”—[Official Report, 11 September 2015; Vol. 599, c. 666.]
As many colleagues know, before coming to this place I was a firefighter in the London fire brigade for 23 years, during which time I worked with asbestos. Its heat-resistant properties meant that the fire service used it for all manner of things. For example, we had asbestos gloves and hoods.
I do not know how many people have seen the terminal stages of those with asbestosis or mesothelioma. It is not pretty. It is not as bad as some of the deaths we have heard about—my hon. Friend the Member for Sheffield Central (Paul Blomfield) spoke about his dad and we have heard about people with motor neurone disease—but it is not pretty. If that is what lies in store for me, I want the right to choose. I want the right to choose for myself and for everyone faced with that kind of situation, and I challenge colleagues who would deny me or anybody else the right to a dignified end.
Like most people, I want to die in my own home with my own family, and in as much comfort and as little pain as possible. Earlier, I tried to intervene on the hon. Member for Grantham and Stamford regarding the references he made to Oregon. One statistic I have not heard quoted in the debate so far is that one third of patients who request assisted dying and meet the eligibility criteria in Oregon do not take the life-ending medication; rather, they want it as an insurance policy. Many actually die of their underlying condition—in some cases outliving their prognosis and not taking the medication because they want to live for as long as they can without suffering.
If I was to be denied the right to choose, I could afford to jet off to Switzerland—this point has been raised by several times Conservative Members—because I have the money, the savings and the pension. However, how many of my constituents in Poplar and Limehouse could afford to do that? Not many, and even if they could afford it, the uncertainty of whether their family members would be investigated by the police for having helped is a nightmare for somebody hoping to die peacefully.
The right hon. Member for Twickenham (Sir Vince Cable) and the hon. Member for Congleton (Fiona Bruce) quoted Lord Sumption. The fuller quote says:
“I think the law should continue to criminalise assisted suicide, and I think that the law should be broken from time to time…It has always been the case that it’s been criminal, but it’s also been the case that courageous friends and families have helped people to die…I don’t believe there’s a moral obligation to obey the law. Ultimately it’s for each person to decide.”
Coming from somebody who is a judge in the Supreme Court, that is absolutely breathtaking. The courts have challenged Parliament to address this issue and to clarify the law.
What we have is confusion. The clarification of the guidance by my right hon. and learned Friend the Member for Holborn and St Pancras (Keir Starmer) when he was the Director of Public Prosecutions, while done with integrity and courage, does not eliminate the risk of prosecution, or certainly investigation and caution. Different constabularies, different doctors and different standards mean that we have not just a two-tier system but a multi-tiered system, and it does not protect the vulnerable. The Bill proposed by the former Member for Wolverhampton South West had 15 safeguards written into it. The law is not as strong today as it would have been had my hon. Friend’s excellent Bill been passed. We need better safeguards, and the 2015 Bill would have provided them.
I want to conclude by thanking the families of the bereaved and campaigners such as Dignity in Dying for the progress that we are making on this issue—because progress is being made. Public opinion is changing. The Lords is almost there and the Commons is slowly coming in behind. I think that eventually we will provide the people of Britain with the right to choose their own end.
Jeff Smith (Manchester, Withington) (Lab)
I do not plan to take the full six minutes, not least because we have heard so many really eloquent and brilliant speeches today. I pay particular tribute to the hon. Member for Grantham and Stamford (Nick Boles) and to my hon. Friend the Member for Sheffield Central (Paul Blomfield) for their incredibly moving and powerful contributions.
I supported changing the law in 2015, and I would do so again. I pay tribute to the Members who came to this debate with an open mind and said that they have changed their minds for having the bravery and open-mindedness to do so. I still support changing the law because I believe that it is not working. I want to emphasise three areas where is not. First, there is the unfairness of the current situation. We have already heard that roughly one person a week goes to Switzerland. However, people go to Switzerland if they have the financial resource, practical resource, and, very often, emotional support to do so. We should not be condemning those without the financial resources to an end that is not of their choosing while other people can afford to go abroad. Even that, I would argue, would not be their first choice and is not the ideal situation, but at least they have the financial means and support to be able to make a choice of some kind. We should be giving that choice to everybody who needs it.
