House of Commons
Deputy Speaker’s Statement
(1 day, 7 hours ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. Before we begin, as Mr Speaker said in his statement yesterday, today marks the 25th anniversary of the 9/11 attacks on the United States. It is also the subject of today’s Adjournment debate. I, too, have seen the site of the attacks, and it is a harrowing reminder. We remember the 2,977 innocent lives lost, including 67 British citizens. The attacks also impacted family members in my constituency of Sussex Weald. We pay tribute to the extraordinary bravery of everyone who risked their lives and their own safety and ran towards the danger in order to save others. I am sure that colleagues from across the House will wish to remember the victims of those terrible events and their loved ones.
Kit Malthouse (North West Hampshire) (Con)
I beg to move, That the House sit in private.
Question put forthwith (Standing Order No. 163) and negatived.
Terminally Ill Adults (End of Life) Bill
(1 day, 7 hours ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
14:15 - The House divided: - Ayes: 293 / Noes: 218 - Question accordingly agreed to.
14:30 - The House divided: - Ayes: 270 / Noes: 286 - Question accordingly negatived.
Madam Deputy Speaker (Ms Nusrat Ghani)
I remind Members that it is not customary to impose a speech limit on private Members’ Bills, but I hope that after the Member in charge of the Bill and the speaker after that, Members will restrict themselves to about seven to eight minutes in the first instance; that includes taking interventions. I may need to ask for further shorter speeches to enable more Members to contribute. I should make it clear that the Chair retains the right to impose a formal speech limit, but I would rather colleagues helped each other, especially on a day like today.
Lauren Edwards (Rochester and Strood) (Lab)
I beg to move, That the Bill be now read a Second time.
It is a privilege to open this debate on the Terminally Ill Adults (End of Life) Bill—a Bill that will give dying adults, under very stringent criteria, choice, autonomy and dignity at the end of their lives.
What is being asked of MPs today? It is a fair question, given that this House already voted to send the near identical Bill introduced by my hon. Friend the Member for Spen Valley (Kim Leadbeater) back to the House of Lords in June last year. On Second Reading, we vote on the principle of a Bill, but we did that in November 2024. It is a broader principle that the House must consider today: who ultimately decides the laws that govern our nation?
Many Members would no doubt prefer to be working in their constituencies today. They are not because a small number of peers in the other place chose to prevent any votes from taking place on the substance of the Bill in the last Session.
Rachel Taylor (North Warwickshire and Bedworth) (Lab)
Will my hon. Friend give way?
Lauren Edwards
I will once I have concluded my opening remarks.
That decision by those peers means that one of the most significant national conversations that we have been having as legislators was brought to an abrupt halt. Who suffers detriment as a result? Clearly, the terminally ill and their families, who had a fair assumption that the will of the people they elected to represent them in this Chamber would be respected, but also those who must navigate our current, unclear laws. They are laws that do not protect or guide those who work in our health system, laws that do not contain safeguards against the risks of coercion, laws that criminalise and traumatise families who simply want to be with their loved one at the moment of their death, and laws that four Directors of Public Prosecutions have urged need to change. If we do not vote today to allow this Bill to continue its passage through Parliament, we accept those outcomes as the cost of maintaining the status quo, and who knows how long it will be before we get the opportunity to consider the introduction of assisted dying laws again, despite consistent polling showing that it receives majority public support?
Jim Shannon (Strangford) (DUP)
The hon. Lady is setting the scene for what the Bill hopes to achieve, but she cannot ignore the overwhelming 68% of the public who believe that it must be paused, or the 73% of people who say that it should be rejected outright. The public see the danger. This House must halt the process, pause the Bill and instead focus on properly funding world-class palliative care.
Lauren Edwards
I think we need to be very careful when we are quoting polling. For instance, we know that Whitestone Insight has been criticised heavily by the British Polling Council in recent weeks for failing to meet its standards in terms of disclosing who has been funding its research. The reference I am making in my speech is to those very robust, independent polls, such as the British attitudes survey, which in 2024 found that 73% of the British public supported assisted dying and have done so over the last 20 years.
Several hon. Members rose—
Lauren Edwards
I will give way to my hon. Friend the Member for Hackney South and Shoreditch (Dame Meg Hillier).
Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
My hon. Friend talks about who makes our laws, and she has talked in articles that she has written about the primacy of this place. If the Bill goes forward, is she willing to accept amendments? She has brought forward a Bill that is exactly the same as the previous Bill, despite its sponsor in the House of Lords himself saying that there needed to be 77 amendments to make it safer.
Lauren Edwards
It is not quite the exact same Bill; it incorporates two amendments that were agreed without a vote in the House of Lords last time. We have had our conversation in this Chamber about this Bill in 2025, and we have had an interrupted conversation as a nation. I am asking Members of this House to send the Bill back to the House of Lords so that they can continue their important work of amending and scrutinising legislation.
Rachel Taylor
Does my hon. Friend agree that unless this House makes it absolutely clear that it is outrageous and unacceptable for a very small number of unelected peers to block legislation, supported by the elected Chamber, then the same tactic could be used again with any private Member’s Bill that comes forward in this House?
Lauren Edwards
Absolutely—it would set a dangerous precedent. Those Members who want to come in on the specifics of the Parliament Acts will have ample opportunity to do so later in my speech, and I will be willing to take interventions on that matter.
I pay tribute to my hon. Friend the Member for Spen Valley for the courage, courtesy and openness she showed during the passage of her Bill. Her engagement with those from all sides of the debate, particularly in Committee, delivered a stronger Bill that this House voted for on Report and Third Reading. One strengthening factor was the introduction of a requirement for the Health Secretary to report regularly on the availability, quality and distribution of palliative care. In asking parliamentarians to consider assisted dying, my hon. Friend also prompted a national conversation about how we improve and fund palliative care. We saw more funding for hospices, as well as Government action to develop a new framework to improve palliative care and end-of-life care.
Anna Dixon (Shipley) (Lab)
I chair the all-party parliamentary group on hospice and end-of-life care, and I wonder whether my hon. Friend shares my concern. Given that an estimated 170,000 people die in this country each year without access to palliative and end-of-life care, there can be no choice until hospice and end-of-life care are properly funded.
Lauren Edwards
It is absolutely right that, for instance, the Prime Minister and the Government have said that improving palliative care must be a priority—I think that is something we can all support. Everybody should have access to good-quality palliative, hospice and end-of-life care in their final moments.
Several hon. Members rose—
Lauren Edwards
I will make some progress. As acknowledged by organisations that provide that care, though, their services cannot address pain and suffering in all circumstances. During the passage of the Bill in the last parliamentary Session, we heard examples of the limits of palliative care from Members with medical expertise themselves.
Imran Hussain (Bradford East) (Lab)
Will my hon. Friend give way on that point?
Lauren Edwards
No, I will make some progress. We heard difficult stories about patients with bile duct cancer facing the prospect of faecal vomiting as their illness progressed. We listened as Members recounted memories of watching patients bleed to death while conscious, cancer having eaten away at their carotid artery. We felt their frustration when the maximum dose of sedatives could not alleviate the choking and suffocation of someone with peritoneal cancer. Those people deserved choice and a dignified end, too.
Dr Zubir Ahmed (Glasgow South West) (Lab)
As a practising surgeon who deals with bile duct cancer, I can reassure my hon. Friend that there is almost never a reason that someone should be in that state, with feculent vomiting, if they were treated appropriately and all the relevant palliative care measures were in place.
Lauren Edwards
The position that I take is that we can, and must, both improve palliative care and support assisted dying. We must grasp the opportunity that is in front of us to create a holistic end-of-life care system that will deliver choice and dignity for every single one of our constituents.
Wendy Morton (Aldridge-Brownhills) (Con)
On the specific point of hospices, I absolutely understand what the hon. Lady is saying; I have visited our local hospices, and I have sat beside my father when he was dying, but not in a hospice. The point about palliative care absolutely matters, but the Government do not recognise the funding that the sector needs. There is a postcode lottery, and the Ministers are not even answering written parliamentary questions, so does the hon. Lady agree that until this is fixed, we should not be having this debate?
Lauren Edwards
I point out that if this Bill received Royal Assent, the four-year implementation period provided for at the end of the Bill would give us the opportunity to work together to improve palliative care and assisted dying, creating the holistic end-of-life care system to which I have referred.
Several hon. Members rose—
Lauren Edwards
I am going to make a little bit of progress. The four-year implementation period means that nobody would be receiving assisted dying until 2031 at the earliest. That would be too late for many people, but it would be plenty of time to make improvements to palliative care, which would go hand in hand with providing the choice of an assisted death for those who still need it. We can, and should, do both.
Simon Hoare (North Dorset) (Con)
The hon. Lady is making a principled argument that the House must listen to and respect, but she has spoken about choice and dignity, and the one thing I have never understood about this Bill is the importance of the specific time period—that it would apply to adults who have six months or fewer to live. If there is to be choice and dignity, and if people are in pain and the condition is terminal, what is the sanctity of six months? If the principles of choice and dignity underpin the Bill, surely six months is way too narrow.
Lauren Edwards
I thank the hon. Gentleman for his intervention. Obviously, Members have previously raised concerns about doctors getting their prognosis wrong when it comes to how long someone is able to live. My understanding is that, given the international evidence, six months was seen a reasonable line to draw, because as the time of death gets closer, the accuracy of the diagnosis is increased.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
Will the hon. Lady give way?