Secondly, the current law results in perverse outcomes. My hon. Friend the Member for Sheffield Central and the hon. Member for Eddisbury (Antoinette Sandbach) pointed out that it results in people dying sooner than they should. I am not going to repeat those remarks because they put it far better than I could. I pay tribute to them for their speeches.
Thirdly, I want to touch on the issue of palliative care. This debate is often framed as a choice between good palliative care and the right to choose how to die, but that should not be the case. Of course we need to invest in good palliative care—we need the best that we can get—but even with the best palliative care, we cannot stop all suffering at the end of life. A person should have the opportunity to choose their way of dying in addition to the availability of great palliative care.
I also want to respond briefly to three points from the debate. First, I agree very strongly with the hon. Member for Grantham and Stamford in his request for a call for evidence to study the experience of Oregon and Canada. I do not share the pessimism of others that we cannot frame legislation that works for the people who need it to work, and gathering that evidence and learning from those examples will, I believe, allow us to do so.
I strongly disagree with the hon. Member for Cleethorpes (Martin Vickers), who said that introducing assisted dying will lessen the value we put on human life. If we value human life and if we value people, we should allow them to live the life they choose, and that includes the death they choose.
My hon. Friend the Member for West Ham (Lyn Brown) quoted a statistic about the number of people in Oregon who gave being a burden as their reason for choosing assisted dying. That only tells part of the story, because people who request assisted dying in Oregon give several reasons—
Jeff Smith
People in Oregon and Washington give several reasons. In both those states, the most frequently given reason for requesting to die—by over 90% of people—is a loss of autonomy. Being less able to enjoy life is chosen by around 88%, and a loss of dignity is chosen by around 74%. It is important to tell the whole story with the statistics.
Lyn Brown
I really regret not putting myself down to speak in the debate, because I think there is an absence of understanding about just how difficult it is for many people in this country and elsewhere to withstand the pressures of family who might feel that they are a burden. We are tripping gently into a hellish nightmare for many people. I urge my hon. Friend to listen properly to what people say.
Jeff Smith
I hear what my hon. Friend says, and I accept that there is real concern, but I think we can create a legislative framework that takes account of those concerns and allows safeguards to be put in place to ameliorate those concerns.
In the end, it comes down to one key question: if faced with a terminal illness and a painful end, would we want the death of our choosing for ourselves and for our family? If the answer is yes, as I believe it would be, we should allow that choice for everyone.
Liz McInnes (Heywood and Middleton) (Lab)
It is a pleasure to follow my hon. Friend the Member for Manchester, Withington (Jeff Smith), although I disagree with most of what he said. That does not mean that my mind is not open.
I wanted to take part in the debate in response to requests from constituents urging me to attend and represent their views. Unsurprisingly, their views are more or less equally split—from the retired GP who urged me not to support any changes, to those who were moved by the very sad case of Geoffrey Whaley to ask whether it would be possible for a change in the law to be made. We all know that this is an emotive issue that divides opinion, with strongly held views on both sides.
I was present in the Chamber the last time we debated this issue, when Rob Marris brought a Bill on assisted dying to the House. On that occasion, 85 Members were hoping to speak, and I was unable to make a contribution due to the huge amount of interest. We must remember that the Bill fell, with 330 Members voting against it and 118 for it. I am proud to say that I voted against the Bill.
I am grateful to be able to make a contribution today, but the views that I held in 2015 have not changed—that does not mean my mind is closed—and I will try to briefly outline why I still feel the same way. My concern then, and my concern now, is that in the current climate, at a time of overstretched NHS budgets and massively underfunded social care, if assisted dying were legalised, it would begin to be seen as an alternative to treatment and care. I believed then, and I believe now, that there is a real risk of a subtle but dangerous culture change in which vulnerable, terminally ill patients come to see assisted dying as a treatment option and the best way to stop themselves becoming a burden to their families, the NHS and wider society.
I worry also about our attitude towards people with disabilities. In 2015, a disability campaigner expressed their concern to me about changes in legislation having the potential to lead to value judgments being made about whether other people’s lives are worth living or not and to send out a message that suicide is acceptable in some cases. As the campaigner said to me,
“Someone taking their own life is seen as a tragedy, except if that person is disabled. Then it is seen as understandable.”
I do not believe that there have been any societal changes between then and now that have led to any alteration in attitudes towards those with disabilities, and those concerns remain valid.