Lauren Edwards
I am sorry, but I will not give way.
I thank all those who took part in the debate on the Bill in this Chamber during the last parliamentary Session. We showed politics at its best through our robust but courteous debates. We did our job, and we did it well; now it is time for us to send this assisted dying Bill back to the House of Lords, so that it can finish what it started. Whatever our respective views on the form and composition of the second Chamber, I hope we can agree that peers play an important role in scrutinising, refining and strengthening the legislation that we send there.
Sir Alec Shelbrooke (Wetherby and Easingwold) (Con)
I am extremely grateful to the hon. Lady for giving way. She has outlined the will of this House, but she may remember that, during the passage of the last Bill, I asked the then Prime Minister at Prime Minister’s questions to do what has happened with similar Bills in the past—on homosexuality, on abortion and on the death penalty—which was to give time on the Floor of the House for Committee of the whole House. That would massively strengthen amendments that are made by using the whole House to approve them. That is a choice for Government Front Benchers, so is the hon. Lady going to lobby her own Government to give everybody in this House the opportunity to properly scrutinise the Bill in Committee?
Lauren Edwards
The Government have been clear, as the Government of the previous Prime Minister were, that they remain neutral on assisted dying, but that they have responsibilities to make sure that the legislation we bring forward is workable. We received those assurances on Third Reading of the previous Bill, when we voted in favour of it as a Chamber.
Several hon. Members rose—
Lauren Edwards
I will not give way. I am asking Members today to start the process of sending this Bill back to the House of Lords, so that they can continue their important function of fulfilling their constitutional role.
Dr Simon Opher (Stroud) (Lab)
I thank my hon. Friend for giving way, and for making an incredibly strong speech. I was part of the Bill Committee, and we gave about 200 hours of assessment to this Bill, which is much more than most Government Bills get. Indeed, the Lords had an enormous amount of time to consider it, too. Saying that there has not been enough scrutiny is simply wrong.
Lauren Edwards
Members should be in no doubt that the Bill we sent the Lords last year was robust.
Lauren Edwards
No. The Bill was expertly drafted by the Office of the Parliamentary Counsel and developed with comprehensive technical advice from officials in both the Department of Health and Social Care and the Ministry of Justice.
Lauren Edwards
No, I will make a little bit more progress, please.
Although the Government are neutral on the issue of assisted dying—then, as now—they have a duty to ensure that any legislation that Parliament passes is effective, legally robust and workable. I am confident in saying to this House that the Bill before us today is a well-designed, safe piece of legislation.
Marsha De Cordova (Battersea) (Lab)
My hon. Friend is making a good case for this Bill, but she will know that when the Bill was introduced in 2024, no equality impact assessment was carried out. Recently, the Government have published the assessment, and it highlights the disproportionate impact that the Bill will have on black and ethnic minority communities and on disabled people. There is nothing in the Bill to address that point.
Lauren Edwards
I would start by saying that the Bill is explicit that it does not apply to people with a disability.
Richard Burgon (Leeds East) (Lab)
What we are considering today is not the general principle, “Do we or do we not agree with assisted dying?”; it is this Bill. We are not a debating society; we are a Parliament. I therefore ask my hon. Friend why it is the case that virtually no disabled people’s organisation in this country supports the Bill. Disabled people often feel voiceless, and I think it is important that their voices are heard today. They are outside Parliament, so I would like her to address that point in her speech.
Lauren Edwards
I would be happy to address that point. There is not a uniform view among disabled people on assisted dying. Like with anything, within organisations there are people who arrive at different views. It is important that we are giving disabled people the same rights as other people. It is very clear in the Bill that it is for adults aged over 18 who have a terminal illness and who only have six months to live. It specifically makes clear that it does not apply to people who have a disability.
Several hon. Members rose—
Lauren Edwards
No, I will not give way. I will make some progress—[Interruption.]
Madam Deputy Speaker (Ms Nusrat Ghani)
Order. The Member has made clear that she is not taking interventions at this point.
Lauren Edwards
As has been mentioned, the Bill has been subject to hundreds of hours of scrutiny, and amendments have been made to strengthen its safeguards, but that does not mean it cannot be strengthened further. As with any Bill, it will benefit from additional scrutiny. The Bill before us today already includes an important clarification on eating disorders that was agreed without a vote in the House of Lords last time. Together with the co-sponsor of the Bill in the House of Lords, Lord Falconer, who is in the Gallery today, I have recently met representatives from medical bodies and hospice organisations to discuss further amendments that could be made in the other place.
Gavin Robinson
I am very grateful to the hon. Lady for allowing me to intervene. She mentions that the Government have a responsibility to ensure this legislation is lawful and workable, yet she is the Bill’s sponsor—that responsibility rests on her, too. Yet despite knowing that the Bill’s sponsor in the previous Session brought forward over 30 amendments and eight new clauses of her own and the Bill’s sponsor in the Lords brought forward 77—a recognition that the Bill is manifestly unworkable—she has chosen not to amend her Bill. What is before us today is for a political—
Lauren Edwards
I disagree with the position that any time we amend a Bill in this place, it is ultimately deficient and unworkable. That is not how it works. All I am asking the Chamber to do today is to send the Bill back to the House of Lords so it can continue its work, which was interrupted, of scrutinising the Bill.
Sam Rushworth (Bishop Auckland) (Lab)
I thank my hon. Friend for giving way; she is being very generous with interventions. Is she willing to share with the House what, if any, amendments the Lords made, besides the two she has mentioned, that she thinks should have been added to the Bill, and, if so, why they were not?
Lauren Edwards
There were a number of amendments around points of clarification—some external organisations wanted some words made a little clearer, although they seem robust to me—that I certainly believe could be made in the House of Lords.
Several hon. Members rose—
Lauren Edwards
No, I will make some progress.
Taking the approach I have outlined respects both the will of this House, as expressed in June 2025, and allows the usual parliamentary processes to continue.
Alicia Kearns (Rutland and Stamford) (Con)
“Erskine May” gives this House a way to send what are called “suggested amendments” to the Lords as a separate motion alongside the Bill, when it goes to the other place. It has not been used since 2004, but does she recognise that if some Members of this House think certain amendments are crucial to the Bill, they can do so?
Lauren Edwards
That is a part of our usual parliamentary process and the hon. Lady is right to raise that point.
By sending the Bill back to the Lords as it stands, we will prevent that same small group of peers who talked it out last time from doing the same thing again. It is my fervent wish that all the peers—
Lauren Edwards
No, I am sorry; I will make some progress.
It is my fervent wish that all the peers in the House of Lords will accept that important distinction between their Chamber and ours, and fulfil their role in the usual way. In doing so, they can consider and send an amended Bill back to us for a final vote before Royal Assent.
Several hon. Members rose—
Lauren Edwards
No, I will make some progress.
If, at that point, Members of this House decide to vote the Bill down, I and many others, in this Chamber and outside, would be upset and disappointed, but I would accept that as a result of the proper democratic processes being followed. What I cannot accept, and what many people both inside and outside the Chamber cannot accept, is the current situation, where a small number of unelected peers filibustered legislation that was supported by this Chamber. That is not how our democracy is supposed to function.
Sir John Hayes (South Holland and The Deepings) (Con)
I am very grateful to the hon. Lady, whose speech is a series of oxymorons: she does not like polling that is against the Bill, but likes it when it is in favour; she feels the Bill should be amended in the House of Lords, but not with amendments that would improve safeguards. On that subject of safeguards, will she explain to the House why the previous legal safeguards to assuage doubts about efficacy were entirely dropped from the Bill?
Lauren Edwards
They were dropped in favour of a stronger safeguard, which was a multidisciplinary panel of people with different perspectives who were trained in spotting coercion—a psychiatrist, a legal expert and a social worker, bringing other people in with different perspectives—to ensure that the person taking the assisted death decision was doing so in an informed and settled way, free from coercion. That was a strengthening of the Bill, not a weakening.
Several hon. Members rose—
Lauren Edwards
I will make some progress.
Members took the best part of a year to grapple with this issue: spoke to constituents; engaged with the organisations that would be affected; read the materials; thought deeply; consulted their conscience. They arrived at a decision—whatever that decision was and however they voted or, indeed, did not vote at all—but it was a difficult process. It is not acceptable that the outcome of those deliberations has not been respected. We owe it to the people we represent to find a resolution on this issue one way or another within this Parliament.
Simon Hoare
I am grateful to the hon. Lady for giving way a second time. This is the democratically accountable House; I think we would all agree on that point. On that basis, is she prepared to accept in Committee and on Report, if this Bill secures its Second Reading this afternoon, amendments authored, debated and voted upon by Members of Parliament?
Lauren Edwards
We have been through that process. There was a Committee that had hundreds of hours of scrutiny and properly kicked the tyres on the robustness of this legislation. What we need to do as a House is send the Bill back to the House of Lords so that they can finish their job. We did ours.
Several hon. Members rose—
Lauren Edwards
I will make some progress.
As important as a democratic point of principle is to the argument I am making, we must not lose sight of the people who are relying on us most: the terminally ill and their families. The Gallery today is filled with inspirational people campaigning for this much-needed change in the law—people who are themselves terminally ill and who, due to the passage of time, may never get the opportunity to choose a dignified death surrounded by their loved ones, but who nevertheless spend the time that they have left campaigning so that others in future may have that choice.