The retired GP, whom I referred to earlier, told me that in her career she had been asked on a few occasions by terminally ill patients if she could end their lives for them. She said to me that when she had explored their issues, she found common themes, including the fear of being left alone without support, worrying about suffering from poorly controlled pain for the rest of their lives and the need not to be a burden on medical staff and carers. There were also psychological issues, including profound sadness and despair at their predicament, sometimes accompanied by depressive illness. However, she then told me that, once she had addressed these concerns properly, the request to end life was not made again, and in most cases it had been possible to achieve a dignified and peaceful death.
If we are to achieve this outcome, it will require good quality palliative care, which does not come cheaply. I speak as a vice-chair of the all-party group on hospices and end of life care. We need to look at the funding of hospices and palliative care, a huge proportion of which comes from charity fundraising, and we need to put the provision of good-quality end of life care on a much more sustainable basis. Some of my constituents who support changes in the law have said to me that they want to see changes because:
“Nobody should be forced to live in unbearable pain.”
I completely agree with that, and that is exactly why we need to make sure that patients receive better palliative care, and to ensure that better information and support are given to terminally ill patients and their families.
I welcome this debate, which forces us to ask the right questions about how we care for the sick and the dying, but I believe strongly that the answer lies in improving palliative care and making it accessible to all those who need it. We need to get that right, rather than changing the law on assisted dying.
Ruth Cadbury (Brentford and Isleworth) (Lab)
I thank the Backbench Business Committee; the hon. Member for Grantham and Stamford (Nick Boles) and the right hon. Member for North Norfolk (Norman Lamb), who brought forward this debate; and those Members who have described in moving terms their personal experiences. I congratulate my hon. Friend the Member for Heywood and Middleton (Liz McInnes), who has just spoken in moving terms about the importance of good quality palliative care, because she is absolutely right. As far as I am concerned, this is a “both”: we need better quality, better informed palliative care and we need to change the law on assisted dying.
On Monday morning, I listened to Ann Whaley’s moving account on Radio 4 of the decision her husband Geoff took to die at Dignitas. Last night, I read Annabel Dixon’s blog in which she described, in such loving terms, her sister Jemima’s life and also her death at Dignitas. Both Geoff and Jemima decided, with their different but in both cases degenerative conditions, that the only way to have a good death—in control, a simple act, taking the medicines oneself, with their loved ones around them—and to get around UK legal restrictions was to die in suburban Zurich.
What struck me about both Ann’s account and Annabel’s account was the difficulty of having to go to Zurich, with the logistics of the journey and the pain of travelling as someone who is very sick, as well as the fear of prosecution, and then there is the cost of fees, travel and accommodation for everyone so that loved ones could be with them at their end. Geoff Whaley and Jemima Dixon, and others who have taken the journey to Zurich, had the capacity and the funds to make the arrangements. As others have said, the cost of going to Zurich is beyond the means of most people.
However, we have heard today of other deaths that were not happy—that were not with loved ones present, and where people could not, because of fear of prosecution, discuss their plans with their loved ones—and particularly the account of my hon. Friend the Member for Sheffield Central (Paul Blomfield).
Clinicians often feel that they have to take control, and they cannot discuss what they do with anyone else. Very often that is about upping the dose of morphine until the person slips away or, as in the much more tragic story mentioned by my hon. Friend the Member for Gower (Tonia Antoniazzi), about removing the drugs that were keeping a loved one pain-free and alive. Those actions also removed the possibility of that person and their family discussing their end, which was going to be soon but needed to be pain-free and calm.
Many constituents have written to me supporting a change in the law, and in 2015 I voted to support that change. I assure hon. Members who are concerned about such a change that this debate is not about disabled people, those with life-limiting conditions, or those considering suicide due to depression. It is not about frail elderly people who are worried about being a burden, and it is not about vulnerable people who are at risk of being exploited on their death.
Reading Anna Dixon’s blog gave me an understanding of the level of assessment and scrutiny that was required over several stages before the assisted death in Zurich was permitted. The change to the law under debate today is relevant only to people of sound mind with a terminal illness—those who can predict the rough timing, but also the nature of their own natural death, which will be undignified, painful, and traumatic if they cannot take control. It is relevant to those who want to choose when to end the suffering that they know they and their loved ones will experience.
As we have heard, public opinion is moving behind a change. People of faith are also changing their views. Yesterday I spoke to a colleague whose faith background would generally oppose assisted dying, but who is now minded to support a change in the law. The medical profession is also coming round to support a change, or at least move to a position of neutrality
I understand the concerns and worries raised by hon. Members today, but we can learn lessons from other jurisdictions that have already implemented the right to an assisted death, and ensure that those concerns are addressed as the law is drafted. We can learn from 20 years of experience in Oregon to ensure that people’s fears are addressed. The UK can, and must, learn from the experience of those states.
I support the proposal to task the Law Commission with looking at this issue. We have to change the law. We owe it to those who know what their final months hold without assisted dying, and who wish to choose the time and place of their passing, and who is with them at their end. We must remove the grey areas for those people and their families.
Andy Slaughter (Hammersmith) (Lab)
It is almost four years since we last debated and voted on this issue, after Rob Marris introduced the Assisted Dying (No.2 Bill), which is now sponsored by Lord Falconer in the other place. I thought it was a thoughtful piece of legislation, and during the last debate I responded from the Front Bench on behalf of the Opposition. It was a highly charged debate, and 85 Members tried to speak. I was slightly surprised that the vote was so decisive, with 330 votes against the Bill and 118 in favour, particularly given that public opinion was then 80%—now perhaps 90%—in favour of such a change to the law. It is unusual for us to lag behind public opinion on matters of social legislation in such a way.
From reading that debate, and from some of the speeches this afternoon, I appreciate that a number of Members speak from a religious perspective. I entirely respect that and their right to make their own decisions, but I do not agree that they should be able to impose those decisions on me or those of my constituents who do not necessarily share that outlook. We have talked about choice, which is important, but I think this issue goes further than that. The ability to choose the time and manner of one’s own death under the circumstances that have been described, sometimes in horrific terms, is a basic human right. That is particularly true when we consider the issue of people’s means because, as many Members have said, someone’s ability to make that choice is restricted to those who can afford the organisation, time, money and support to go to Switzerland or somewhere else abroad.
The arguments about dignity and suffering have been very well made and are very difficult to rebut, but the more one looks into this the more compelling the case becomes. I met Ann and Geoffrey Whaley when they visited this House the week before Geoffrey went to the Dignitas clinic. Meeting them was one of the most profound things to have happened to me since becoming a Member. It was extraordinary to witness not just their courage but the certainty and the measured way in which they put forward their arguments. I pay tribute to them. They then had to go through the stress of a police interview. The fact that the police, I gather, interview in about 50% of such cases, is itself strange, but in 100% of cases the threat is there for those relatives—the feeling that the police might turn up on your doorstep at the most vulnerable time in your life.
There is also the risk of forfeiture, or at least having to go to the courts to apply for relief from forfeiture, because it is quite possible that joint assets cannot pass to a succeeding spouse, for example, because of their involvement in that regard.
Fiona Bruce
Does the hon. Gentleman recognise, though, that it is that concern that the police might call that protects so many vulnerable people from abuse? If we do away with that, there will be no reason for relatives not to support or even encourage vulnerable relatives to consider assisted suicide. What sanction will there be?
Andy Slaughter
I do not think the hon. Lady does herself any favours by making that argument. It is quite barbaric to think that relatives may sit in fear of a knock on the door from the police. The police themselves are in a very difficult situation. As Ann Whaley recalled, the police felt that they had to go through with an obligation which they perhaps did not want placed upon them.
Consider the case of Tony Nicklinson, who lost his case in the higher courts. I make no criticism of the higher courts— I think this is a matter for us rather than the judiciary—but he effectively had to starve himself to death to achieve the same objectives. The fact that people are going to their deaths earlier than they need to, and going through the most distressing of additional circumstances to do so, should prick our consciences rather more than it does. On the other hand, I do understand—this is why I have moved over a period of time—the arguments about undue influence and the slippery slope. It is important to look at what safeguards are there. I believe, from what we have heard today, that the safeguards are there, but I also believe that this is a balancing act.
Members will perhaps be aware of the case of another very brave man, Phil Newby, another sufferer of motor neurone disease, who is crowdfunding at the moment to take a case on the basis of proportionality. Yes, there are rights for those who are in a difficult circumstance and who might fear, or feel, pressure on them, but there are rights for those who are in great distress because they feel the need to end their own lives and are unable to do so.