Lauren Edwards
I am sorry; I will not.
Those people include Christie Arntsen, who has lived for more than a decade with incurable metastatic breast cancer, which has sadly returned for the fifth time. She is undergoing what may be her final treatment of chemotherapy. Christie speaks eloquently about how her fear of a difficult death has weighed on her mind since her diagnosis and affected her life:
“For me the scariest part of having the diagnosis was that I had no control over the last few weeks of my life…If I had known that assisted dying was an option, a weight would have been lifted from my mind for the last 10 years.”
Several hon. Members rose—
Lauren Edwards
I will make a little more progress.
This is the cost of accepting the status quo: the fear and worry for those who know that palliative care may not be enough to avoid a difficult and painful death. It snatches away their final moments, which, as I know from speaking to friends and family in Australia, can be much better spent when there is a safe voluntary assisted dying system in place.
Rebecca Smith (South West Devon) (Con)
I thank the hon. Lady for being so generous with her time. Is she aware of the sheer number of palliative care consultants who are not prepared to take part in assisted dying, and the impact that that will have on the palliative care system? In my constituency, all three palliative care doctors who work in Plymouth’s Derriford hospital are against assisted dying and are saying that they would leave the profession. How can we offer palliative care at the same time as assisted dying?
Lauren Edwards
I would point out that there is a range of views among those in the palliative care community. It is specifically for that reason that the Bill allows them not to be involved in the process if they do not wish to be.
Imran Hussain
Will my hon. Friend be generous enough to give way on that point?
Lauren Edwards
No, I am sorry.
I end with the words of Elise Burns, who, like me, called Kent home, and who sadly died in July with secondary cancer of the lungs, liver and bones. She said she would love peers
“to look me in the eye and tell me why me and my friends, and anyone with terminal illness, don’t deserve to die with dignity and to have the choice to die…without pain.”
We owe it to terminally ill people like Elise, who are relying on us and who were so filled with hope when we voted in favour last time. Quite rightly, they cannot understand how, having secured the support of the people they elected to represent them, the issue that is so important to them has been frustrated by a small group of people with no democratic mandate.
The important conversation that we have been having on assisted dying, as legislators and as a society, has been interrupted. To leave it so would have a profoundly negative impact on people’s trust in our political system. If we fail to support the Bill’s Second Reading, are we not saying that it is fine for a minority of unelected peers to defy the will of the House of Commons? Are we really prepared to cede that point and accept the consequences not only for this vital legislation but for future legislation too?
I ask hon. Members to join me in sending a clear message that the will of this Chamber should be respected, on behalf of all the people that we represent, and to support this Bill on Second Reading.
Dame Karen Bradley (Staffordshire Moorlands) (Con)
This is a very difficult day. No one could fail to be moved by the grief of campaigners and by the deeply personal stories, whether born of their own experience or of those they have lost. Those voices deserve to be heard, and it is important in this place that we respect all views, whether we agree or disagree; but as we deliberate today, I go back to the words of the hon. Member for Bradford West (Naz Shah) in a past debate, asking us to remember
“the quiet ones, those who may be less organised or not as powerful but who are none the less equally, if not more, important—the voiceless”.—[Official Report, 13 May 2026; Vol. 786, c. 11.]
Those words resonated particularly strongly with me, because I had the privilege of serving 10 years ago as the Minister for Preventing Abuse, Exploitation and Crime—the first time that safeguarding brief had been brought under one Minister. It was so often the quiet voices that needed to be heard. It was the time I spent with victims that persuaded me that modern slavery was something we needed to legislate for. It was the time I spent with the victims of domestic violence, some of whom did not even want to admit that they were victims, that persuaded me we needed to do more and that we needed to legislate in this area.
When I took the coercive control offence through Parliament, it was incredibly important. That is a very difficult offence; coercive control is not easy to prove or to find the evidence for, but it was so important that we did that. I remember speaking at an event not long after the legislation had gone through, where I explained that coercive control offence and what we were trying to do in Parliament. Afterwards, a woman came up to me privately, in tears, and told me that what I described had been her life some 30 years earlier. She had recognised eventually that she was a victim; so often victims do not recognise that they are victims, but she did recognise it. She had gone to the police, but because the offences were not violent or physical, they said that there was nothing they could do. They even said, “Lock the door and hope that he beats the door down, because then we could arrest him on criminal violence.” That was all they had. There was nothing they could do to help this woman.
That encounter stayed with me, and it reminds me time and again that abuse is not always a single act. It can be the gradual erosion of somebody’s confidence, independence and sense of what choices are really theirs. Coercion to end one’s life may not come as an explicit threat. It may be the repeated suggestion that someone is becoming a burden.
Dame Karen Bradley
I will not be giving way much, Madam Deputy Speaker, but I will give way to the hon. Lady.
Catherine Fookes
I thank the right hon. Lady very much for giving way and for sharing that really difficult story. Does she not agree that the current system has no safeguards at all against coercion, and that is exactly why we need this Bill?
Dame Karen Bradley
Coercion is something that we absolutely need to tackle and understand as a society, but I do not think that this Bill has the safeguards that are needed.
Several hon. Members rose—
Dame Karen Bradley
I will give way to the hon. Member for Strangford (Jim Shannon), and then to the previous sponsor of the Bill, the hon. Member for Spen Valley (Kim Leadbeater), and then I will make progress.
Jim Shannon
I quote the story of one of my constituents, a motor neurone disease sufferer. He said that, if he had had the option of assisted dying two years ago, he probably would have taken it. But, in his words, “I would have missed out on the most fulfilled two years of my life and the knowledge that I can have more moments like this ahead of me.” His words are, “Please don’t do this, life is worth living.” Does the right hon. Lady agree?
Kim Leadbeater (Spen Valley) (Lab)
The right hon. Lady is making a very important point, which I have considered at length during the last two years. Many amendments relating to coercive control were made to the Bill to ensure that all professionals involved have training, and there are multiple checks for coercion throughout the process, which do not currently exist. At present we check for coercion only when someone is dead.
Dame Karen Bradley
I accept what the hon. Lady says, and I know she speaks with great sincerity, but it is still the case that under this Bill, somebody could be seen remotely—without a face-to-face appointment—where they are not alone and the coercive perpetrator may be forcing them.
Jess Phillips (Birmingham Yardley) (Lab)
Suicide currently outstrips homicide as the main reason for the deaths of women in cases of domestic abuse and coercive control, so what the right hon. Gentleman outlines is currently happening. Arguing for the status quo is not something I feel comfortable with. I feel considerably stronger about the safeguards that I worked with my hon. Friend the Member for Spen Valley (Kim Leadbeater) to ensure that the Bill had.
Dame Karen Bradley
I have enormous respect for the previous Minister, who I have worked closely with, but the point she is making about suicide of women who were victims of domestic abuse is a separate matter. For women to feel that they have nowhere else to go other than to commit suicide, is the most outrageous and horrendous situation, and we absolutely have to tackle and work on that. But this Bill is not the solution to that problem.
Naz Shah (Bradford West) (Lab)
I speak as a survivor of domestic violence and as a survivor of an attempted suicide many years ago, while campaigning about domestic violence. Does the right hon. Lady agree that coercion is not always external? Coercion can also be internal—“Am I a burden on my family?”, “Can they afford to look after me?” That coercion is not picked up on in training, because it comes from deep inside when a person is vulnerable and at their lowest ebb.
Dame Karen Bradley
The hon. Lady makes the case so powerfully. I am going to disappoint Members now, because I will not take any further interventions for some time.
Like the hon. Lady, my fear is not principally for those who are confident, articulate and able to insist on what they want; it is for the person who does not want to make a fuss—the person accustomed to putting everybody else’s needs before their own, who internalises that coercion and feels guilty about the care they require, or has simply been deprived of it.
Recognising abuse is really difficult. Those who have the misfortune of watching daytime TV may notice that there are currently adverts for “no frills” cremation services. I am particularly struck by one, which features a woman of late middle age, who is slightly small and says in a quivering voice that she does not want to be a burden or cause any fuss and does not want her family to have an awful time at the point of her death. Therefore, she is investing in a “no frills” cremation to make things better for her family. That person exists. The advertising agency would not bother making that advertisement if that person did not exist.
We have to think about the most vulnerable. These are the people who Parliament—this House—has a particular duty to remember when we legislate and, today, when we decide whether this Bill, without further changes, is safe to become law.
The question before us is, what decision will this House make. I recognise that the sponsor, the hon. Member for Rochester and Strood (Lauren Edwards), is keen to focus on the other place. There is an appealing simplicity in saying, “Send it back there and let them do their work”, but this is not really about the other place anymore. That House has made itself irrelevant. It is about this House and this House alone.
If we seek to engage the Parliament Act, we are, in effect, taking a unicameral decision, and we should understand what that means. We would be declaring that the Bill before us is in a fit state to become law whether or not the other place completes its work. There is no separate process by which this House later authorises the Parliament Act. Our approval of the Bill is the decision.
Dame Karen Bradley
I will not; I really need to make progress.
The hon. Member for Rochester and Strood and co-sponsors of the Bill have been clear, including in the debate now, that there will not be amendments made in this place. A deliberate decision has been taken to introduce a near-identical Bill and not to incorporate the 77 amendments from the Lords sponsor, including changes that addressed issues that he himself accepted required attention.