The medical profession was mentioned by a number of hon. Members. I think there is a change of mood. If one looks at the Royal College of Physicians, the direction of travel even over the past decade has been from 70% of its members being against a change in the law to about 50% now. I think that trend will continue. I understand the additional pressures it would put on the medical profession. I understand that for some it looks like a conflict of interest and a compromise of their role, but I feel that everybody must take a mature view and I believe that opinion in the medical profession is changing.
I think we all support good quality palliative care for a number of reasons, including taking the pressure off the acute sector and off our hospitals. A palliative care setting can often be the best place to die. I am furious that the Pembridge palliative care unit, which serves my constituents, is being decommissioned; we only learnt of that last week. It is an excellent unit, and I will fight to preserve it. However, I do not believe that there is a conflict there with what we are discussing today. The two things sit alongside each other. They are both matters of compassion, and about doing the best for people in extremis in the most difficult parts of their lives.
So, with a lot of thought, I support what has been said and I congratulate the Members who tabled the motion.
Jim Shannon (Strangford) (DUP)
On 4 June, in making the case for holding this debate to the Backbench Business Committee, the basic justification set out by the hon. Member for Grantham and Stamford (Nick Boles) was that a lot has changed since the House last debated these matters, and therefore it would be opportune for the House to have an opportunity to discuss them. I would like to go into that in some detail, in the short time that I have.
First, I want to say that I respect the views of others in the House greatly, and I hope that right hon. and hon. Members will respect my point of view, which may be very different from some of those expressed in today’s debate. I am a man of faith. My father was a man of faith; he died, and I know he believed in the sanctity of life, as do I. I believe that in my constituency of Strangford, the vast majority of my constituents also believe in the sanctity of life, and they also believe that the law should not be changed. I want to put that on the record at the start of my speech.
Both the Royal College of Nursing and the Royal College of Physicians have moved to adopt a position of neutrality on the question of assisted suicide. The Royal College of Nursing actually adopted its position of neutrality some 10 years ago—six years before the Marris Bill came to this House. Neutrality is far from endorsement, and that has to be understood. It no more gives grounds to positively endorse assisted suicide in 2019 than it did in 2015.
The manner in which the Royal College of Physicians approached its poll, however, has had the effect of leaving a significant cloud hanging over it. In the 2014 poll, those who opposed assisted suicide were 44.4%; in the 2019 poll, they were 43.4%. The proportion opposed to assisted suicide is the largest by a significant margin, and almost identical to the 2014 result. For the Opposition side of the House—indeed, it is important for the whole House—I point out that in Tony Blair’s landslide 1997 general election victory, he received 43.2% of the vote. The Royal College of Physicians actually voted against this change by 43.4%. So there is a figure, when we come to stats in this House.
Before that poll, however, the council of the Royal College of Physicians, without consulting its members, decided that it wanted to go neutral, and structured the rules of the contest in such a way that that was bound to be the outcome. It took the extraordinary step of saying that unless 66% of respondents either opposed or supported assisted suicide, the college would adopt a neutral position. From that very moment, the result was a foregone conclusion. I want to talk about some reasons why it is the wrong one, and worded the wrong way.
Professor John Saunders, a former chair of the RCP’s ethical issues in medicine committee, wrote in The Guardian to accuse the college of carrying out
“a sham poll with a rigged outcome”.
Over 1,500 doctors and medical students signed an online petition expressing alarm over the college’s behaviour. Professor Albert Weale, chair of the college’s ethical issues in medicine committee, resigned in protest. He claimed that the RCP council failed to take notice of ethical advice that the committee had provided on the subject of the poll.
Jim Shannon
I am sorry; my speech is subject to a time limit.
Professor Weale commented:
“There is simply no point in the committee offering reasoned positions if they are ignored by council.”
The process has resulted in a legal challenge, which is ongoing, and damaging criticism from the Charity Commission as well:
“It is unclear whether the Council took into account that”
the majority of at least 60% required
“would make it almost impossible to achieve”
that majority.
In looking at the results of the RCP survey, it is very important to consider the detailed response to the 2019 poll by specialty. It reveals that those whose specialism means that they have a real expertise in the field of death and dying remain overwhelmingly opposed to assisted suicide: 80.9% of those participating in the poll working in palliative medicine were opposed to a change in the law. Some 48.3% working in respiratory medicine were opposed, 44.1% in geriatric medicine, 43.5% in neurology and 43.4% in gastroenterology. Again, those figures tell the story.