Dame Karen Bradley
I really cannot; I am so sorry to my hon. Friend.
We could have dealt with this over the summer; we had time to work on it. We could have included, for example, a clause that would have given an equal right to palliative care or a simple assessment of unmet need—something, anything, to allow there to be a genuine choice. But that opportunity is now gone.
Let me be absolutely clear about what today’s vote is and what it is not. It is not another vote on the principle of assisted dying as on an ordinary Second Reading debate, and the hon. Member for Rochester and Strood said that herself. It is not a vote to allow this House to improve the Bill. It is not even a vote to allow the other place to improve it, because that is not in this House’s hands. If this Bill is sent to the other place and falls for whatever reason—even if that is because Parliament prorogues early and it receives not a single further hour of debate—it could be forced into law as it is. The Hansard Society put it plainly in saying
“bills proceeding under the Parliament Act have been subject to only minimal amendment.”
The House needs to understand that the proposed approach requires
“preserving an unchanged bill with…defects”.
That is a very different decision.
I know that there will be Members in the House saying to themselves, “Nothing has changed since I voted for this before—why should I change my vote now?” My answer is simple. A great deal has changed, though not, unfortunately, in the Bill itself. We know more now than we did then, and changing one’s conclusion when the evidence changes is what Parliament is supposed to do.
We now have revised estimates from the Government showing that many more people may seek an assisted death than Members previously understood: up to 4,610 may apply in the first year, and up to 10,428 in year 10. That is more than 1,000 times the number going to Dignitas each year. That is not a slow run-up during which we can watch the system develop, identify mistakes and quietly correct them.
Dame Karen Bradley
I am sorry; I really must make progress.
We could have thousands of people entering the system immediately. If the safeguards are not right on day one, vulnerable people will be exposed on day one.
We also have the updated equality impact assessment, to which the hon. Member for Bradford West referred, and its conclusions should give every Member pause. It recognises that
“disabled people may feel subtle pressure due to attitudinal barriers or a lack of alternative appropriate services and support…This could also include structural pressures such as neglect, poverty and difficult living conditions”.
It also recognises that we may see
“disproportionate numbers of ethnic minority people choosing to have an assisted death to avoid financial hardship or escape abuse.”
I believe that the Bill is not finished, but we are effectively voting today for a completed and finished Bill. That worries me enormously. Much has been said previously in the debate—I will not repeat the point—but we are giving powers to a future Government to implement this Bill. We are not giving those powers to the Ministers sitting on the Front Bench today, and we are not necessarily giving them to those on the Opposition Front Bench; we are giving them to a future Government of any political persuasion. When I was a Government Minister, I remember always asking myself, “Would I be happy if another Government took this forward—if they had the power to do this?”
I ask Members to apply a test that we too rarely apply when legislating: do not ask whether you trust the people who will administer these powers today; ask whether you would be content with the political party you trust least possessing them tomorrow. There is simply not enough detail in the Bill to constrain how many of these decisions would be made. The National Down Syndrome Policy Group put it best: this Bill hopes for the best rather than prepares for the worst.
Lewis Atkinson (Sunderland Central) (Lab)
Will the right hon. Member give way?
Dame Karen Bradley
I feel sorry for my hon. Friend from the Home Affairs Committee, but I really must make progress, because Madam Deputy Speaker has been clear to me that I must.
I say to colleagues who supported the Bill before and have wrestled sincerely with the issue since: you do not have to repudiate the vote you cast last time to vote differently today. You do not have to decide that assisted dying can never be right. You do not have to abandon the compassion that led you to support the principle. You need only ask whether this Bill, in this form, on the evidence before us today, is safe enough for Parliament to force it into law. That is today’s test. There is no shame whatsoever in concluding that the answer to a different question is different. Indeed, there would be something profoundly wrong with a Parliament in which Members felt bound by an earlier vote, regardless of everything they had learned since.
Success is rare for private Members’ Bills. It is an amazing route when legislation is simple and consensus is easily achieved, and the whole House came together last Friday to do something quite remarkable for babies, but it is a terrible route when the risks of getting it wrong are great and there is great complexity and such emotion.
Before a Government Bill is introduced, Departments will normally spend months or years developing the policy—sometimes that is too slow, but that is what they do. They consult experts and those affected, test the legal and practical implications, produce impact assessments, secure cross-Government agreement and have the legislation professionally drafted and scrutinised by parliamentary counsel. Finally, the legislation goes through the Parliamentary Business and Legislation Committee, where Ministers have to prove to the rest of Government that the Bill is fit for purpose. That is what we needed here, when dealing with one of the most profound changes that Parliament could make to the relationship between the citizen, medicine and the state.
Some say they want to amend the Bill. Have there been any reassurances that those amendments will be supported? The promoter controls the make-up of the Public Bill Committee and will have a majority. On Report, if we are fortunate Members may have the opportunity to vote on only a handful of issues, and those who support the Bill will be asked to reject each one. We are being asked to support the Bill as it stands, alongside a commitment to force it into law regardless of what safeguards are forgone or what gaps, through which vulnerable people may fall, remain.
There is no one else to whom we can pass responsibility. We cannot say that the other place will sort it out, or that we will fix it later. If the Bill becomes law, Parliament may not get another opportunity to reopen it and put right what we discover we got wrong. The consequences will instead be worked out in practice—in hospitals, homes and, ultimately, the courts, where judges will make decisions based on the law before us today. For the people affected by a mistake, “We will sort it out later,” is no safeguard at all.
My appeal today, particularly to those who voted for the Bill before, is this. Look at what we know now. Look at the people who will depend on our having got every safeguard right. Remember the quiet ones. Are you prepared today to say that this Bill, in this form, is safe to be forced into law?
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
More than 90 Members are trying to catch my eye. I can maximise contributions only if colleagues keep their speeches to around six or seven minutes.
Claire Hazelgrove (Filton and Bradley Stoke) (Lab)
Today I am going to share the most personal of stories publicly for the first time, and I ask for the kindness of colleagues in not intervening so that I can.
Last October, my mum, Ruth Hazelgrove, chose to bring her late-stage terminal illness to an end, on her terms, at home, with dignity and with a strength that I can only try to imagine. Mum had just turned 61. She had endured significant health challenges for almost half her life. When mum was 32, she was diagnosed with a rare blood cancer, polycythaemia vera. Thankfully, she was able to see us grow up and meet her grandchildren. Mum loved life and laughter, and our family will remember her this way.
In early 2024, mum was told that her condition had taken a significant turn. That autumn, while we debated the initial version of this Bill, her pain was excruciating. She had access to good palliative care, but what we learned the hardest of ways is that not all pain can be palliated. I will never forget seeing her writhing and screaming in pain, at points for weeks. None of us will. I know of no deity that would want that. Eventually, some medication helped her leave hospital, but it then became less effective over time.
For mum, it was not a choice of life or death; it was a question of what kind of death she would have. She was clear that she did not want a painful or undignified death. She wanted peace. For us, it will always be a tremendous personal sadness that the current law meant that she could not tell us her plan, and we could not say goodbye to her—but more importantly than that, that she could not say goodbye at the end of her life, or be surrounded by her loved ones, which is what she would have wanted for her death.
Instead, the harmful status quo meant that mum died alone, with photos of us around her. This was 11 months ago either today or tomorrow—we will never know whether she died late one evening or early the next morning, or whether we are ever marking the anniversary on the right day. This is the status quo. This needs to change. That is why our vote today and our work on this issue is so important now. People with terminal illnesses, and those who will be diagnosed with them soon, matter greatly. If we were again to leave this issue to another Parliament, it would be too late for other people with terminal illnesses who want this provision, but instead face the same impossible bind as my mum; they would continue to face it well into the 2030s, at best.
An excruciating death or dying alone is simply not an acceptable bind for a human being. To allow choice does not impose an outcome, but to continue to restrict it does. In part of mum’s last note to us, which is why I am speaking today, she wrote,
“I wish the Assisted Dying Bill would have come into force in my lifetime…Maybe there will be hope for others in the future.”
Ultimately, is it not what Parliament is for to provide safeguards and freedom? I believe that we are here not to dictate how people live their lives and their deaths, but to enable safe individual choice. Today’s vote is on whether we should continue to work on this, or not at all. I ask right hon. and hon. Members to ask themselves if they feel that this impact of the status quo is right, is just.
My hope, and I know my mum’s hope, is that her story can help us choose to end this harmful status quo and see terminally ill adults finally have true choice over their lives and their deaths.
Sir Edward Leigh (Gainsborough) (Con)
The hon. Member for Filton and Bradley Stoke (Claire Hazelgrove) has spoken most movingly, and we know that many of us are very conflicted on this issue. We have to respect each other and show compassion—we know what this debate is all about. No one side has a monopoly on compassion.
I will say in a moment why I believe in being assisted to die in a dignified way, but will the House forgive me if I start with an essential legal point? We know that what this is all about is ensuring that the Bill we are debating today leaves the House unamended so that the Parliament Act can be imposed. The Isle of Man had an assisted dying Bill, which, like this Bill, left a lot to delegated powers. The Ministry of Justice concluded that this meant that that Bill was not compatible with the European convention on human rights. When the result of the private Member’s Bill ballot was published, three former Attorneys General of both parties—Baroness Scotland, Dominic Grieve and Baroness Prentis—wrote to the promoter to urge her not to present the same Bill, as it would run into the same legal and constitutional difficulties. It is unfortunate that that offer has not been taken up, and we have to ask why.