I appreciate that the Royal College of General Practitioners and the British Medical Association have said that they will poll their members on this issue, but we do not have any results yet. Both those bodies would be well advised to study the RCP experience and learn from its mistakes. In that regard, they would do well to study an important new paper written by the former chair of the ethics committee, Professor Weale. They would find it very helpful indeed.
There were questions about the wording of the ComRes poll. In Dr Al Baghal’s executive summary of his review of the poll, he says:
“Overall, we would caution MPs and the public…There are a number of problems noted with this survey.”
Those problems included the fact that the poll is likely to be unrepresentative because of the demographic profile of respondents; the fact that only one side of the argument was presented to respondents in the question wording, using emotive language including terms such as “unbearable suffering”; and the fact that response options for several questions were designed such that they led people to choose a certain answer, even if they did not have a strong opinion, and may have led to respondents tending to select positive options even if that was not their settled opinion.
The basic problem with the proposal to legalise assisted suicide remains unchanged. It costs about £5 to give someone a lethal dose of barbiturates. It costs between £3,000 and £4,000 to keep someone in a hospice for a week. In that context, the right to die for the eloquent and financially well off will become a duty to die for the vulnerable. That is how I and other hon. Members feel, and it is deeply shocking that anyone living in a so-called civilised society should avail themselves of a state-sanctioned means of killing themselves.
In both Oregon and Washington State, 52% of those questioned said that not wanting to become a burden was one of the motivations for their decision. I have no desire to live under a law like that, and no desire therefore to see the legalisation of assisted suicide in the UK. We need a system that supports and helps families so that no one feels they are a burden, and I will push for change on this rather than in the current law.
Imran Hussain (Bradford East) (Lab)
There is no doubt that this is a deeply sensitive debate on matters of considerable gravity, and I thank all hon. Members who have contributed to this important debate this afternoon. The topic of taking a life is not one that this House can or should debate lightly, and clear opinions—including strong points and robust arguments—have been expressed on both sides this afternoon, including by Members who have been directly affected. We heard from the hon. Members for Grantham and Stamford (Nick Boles) and for Worthing West (Sir Peter Bottomley), the right hon. Member for Twickenham (Sir Vince Cable) and my hon. Friend the Member for Gower (Tonia Antoniazzi), who all referred to personal experiences. We also heard the passionate and emotional speech from my hon. Friend the Member for Sheffield Central (Paul Blomfield). It is always difficult to stand up in this place and refer to very personal matters. Whether we agree on those matters or not, we should pay tribute to hon. Members who show bravery in talking about their experiences.
In the short time I have, I will seek to summarise the debate so far. We have heard arguments made about why the law on assisted dying should be changed. The primary point that is put forward for changing the law is that it would end individuals’ suffering in the final days, weeks and months of their lives after having been put through the tortures of terminal illness. A further point about individual liberty is also made, with hon. Members stating that we have free will, are responsible for our own lives and should be able to choose the time and place of our passing when we face a terminal illness. Many state that the safeguards that would be absolutely necessary should assisted dying be legalised can be put into place to prevent abuse of the system. Several hon. Members have mentioned the finances and the fact that if one has means, one is able to travel out of the country, but none of these issues should ever be linked to one’s ability to pay.
There is resistance to changing the law, and as some hon. Members have pointed out, any attempt to legalise assisted dying for people with terminal illnesses represents a slippery slope that can start with legalised assisted dying but then escalate to legalised assisted suicide and legalised euthanasia. Such a situation, it is argued, would be beyond what was originally envisaged in legalisation for assisted dying and could lead to further issues. For instance, people with terminal illnesses or chronic conditions, particularly the elderly, could see themselves as being a burden on their friends and families and could opt to end their lives to allow them to escape those perceived pressures. Another concern is that the elderly and those with medical conditions could be pressured into ending their lives against their will by a number of different people.
There has been some resistance from the medical profession—the British Medical Association has set out its opposition to the policy, and the Royal College of Nursing has refused to advocate it—although a number of Members have rightly pointed out that the profession’s position has also been shifting of late.