Let me give my own personal views as briefly as possible. I will surprise the House by saying that I am in favour of assisted dying. I am in favour of the idea that when I, or when any of us, approach our last moments, we go into a hospice and are assisted to die. That is what doctors and nurses do all the time. I have been very impressed by what our Prime Minister has said on this issue—he has not been mentioned yet. It is about ensuring that everybody receives excellent palliative care, as we see in our hospices like St Barnabas hospice in Lincoln. So we are agreed on that.
Sir Edward Leigh
If the hon. Member will forgive me, I have been told to be brief.
I am in favour of our being assisted to die as painlessly as possible, and every palliative care nurse and doctor I have ever talked to has made it clear that in the overwhelming majority of cases, that is possible. Of course, we can be anaesthetised, as we all are when we have operations. I hear the argument, but I believe that we need to improve palliative care.
What worries me about the Bill—this is my point—is that I do not believe that it will be just an assisted dying Bill; I think that in time, it will become an assisted suicide Bill. I have mentioned the ECHR. What is the logic of the Bill? We all know it is terrible if you have a terminal cancer prognosis, but what if you are clinically depressed? What if you are quadriplegic? What if you are sentenced to a lifetime of being unable to move your arms or legs? What if you know, as a member of our family in Canada does, that you will get more and more dementia, so you take the assisted dying route? The truth is that we cannot differentiate between these conditions that make life unbearable for many people. I make this prediction: if this Bill goes through—if the Parliament Act ensures that it does—I believe that in 10 years’ time we will be in similar situation to Canada, and very large numbers of people will be choosing assisted dying.
We hear a lot that this country is broken, and that the elite is ruining the country. I think that is rubbish. This country is not broken. The reason we are under pressure is that there are too many of us—too many old people; too many people with multiple health conditions. There is tremendous pressure on the NHS; we know that. We heard a lot from my right hon. Friend the Member for Staffordshire Moorlands (Dame Karen Bradley) about coercion. We have also heard that coercion is not necessarily external; it can be internal. I believe that if we move to a society in which assisted suicide is the norm, vast numbers of people will take it up. Is that really the sort of society that we want?
Daisy Cooper (St Albans) (LD)
On that point, will the right hon. Gentleman give way?
Sir Edward Leigh
No. I agree that we would have more prosperity and be a richer country, and would have more choice and freedom, but would it really be a happier country? What I stand for, and what I believe in passionately, is respect for all human life—the life of old people who are suffering so much from dementia that they cannot even recognise their own children, and the life of people who have appalling long-term conditions. I believe that there is a greater thing than choice or prosperity; it is love—love of life. All of us in every country in the last 100 years have said that whatever happens, we should respect life and not take it. Yes, this will be difficult for many people, and we have heard moving stories, but take the NHS; at the moment, when a person goes to hospital, they know that they will be dealt with compassionately by a doctor or nurse, and that the conversation will be all about relieving their symptoms and trying to save their life. Do they want the conversation to start with the fact that their life is unbearable?
I know that there is passion on both sides of this debate, and we treat each other with respect, but before we vote for this Bill at 2.30 pm, remember what sort of society we would be creating—not a society that loves life.
Dr Zubir Ahmed (Glasgow South West) (Lab)
I speak on this matter as an active medical practitioner, a transplant surgeon and a cancer surgeon. Much of my clinical practice for the last 20 years has revolved around caring for unwell complex patients, many of whose illnesses flicker between the labels of “terminal illness” and “life-limiting illness”. It is some of that experience that I wish to bring to bear on this debate.
Let me start off by acknowledging the varied experiences people have at the end of their life, or their loved ones’ lives. I have cared for and operated on thousands of patients in that position, and I have helped many, but I have often fallen short, and some of those stories have played vividly in my mind over the last few days. When they have, I have reflected on the fact that more often, when things have not gone right, it is not because of a failure, but rather an absence of universally available good-quality palliative and psychological care. Today, as a Member of this place and as a surgeon, my job is to help move this discussion beyond the emotive and the case study to level-headed analysis that will serve our society well, not only today but for decades to come.
Having read this Bill again, and with the hindsight of ministerial experience in the Department of Health and Social Care, I am more convinced than ever that our social care and palliative care systems simply are not ready to meet the demands of this Bill—at least not equitably.
The Bill, when taken from the laboratory of legislative text and dispatched to the bedside and the clinical frontier, will not serve its laudable aims of bringing choice and control over a pre-emptive, quick death, which is what many desire and expect from this legislation. While it will not fulfil those aims, it will expose millions: the quietly vulnerable. I think of constituents and patients of mine in Glasgow South West, more often than not women, who quietly concede to me, usually in the sanctity of a clinic room, that they do not wish to be a burden, and who have on many occasions asked me to end their life because they have suffered multi-generational financial strains and do not want their illness to hold back their children and their grandchildren. When you visit places like Govan and Pollok as a parliamentarian, as well as a doctor, you understand that as a society, we are only scratching the surface of understanding the full extent of coercive control in this country.
Sorcha Eastwood (Lagan Valley) (Alliance)
It pierces my heart whenever cancer is mentioned in this conversation, and I am grateful to the hon. Member for West Lancashire (Ashley Dalton) for her advocacy. A person may have cancer, and a terminal diagnosis, and still want to live. We should support those people to live first, before we contemplate their death.
Dr Ahmed
I commend the hon. Member for her powerful testimony. I know that she has personal experience of this matter.
When you visit places like Govan and Pollok, you know what vulnerability looks like. Those people cannot send their voices down here via the mic, the TV studio or a billboard in Westminster tube station. We need to make sure that they do not feel the burden of making what some call an option, or a choice, their obligation or duty.
Dr Ahmed
Not at the moment.
It is on the foundational principles of the Bill that I primarily want to concentrate today. The first is the idea of a “six months to live” label. “Terminal illness” is a fast-changing medical diagnosis in the modern medical world, and it is becoming an increasingly meaningless term. Only yesterday evening, I was in the company of a professor of respiratory medicine who, with rightful satisfaction, told me that many of his stage 4 lung cancer patients who were designated with six months to live in 2023 are being managed as having a chronic disease in 2026.
In my practice, if a patient comes to see me with stage 4 colon cancer that has spread to their liver, the advent of immunotherapy means that I have an equal chance of telling them they have six months to live or six years to live. Under this law, when I meet that kind of patient, it is unclear to me, with the Supreme Court precedents around consent, whether I should be offering them immunotherapy and an assisted death at the same sitting.
A six-month prognosis will take a new and unhealthy salience in every clinical conversation. It will be a label some will desire, and others will want at all costs to avoid being placed on their clinical record. It will fundamentally change and undermine the candidness and sanctity of the patient-doctor conversation and relationship.
Torcuil Crichton (Na h-Eileanan an Iar) (Lab)
My hon. Friend is making a very informed speech on how the medical landscape has changed, but while the arguments we make today are the same, the political landscape has changed as well. Would he agree with the Father of the House that we now have a Prime Minister committed to solving the problems with social care and palliative care, and that in Scotland, where the hon. Gentleman comes from, we saw the political landscape change in front of our eyes? MSPs initially voted for similar legislation, but ultimately voted against it. People can change their minds, and I hope that they do.
Dr Ahmed
I am grateful to my hon. Friend for mentioning the Scottish context. We voted down such legislation on Third Reading, when we understood the impacts and the wider societal ramifications.
I have to be honest. When I am asked to prognosticate on whether someone has six months to live, I am as often wrong as I am right. It is no longer a good enough marker for the DWP to use in discharging benefits for life-limiting conditions, and I do not see why it should be a good enough marker for prescribing death.
There is another paradox in this legislation: someone like me could write a prescription to induce death with less regulatory oversight than is on me when I have to remove a kidney to give life through transplantation. Of course, I sympathise with and endorse the desire of many colleagues who support this Bill to relieve suffering. To be clear, we have many tools to do this, and we must bust some myths today. Clinical discretion, for instance, means that there is no maximum dose of morphine, so I can give my patients whatever they need, in the setting in which they need it. But this Bill is less about relieving suffering and more about bypassing its possibility, and I understand that.
The Bill is in many ways advocating for death as prophylaxis. Under the definition in this Bill, death must be induced by medical prescription. It will be the only medical prescription that I will be able to write as a doctor but not administer, because the burden of administration falls to the patient, and the weight of expectation falls on the patient. We must discuss the mechanisms by which death will occur: muscle paralysis, slowing of the heart rate, sedation, and the possibility that paralysis will take hold before sedation does. Death will not be an event; it will still be a process. In 15% of cases, it will be subject to some form of complication, such as vomiting or seizures, and it will not always achieve its goal.
I wish I could give hon. Members more information about the complication profile, but despite this procedure being prevalent in other jurisdictions across the world, the data continues to be woefully lacking. Alongside that, the 14-day cooling off period means that the patient must remain lucid in that time. There have been cases elsewhere in the world where patients have denied themselves palliative care and pain relief to remain lucid in order to consent to their death. I am therefore of the opinion that the foundational elements of this Bill will create the allure of choice and control, but not the agency to pursue either.