One of the positives that will emerge from this debate is that we are talking about death, because, as a country, we do not do that enough. Death is one of society’s last great taboos, which we still have not overcome. We close up and do not discuss it, because we think that by not discussing it we can avoid it—can prevent it from happening to our friends and family, to those whom we care about and to ourselves. We do not have these conversations often enough or engage in them deeply enough, particularly when a friend or family member is suffering from a terminal illness and approaching the end of their life. That is one of the reasons why palliative and end-of-life care is not as good as it could be, and why too many people are reaching the end of their lives in hospital rather than in their own homes, surrounded by their families.
There is no reason why we, as a society, cannot provide end-of-life care that provides full pain relief and soothes mental distress. That is why we have committed ourselves to providing free social care for those on the palliative care register, starting with those with the highest needs, so that no one will have to die in hospital for want of a social care package of support.
Time does not permit me to say much more; I have already exceeded my allocated time by a few seconds. Let me end by saying that this is a clear issue of conscience. Members on both sides of the debate have advanced strong and robust arguments. If we are to take one thing from the debate, it must be a commitment to improving the care received by those approaching the end of their lives and to giving them dignity in death.
The Parliamentary Under-Secretary of State for Justice (Edward Argar)
With your permission, Mr Deputy Speaker, I will endeavour to conclude my speech a few minutes before 5 o’clock to allow the hon. Member for Grantham and Stamford (Nick Boles) a few minutes in which to respond, if he wishes to do so.
It is rare for a Private Member’s Bill Friday to be one of the most memorable occasions in the House, but the debate that took place in 2015 on a private Member’s Bill on this subject was one of the most memorable during my time in the House thus far. It was a crowded House; the speeches were many and of an exceptionally high quality; and the Division saw an exceptionally large number of Members voting on a Private Member’s Bill. It was an example of the House at its best, debating a deeply emotive issue of huge significance in a dignified, informed and passionate but also respectful manner. The same is true of today’s debate, which it is a privilege to wind up on behalf of Her Majesty’s Government.
I have been contacted by a number of constituents with different views on this subject, as, I am sure, have many other Members. They have asked me to attend the debate and to speak in it. I had to say to them that while, as a Minister, I would endeavour to attend, I would not be able to speak; but, having been nominated by the Government to respond, I can now say that it is a privilege to do so.
I congratulate the hon. Member for Grantham and Stamford on securing the debate. Indeed, I congratulate all 26 Members who have spoken, including the shadow Minister, the hon. Member for Bradford East (Imran Hussain). I will turn to their individual comments shortly, but all spoke with sincerity and from the heart.
Since that 2015 debate, legal and other developments and campaigns have served to keep this issue very much in the public eye. In respect of campaigners in the House, it behoves me to mention one of my hon. Friends who, by virtue of his ministerial office, can no longer campaign and speak about the issue. My hon. Friend the Member for North West Hampshire (Kit Malthouse) did a great deal in this regard before becoming a Minister. We have seen various opinion polls and media coverage, most recently on Radio 4’s “Today” programme, focused on this issue.
The Government’s position remains that any changes to the law in this area remain an issue of conscience for individual Members of this House, and it is right that this is so given the strength of the deeply and sincerely held views on both sides of this debate. It remains a matter for this House to decide, not the Government, but a Government must implement and work with whatever this Parliament and future Parliaments decide. In the recent lectures by Lord Sumption, which a number of Members have alluded to, he touched on this issue, and while it is important that the courts should, and do, interpret the law, Parliament cannot and should not seek to avoid or outsource decisions on such profound moral questions to them. It is for this Parliament to debate and to determine the law in this area.
As I mentioned, powerful and moving arguments are put by both sides, and we have heard many of them today. Those speeches whether in favour of or opposing a change in the law were equally motivated by compassion and a sense of humanity. Those who oppose changes to the current framework do so from the basis of profoundly held views about the sanctity of human life and about the position a change could place medical professionals in, and because they have genuinely held concerns about whether vulnerable people, or people with a serious and terminal illness who are at their lowest ebb, may feel pressure, real or imagined, to take such a step, and they fear that no safeguards, however well-designed, could adequately protect against this.
We heard very powerful speeches from my hon. Friends the Members for Cleethorpes (Martin Vickers), for Congleton (Fiona Bruce) and for Worthing West (Sir Peter Bottomley) and the hon. Members for Heywood and Middleton (Liz McInnes) and for Strangford (Jim Shannon), and although the hon. Member for West Ham (Lyn Brown) did not make a speech, she intervened on a number of occasions powerfully and movingly.