Turning to safeguards, much is made of the provision requiring two doctors to assess eligibility, but the trouble is that neither has to know the patient well, or go to any great lengths to exclude the likelihood of coercion. Doctors are trained to do many things, but assessing and picking up on coercion is not one of them. In fact, consultant psychiatrists with PhDs in coercion, like the hon. Member for Runnymede and Weybridge (Dr Spencer), whom I hope we will hear from soon, have said in written testimony presented in court that they would find it difficult to exclude coercive controlling behaviour.
I came into medicine, and into Parliament, to act with compassion, and to provide dignity to those we serve. I believe that is why we are all here. Compassion and kindness is not the preserve of one those on one side of the argument or another, but for me, compassion and kindness also calls to courage—the courage to be honest with patient and constituent alike. We need the compassion and honesty to say that the Bill will not fulfil its aims; it will disappoint many who crave total agency and control, and it will expose and disenfranchise further the vulnerable in our society. We need the compassion and honesty to say that our NHS, while a great institution, is not, in its current form and state, ready. It is not safe for this conversation or for this Bill in this moment.
Several hon. Members rose—
Madam Deputy Speaker (Ms Nusrat Ghani)
Looking around the Chamber, I see many Members wishing to contribute. In case I did not make myself clear, I urge colleagues to keep their contributions to five minutes or less; otherwise, I will be forced to put a speaking limit in place.
Kit Malthouse (North West Hampshire) (Con)
As co-sponsor of the Bill once again, I am acutely conscious that there is more at stake today than merely the fate of those who are facing their end, because the conduct of the other place means that our democracy is also on trial today. I sat in the Chamber at the other end of this building on a number of occasions when it was debating the Bill, and I saw more of the debate on television, and I watched with unfolding horror the game that was being played there—a game that was marked in homes across the country with dismay, misery and agony. I contemplated the Lords effectively putting up the pretence of scrutiny, but at the same time tabling 1,000 amendments—
Jess Asato (Lowestoft) (Lab)
On that point, will the right hon. Gentleman give way?
Kit Malthouse
I will not. The Lords tabled 1,000 amendments, many of which were cruel or absurd; they were effectively designed to be sand in the engine, and to slow up what should have been proper parliamentary process—a process that the dying deserve to see operate correctly.
We have to be aware in this House that expectations are high, and the people who send us here should be able to rely on decisions made in this House proceeding into law. I am afraid that what is at stake today is our democracy. If this Bill falls today, one of the biggest losers will be the standing of this House and this institution as a whole.
Sir Jeremy Wright (Kenilworth and Southam) (Con)
I applaud my right hon. Friend’s passion and clarity on this issue. On the subject of democratic accountability, he knows that if, as the hon. Member for Rochester and Strood (Lauren Edwards) has made clear, no amendments to the Bill can be accepted from this House, the authority to decide whether the Bill changes passes to the other place. There must be a problem in my right hon. Friend’s argument, with this House saying, “If we are worried about the content of this Bill at the moment, we can do nothing about it, and we rely on the other place to do something instead.”
Kit Malthouse
I respect my right hon. and learned Friend’s expertise in this matter, but, as he has already heard on the Floor of the House, it is perfectly possible for this House to suggest amendments, negotiate them with the promoters of the Bill, place them against the legislation in the House of Lords and then have them come back to this House for approval. We would much rather that had happened in the first place.
This House now faces an invidious choice: if we amend and pass the Bill in this House, it will just be talked out again. I am afraid I have no faith that the small group that dedicated themselves to holding up the Bill to deny dying people what they seek, because of their own—
Kit Malthouse
I will not.
Some of those Members had just a few months before been specifically rejected by the electorate and replaced in this House by others, and I am afraid that they cannot be trusted not to do the same thing again. I grant my right hon. and learned Friend the Member for Kenilworth and Southam (Sir Jeremy Wright) that this is a less than ideal situation. However, I know that the sponsor in the House of Lords is willing to entertain amendments being tabled in the Lords, which will come back to the House for conclusion.
Before I conclude, I want to deal with a couple of other issues. The first point is about the notion of palliative care, which we discussed extensively on Second Reading. I am pleased that this legislation has stimulated a strong debate about palliative care. The Health and Social Care Committee of the House of Lords found that in territories that have assisted dying, palliative care generally improves, because people become less afraid of talking about death. But we must be careful not to say that perfection is a precondition for those who are dying; perfection has to be an objective for those of us who will carry on living. We cannot delay and indulge the dying in their agony because we are not satisfied with the state of palliative care. We have to deal with the choice that those people are facing at the point of their death, and give them the choice that so many of them seek.
The second point is about coercion. The Father of the House, my right hon. Friend the Member for Gainsborough (Sir Edward Leigh), talked about love. One of the most affecting people I have met over the last 11 years of campaigning on this issue is Warwick Jackson, who came to our party conference a couple of years ago. Warwick’s wife, Ann, was diagnosed with terminal peritoneal cancer. She basically knew that she was going to die a slow, suffocating death at the end. As Warwick watched her dying and heard her begging her palliative nurse to end it all for her, he contemplated smothering her with a pillow. The only thing that stopped him was that he did not want her dying thought to be that her loving husband had brought her life to an end. That is the conflict of love that we pose to people by perpetuating this appalling status quo. We have heard time and time again that the situation that thousands of our constituents live with every single day is so horrific and appalling that even the best palliative care cannot alleviate their pain.
I urge colleagues to consider what their vote may mean today. As we said on Second Reading previously, a vote against this Bill is not a passive act. It is not something neutral; it is a vote for a status quo of misery, degradation and cruelty for so many. We know that the British people support this measure. We know that there are lots of territories around the world that we respect and admire that have assisted dying and have operated it for many years successfully. It is not beyond us to get our democracy operating as it should and to design something that will work for the British people. We cannot give dying people more time, but we can give them mercy and love. I urge Members to vote for the Bill today.
Ashley Dalton (West Lancashire) (Lab)
The last time this House considered this Bill on Second Reading, I was keeping a secret. While hon. and right hon. Members were debating the issue, I was grappling with my own terminal diagnosis. I was told that I have stage 4 incurable metastatic breast cancer. I was overwhelmed with grief, fear and anxiety; I was scared of what was to come, and fearful of how it would impact my family and my loved ones. I was scared that I was going to get really poorly and thinking, “How will I cope? How will my family cope? How will I be cared for? How will I afford it? How badly will it hurt? How long will it last?”
When you hear those words, depression, anxiety, grief, fear, shame and guilt come in bounds. Suicide risk is highest immediately after diagnosis, and it usually falls quickly, within three to six months. I would be lying if I said that when thinking about all that was to come, I did not consider that it might be fairer and easier on everyone if I just got the dying over with as soon as possible. Having treatable depression, however, will not exclude anyone from an assisted death under this Bill, and depression is common among people with terminal illness, but it is often treatable. Clinicians are trained to prevent suicide in people suffering from depression, but where would the line be drawn? This Bill makes no provision to support this difficult transition, or to create safeguards around it.
A person can also be suicidal and have unmet mental health needs prior to developing a terminal illness, and then ask the state to kill them without any assessment of their psychological health, just an assessment of their mental capacity—because mental capacity and mental health are not the same thing. The Royal College of Psychiatrists recommends a holistic, multidisciplinary assessment of every applicant. The three-person panel at the end of the assessment process provided for by this Bill is not what most NHS clinicians recognise as a multidisciplinary team; it certainly does not allow for meaningful multidisciplinary decision making. The assessment needs to happen at the beginning of the process, not the end, and each team member should be independently assessing the patient in person. That is not what is included in this Bill.
I do not know how long I will live. I will be on treatment for life, however long or short that may be. At the moment, I live between scans, in nine to 12-week blocks of time. The last scan might have shown that the disease is stable, but the next scan might show that it is growing again. If the disease is stable, the drug is working and we can carry on. Eventually, the drug will stop working, the cancer will grow, and we will have to try another drug and see if that works. At some point, we will either run out of drugs to try, or I will be too poorly to tolerate them—then I die. It could be months. It could be years. No one really knows. Prognosis is notoriously difficult to predict. Palliative care professionals and oncologists tell me that while they can more or less give me an indication of when I will die when I am a few days or weeks off, anything beyond that is the flip of a coin. The six-month prognosis in this Bill is something no one can ever be really sure of. What the palliative care professionals have told me is that palliative care can help me when I die.
In the campaign around this Bill, though, it seems to me that it is being implied that a person with a terminal illness will have a dreadful, painful death unless they have access to assisted dying. That is simply not true; palliative care in the UK is excellent. Far too many people do not have access to the palliative care they need, but the idea that it is not possible to alleviate pain and discomfort is false. People have been terrorised—I have been terrorised—with tales of people vomiting up their own faeces, as though this is commonplace during death. It is vanishingly rare. Bowel obstructions are more common, but they are treatable. I know—I have had one. It is nothing short of irresponsible to scaremonger people like me into believing our deaths will be horrific when all the evidence suggests that, with access to good palliative care, deaths are, on the whole, gentle.
The answer is not to terrify people and their families. It is to sort out palliative care and social care first, because none of this takes place in a vacuum. Until we can say that everyone who needs it has access to high-quality palliative care, we are offering nobody a choice. A terrible death or an assisted death is not a choice; it is a threat.
While I speak today from the position of someone with a terminal illness, I am acutely aware that this is not about me. This debate is also not about an abstract concept or a position of principle. The question that will be put at the end of this debate will not be, “That this House has considered the question of assisted dying.” It will not even be, “That this House agrees with the principle of assisted dying.” The question will be, “That the Bill be now read a Second time”—this Bill, not the Bill it might have been, not the Bill that Members might have hoped it would be, and not the Bill it could be. This Bill is the only thing before us today. Incidentally, there is absolutely nothing before us about the House of Lords. That is not the question we are being asked.
Whatever hon. or right hon. Members think about the principle of assisted dying, surely our first and foremost responsibility is to write law that is safe and workable. Not one of the professional bodies that would be tasked with delivering the Bill is willing to attest that it is, as it stands, safe or workable. The Royal College of Psychiatrists, the Association for Palliative Medicine and the Royal College of Physicians all say that the Bill is seriously inadequate. They are not opposed to assisted dying in principle, but they cannot support this Bill.
Instead of bringing a Bill identical to the last, so that the Parliament Acts can be used and the Bill can be forced unamended on to the statute book, why did the proposers not spend the summer working with the royal medical colleges, the professional bodies and organisations to build a Bill that they could support? If they had done that, it would have been difficult for anyone opposed to the principle to argue against the Bill. But they did not do that.
This is not about sides. This House is not a debating society; it is about making the law. While we may be campaigners out there, in here we are all legislators. It is our responsibility not to pick a side and dig in, but to work together to build the best laws that we can, and that is never truer than with a private Member’s Bill on a matter of conscience.
Ashley Dalton
No, I will not. This Bill does not protect the most vulnerable. It does not mitigate against the poor, the old, people with disabilities, or black and minority ethnic people being disproportionately affected. It does not protect people who are mentally ill. It does not recognise that not everyone has the same level of agency, control or influence over their decision making. The clinicians we would ask to deliver this Bill are saying that it is not even workable—that there is every expectation that it would not even work for the terminally ill people who want an assisted death either.
And there would be no stopping it. Auto-commencement means that if the Bill is passed by the Commons and pushed through via the Parliament Acts, it has to happen on the stroke of four years after being passed. Even if the Government or the NHS are not ready, even if there is no funding, even if palliative care is still broken, and even if it is known to be dangerous, flawed or unworkable, then it is still happening, ready or not.
This is not a last-chance saloon. This debate has been going on for years. It is not a once-in-a-generation opportunity; it could come back again in the next Parliament. My days may be numbered, but that does not mean that I want this Chamber to rush through bad law, just so I might have a chance to see it or use it. This matter is of huge importance. If hon. and right hon. Members have any doubt that the exact Bill before us today is not the best it could be—if it is anything less than excellent, well thought-out and robustly drafted legislation that protects the vulnerable and recognises the expertise of our world-class clinicians—and that it is not the Bill that I and other terminally ill people deserve, then I urge them to vote no or to abstain.
Pippa Heylings (South Cambridgeshire) (LD)
I begin by thanking the hon. Member for Rochester and Strood (Lauren Edwards) for her courage and compassion in bringing this Bill back before Parliament. The debate in this House, the other place and across the country is profoundly important.
“We need to get better at talking more openly about death and what dying well means.” Those were the words of the end-of-life care clinical lead during my last week’s visit to the new dedicated palliative and end-of-life care ward at Addenbrooke’s hospital in my constituency of South Cambridgeshire. It is something my own father said to me many, many times over 40 years ago. He was a family doctor in Hull, in the deprived communities, witnessing the family births and deaths of many patients at home and in hospital. “Love life, live life as much as possible and have a good death.” The last time this Bill came before the House, it encouraged that conversation. There was respectful debate, evidence was examined and safeguards were strengthened. The Commons voted in favour and the Bill was sent to the House of Lords for further scrutiny. What we are doing today is allowing due process to continue by sending the Bill back to the Lords, so it can complete its passage.
I am grateful to the many constituents who have written to me on all sides of the debate, sharing deeply personal experiences that have shaped their views and informed my own thinking. Having listened carefully over all our debates—the Bill Committee, the witnesses, the evidence—I continue to support the Bill. There is a need to change the status quo.
Receiving a terminal diagnosis, as we have heard, is devastating. It brings a loss of control of the future that many people find deeply frightening. One of those people is my constituent Jodie, who is living with a terminal grade 4 astrocytoma brain tumour. Following lifesaving surgery, she continues treatment aimed at preserving the best quality of life possible. Fiercely independent, she is living every single day. Yet, in her own words, the prospect of the disease eventually taking over her brain, leaving her unable to think clearly, communicate or make decisions, frightens her more than she can express:
“None of us know what the future holds, but knowing that the option of assisted death would be available should I ever reach that point…would provide me with enormous comfort and reassurance”.
As we have heard today, what we do not talk enough about is the status quo—it is almost as if there is a taboo—which for some terminally ill people is an unsafe and cruel status quo, with hundreds of people already taking matters into their own hands.
I want to share the story of my constituent Cath Shepherd. Her sister, Emma Windred, was a keen and active outdoors woman who loved life. Facing the end of that life, she chose the only legally defensible and medically supported route available to her: voluntarily stopping eating and drinking. We know that many medical practitioners feel that that is a grey area, and much more guidance is needed. That should not be the only option. Emma felt robbed of the death she wanted and she campaigned for the law to change until her end came. After Emma’s death, Cath has continued that campaign so that others might have the option of the gentle and dignified death her sister believed she was denied.
As we have again heard today, too often assisted dying and palliative care are presented as competing alternatives. They are not. Both are rooted in the same aim: ensuring that people approaching the end of life are treated with dignity, compassion and respect. I am fortunate that Arthur Rank hospice serves my constituency and the wider region. It provides outstanding care and support to patients and families at some of the most difficult moments in their lives. Its staff and volunteers do extraordinary work. Yet, like many hospices around the country, it faces huge cuts and the loss of beds, something that I and many others are campaigning to stop happening.
We all know there is a disgraceful crisis in adult social care. Hospices, hospice-at-home services, district nursing and community palliative care are all desperately underfunded. I therefore welcome the Prime Minister’s call for cross-party talks on social care—we all do as Liberal Democrats—but I do not share the premise that assisted dying legislation must wait until palliative care is fully funded and available everywhere. This is not an either/or. This is not a before/until. These are not and should not be competing priorities.
My support for the Bill is matched by my belief that we must equally strengthen palliative and end-of-life care. Dying with dignity means access to outstanding palliative care, compassion at every stage of life and the ability to have choice, agency and dignity for those very final days. This Bill will not make a choice for anyone. It will simply allow terminally ill people to make that choice for themselves, safely, challenging the status quo and with their loved ones around them, if they so wish.
Josh Fenton-Glynn (Calder Valley) (Lab)
I have struggled with this vote perhaps more than any other in Parliament. Had I been asked at any time in my life whether I was for or against assisted dying, I would have said that I am in favour of it. I believe that people have autonomy over their own bodies as a fundamental liberal principle. But we do not vote on principles here; we vote on legislation, and this Bill at this time is not one I can support. I do not believe that it is safe. I do not believe that it addresses the very legitimate concerns raised by disabled voices, and I do not believe that it has come at the right time. In my speech, I will cover the state of palliative care and fears of coercion, but first, I thank my constituents for the role that they have played in this, coming to meetings, speaking to me at surgeries, writing me emails in a respectful way—the way that we should conduct our politics in all things but particularly those that are so serious.
I bring professional and personal experience to this debate. I have been a council cabinet member for social care, sitting on a safeguarding board, I have worked for the General Medical Council and for the past two years I have sat on the Health and Social Care Committee. Like many people, I have also sat with a loved one as they died. Ultimately, my experience means that I do not for one minute believe that this is simple. I know that if we do not pass this Bill, some number of people will die in preventable pain and suffer a painful death. I also know that if we pass any Bill, there will be some number of people who are coerced into taking their own lives. If you have moral certainty—
Josh Fenton-Glynn
I will not give way just now. If you have moral certainty on this question, I honestly envy you.
On the state of palliative care, we are told that this Bill is about giving our constituents more options—a choice between good palliative care or an assisted death. But in a world where there are such gaping holes in our health, social care and palliative care system, that is simply not the case.
Josh Fenton-Glynn
Not just now. Our Committee asked our independent expert panel to look into the quality and availability of palliative care, and the results should give everyone in this room pause for thought, because we do not have a universal offer of palliative care in this country. The report points to a postcode lottery of provision. Hospices are largely funded through charitable donations, which means that in better-off areas there is better care. The Committee hears constantly about the social determinants of health. Let us not have one of them be that those in wealthy areas have the choice of a comfortable death, while the poor must choose an early one.
Furthermore, there is a workforce crisis in palliative care. There are 700 palliative care doctor posts, but 70 vacancies. Add to that 130 doctors expected to leave the profession in the next five years while, to make matters worse, training bottlenecks mean that there will not be specialist doctors trained to replace them. All that is in a landscape where we expect demand for palliative care to increase by 55% in the current decade.
I want a safe Bill that takes all those things into account. A safe Bill would give some discretion to the Health Secretary on when they implement it. This Bill does not.
Josh Fenton-Glynn
I am sorry; I will not just now. This Bill has an auto-commencement clause, which means that within four years of the passage of this Bill—whatever the state of our health service, of our social care, or of our palliative care; even if there has been another pandemic—it will come into force.