Those who advocate change again do so on the basis of sincerely held and equally strong views. No one can fail to be deeply moved by the situations in individual cases described by people as they set out the terrible choices they and their loved ones faced, and in that context, I pay tribute to the dignity shown by Ann Whaley in her campaigning on this issue, reflecting her situation and that of her husband, Geoffrey, which I know has deeply moved Members of this House and, indeed, those outside this place.
I would like to recognise those across the country who have campaigned, including a number of my constituents—for example, those in the Leicestershire and Rutland Dignity in Dying group. They have contacted me, as I am sure different groups and individuals will have contacted other Members or even come to see them to set out with conviction, sincerity and always courtesy their reasons for wishing to see this House reflect on the law and consider changing it. They wish to see the law changed to allow those who are terminally ill and in great pain, and who have the ability to make such a decision, to decide what they wish to do with their own body and life and their right to have a choice in ending that life with dignity, and with assistance if they need it, without fear for them or their loved ones. They have set out, as I said, their case with equal dignity, and I pay tribute to them all now.
I turn to the Members who spoke very powerfully in support of changes in this space, and I pick out to start with of course my hon. Friend the Member for Grantham and Stamford, who spoke deeply movingly and, I know, on a very personal basis. He asked a very specific point about a call for evidence. I know that he has recently met and spoken to my right hon. Friend the Secretary of State for Justice, where he put, with typical eloquence and persuasiveness, his case. I know that my right hon. Friend the Secretary of State is reflecting carefully on the case that the hon. Gentleman put to him.
Other hon. Members spoke movingly from a personal perspective in arguing for a change. The hon. Member for Sheffield Central (Paul Blomfield) spoke with incredible dignity and courage in sharing his very personal story with us and those beyond this place, and he did it because he believed that that was the right thing to do to advance this debate. I pay tribute to him. I also pay tribute to my hon. Friend the Member for Eddisbury (Antoinette Sandbach) and the hon. Members for Gower (Tonia Antoniazzi) and for Edinburgh West (Christine Jardine) for their very personal stories, and to the right hon. Member for Twickenham (Sir Vince Cable) for his willingness to share a very personal story reflecting his position. I would say to him that, whatever view one takes on this issue or others, the willingness to change one’s mind is a sign of strength and never of weakness.
I will reference other hon. Members, but I will not go into what they said, owing to pressure of time. They are my hon. Friends the Members for Shrewsbury and Atcham (Daniel Kawczynski) and for Reigate (Crispin Blunt), the hon. Member for Swansea East (Carolyn Harris), the right hon. Member for North Norfolk (Norman Lamb) and the hon. Members for Hammersmith (Andy Slaughter), for Birmingham, Selly Oak (Steve McCabe), for Bristol South (Karin Smyth), for Poplar and Limehouse (Jim Fitzpatrick), for Manchester, Withington (Jeff Smith) and for Brentford and Isleworth (Ruth Cadbury). I think that I have referenced every right hon. and hon. Member who has spoken. They all spoke with passion, with clarity and with a true sense of the tone in which we would wish the House to conduct this debate. I pay tribute to them all.
This has been a humbling debate to listen to and to have the opportunity to wind up. The views on both sides of the debate have been reflected with eloquence and dignity in the House. This Parliament has a responsibility to the people we represent. It has a responsibility to deliberate on behalf of our nation on the most difficult questions that we consider, and this is certainly among them. It is right that the House continues to do this, and I believe that the tone and content of this debate reflect how those who send us to this place would wish us to conduct ourselves.
Nick Boles
I should like to thank you, Mr Deputy Speaker, and your colleague Deputy Speaker very much for chairing this debate so well. I should also like to thank all hon. Members for contributing to it so powerfully and persuasively. I would particularly like to thank Ann Whaley for attending the debate. She has inspired us all to be here, and, whatever arguments we have made, I know that we all think she is a truly marvellous woman. Her husband would be very proud of her today. I would also like to thank all the other family members and those suffering from terminal illnesses who have taken the trouble, at a time of great stress in their lives, to join us and to observe our debate.
I should like to end on this note. I have changed my mind about this issue. Many people have changed their minds about it, and I hope that more people will change their minds about it so that we can get on and change the law and make this country a more humane place for people to live and die.
Question put and agreed to.
Resolved,
That this House has considered the functioning of the existing law relating to assisted dying.