That brings me to our safeguards. I cannot vote for a Bill that does not sufficiently guard against coercion. That is what my constituents with disabilities say they fear the most and, having been in charge of social care, I know what that looks like. Let me be clear: the safeguards in this Bill are not enough. If the Bill in its current form passes, a patient would be subject to more scrutiny to give up a kidney than to give up their life. The ultimate weakness of this Bill is that the question being asked when a patient goes to the panel is a medical and legal one, not a social and psychological one. The main judgment will be an assessment of whether they are likely to die in the next six months, not of why they have chosen to die or whether there is a risk of coercion.
Coercion is not always committed by the traditional villain; it is not someone who wants money. It is often committed by a loved one at the end of their tether, as support falls away, money drains, options narrow and people’s sense of what choices they have narrow, too. Without improving palliative care, we will put far too many people in that heartbreaking position.
As MPs, we are used to being forthright in our opinions and advocating for ourselves and our constituents. On our Select Committee, we constantly hear from vulnerable patients who say that they are frequently ignored, talked about or talked over by medical professionals. They feel talked at, not talked to. When considering this legislation, I do not ask whether it will work for people like me; I ask whether it will work for the most vulnerable—those whose voices are rarely heard and who are most dependent on the state for protection. They rely on us to be their voice.
The Bill comes from a place of compassion, but it could lead to a place where a disabled person feels that they are less. It could lead to a place where poor social care means that people do not feel that they have a choice between a comfortable life and an early death. That is why I say, with a heavy heart, not this Bill and not at this time.
Sir Bernard Jenkin (Harwich and North Essex) (Con)
I welcome the speech from the hon. Member for Calder Valley (Josh Fenton-Glynn), who is an example of what we have seen throughout this debate, going back to the early 2000s: people peeling off from supporting assisted dying in principle and, certainly, peeling off from supporting this Bill.
I am a case in point. I came into the Chamber to listen to Lord Falconer’s Bill in 2014 absolutely determined that I was going to vote for assisted dying. I sat through the debate and ended up voting against, because I thought that the arguments were not made in favour of the Bill.
The second reason we should throw out this Bill is that it keeps changing. Even now, it is not settled. Even now, its advocates want changes to it. They are stuck with the reality that if the Parliament Act is invoked, they will only be able to invoke the Bill as it stands today. They will not be able to have their changes. So if in doubt today, the House must vote no.
Thirdly, the question is far bigger, it turns out, than just a matter of conscience or an isolated matter to be decided. It is a massive question that affects public policy and has major public expenditure consequences. That has convinced me that we really should not see another Bill like this one until we have had a Government Bill go through the process of proper scrutiny within Government, with all the consequences laid out and dealt with. It must be a responsible and accountable Secretary of State that presents the Bill; it must not be a Back-Bench Bill.
Maybe there should be a citizens assembly on this question—it is a subject that would lend itself to a citizens assembly. [Interruption.] Well, it would not take away any power from this House. This House would still be able to decide, but it would inform the debate in a way that the debate is still not informed.
My mother and father passed away in recent years, and I am so grateful that my mother never had to confront this question. She often said, “Oh, I just want to die. I am just a burden on the family.” Though she would never have qualified for this Bill, I am so grateful that there were never any circumstances that would possibly have confronted her with this question.
I advert to another conversation. I have a very dear friend—someone who has become a mentor—who is a very interesting, clever, intellectual, determined and courageous lady. She has scoliosis of the spine. The last time I went to see her, there she was, hardly able to sit up and in constant pain. We have open conversations, so I asked her, “If assisted dying were available to you, would you take it?” Without hesitation she said, “Oh, yes.” When I asked why, she said, “Because I am a burden to my family.” I said, “Well, I have been voting against assisted dying. I am going to have to rethink my position.” Then she said, without hesitation, “Oh, I don’t advocate it.” She understands the complexity of this, and she knows that it opens a can of worms that we really have not understood fully.
I urge colleagues in the House to vote against the Bill today.
Jess Phillips (Birmingham Yardley) (Lab)
I pay tribute to my hon. Friend the Member for Filton and Bradley Stoke (Claire Hazelgrove). Mainly because I am a bit lazy, I rarely prepare to speak in debates, and never have copious notes. Her remarks have led where my remarks will go. I will cover the issue of coercion, which hon. Members have mentioned, and, like her, will talk about my mother, who also died when she was 61 years old, unfortunately when I was much younger than my hon. Friend. My mother died when I was 28 years old—many years ago now.
My mother had a leiomyosarcoma, and suffered with it for around three years. The prognosis did change—I hear the arguments that some hon. Members are making—but towards the end of her life, at one point she felt she was going to die. It was coming to the end. She was in a wheelchair. She was completely paralysed. She was doubly incontinent by this point. To give hon. Members an idea of the kind of woman my mother was, she was an absolute titan. She was like Erin Brockovich, but with a bad perm, in the 1980s. She could lay claim to being able to spot talent, because she gave a job to the current Prime Minister, who worked for her for some time. He is often teary-eyed when I talk to him about her.
My brothers live in different parts of the world and country, but I live 20 minutes from where I was born and where my mother lived. When she got to this stage, we all went back to be with her, because we believed that this was it—that she was going to be taken, that she was going to die. She did not die on that occasion, so my brother, who lives in France, went back home. Then, when it came to the point that a doctor made the call and said, “Your mom is about to die,” my brother could not come back—this was about four weeks later. So it was me who was with my mom when she died—not all of her children, and not all of her grandchildren. I am eternally grateful that I was there. This was a woman who had written every part of her funeral. She knew exactly what she wanted us to feel. She had planned, to the nth degree, what would happen after she was gone. The other day, I found a recipe for Christmas puddings and the PIN for her credit card—she was like, “Your dad might not be able to get money.”
My mom had thought about everything, but she was not gifted with the ability to think about this. She would have taken the choice on that day, when my brothers were surrounding her. She did not die in terrible pain—I recognise what my hon. Friend the Member for West Lancashire (Ashley Dalton) is saying. She was not writhing. It was not awful. However, she should have been able to choose to have her family with her. I will vote for this Bill. I went to women’s liberation playgroup, which she set up with a load of women. She raised me to believe in a right to choose—my gosh, more than anything else in life. She would tell me what to do today.
Many people have mentioned coercion. I am a scholar of coercion, and I say this to everybody today: do not rest on your laurels thinking that, if we do nothing, people today will not be coerced to death. That will literally happen today. The idea that if we just do nothing—
Jess Phillips
I am not going to, because Madam Deputy Speaker has been clear.
The idea that if we do not pass the Bill today, we are going to walk out of here and women in our country will be any safer is an absolute myth. Doing nothing is not the same as acting.
Layla Moran (Oxford West and Abingdon) (LD)
I pay tribute to all the Members who have shared their story; I feel we have learned a bit more today about how the hon. Member for Birmingham Yardley (Jess Phillips) became how she is. I am sure we have all heard so many heartbreaking stories from our constituents, and I want to thank all those who have contacted me, whether or not we agree, because sharing these stories is profoundly difficult.
One constituent with incurable cancer contacted me, asking for the freedom to choose when to give up their battle. Her own brother had an incurable melanoma spreading down his neck, which left him barely able to speak to his loved ones. He went out at 2 am in his dressing gown, climbed on to a bridge and jumped on to a motorway below. This was witnessed by two girls who were walking home from a party. My constituent asks:
“how many more need to take their own lives in horrific ways because they simply cannot bear the pain, discomfort and hopelessness any more?”
She wants the right to decide for herself when enough is enough.
Then there is the constituent whose sister went abroad to access assisted dying. The 84-year-old sang to her sister, who ended her life peacefully with her family around her. My constituent said:
“It was a painless, peaceful and dignified death at the time of her own choosing. Together with giving birth to my children, it was one of the most beautiful experiences of my long life.”
I do not believe that only families with means should be able to have that experience; it should be open to everyone.
Let me turn to the issue of palliative care. I pay tribute to the hon. Member for Calder Valley (Josh Fenton-Glynn), who is a fellow member of the Health and Social Care Committee. Although we wrote the reports together, I have come to a different conclusion, with great respect. It is, frankly, a stain on successive Governments that palliative care is in this state. Our Committee’s findings were stark: commissioning variation creates a postcode lottery, bereavement support is frequently inaccessible, services are fragmented, workforce and skill shortages are widespread, and systemic inequalities persist.
Layla Moran
No, I shall not.
It is worth noting that the NHS has not been meeting its own standards on palliative care for decades. The then Minister for Care, the right hon. Member for Aberafan Maesteg (Stephen Kinnock), appeared before our Committee in the spring, and he mentioned the importance of workforce. I ask again, where is that workforce plan? We need it, but that will not be the whole answer; we also need better data and early identification, clearer guidance and joined-up working with adult social care and local authorities.
The Government have said that they will publish a modern service framework for palliative and end-of-life care, and it is very positive that the interim MSF has been published, but let me tell the House how I see it as Chair of the Health and Social Care Committee. I genuinely do not believe that palliative care would have been included in the early batch of MSFs if it were not for this Bill forcing the Government to do so. Furthermore, given all the issues and competing priorities of the NHS, let alone the competing political priorities of this Government or any other that comes after it in the next four years, I do not believe that palliative care will improve as fast as we want it to without the pressure of a Bill like this. I do not believe that this is an either/or proposition. I want palliative care to improve, therefore I will be voting for this Bill.
I have to end with one more constituent’s story, and it is the story of Robert. His two parents had different views on this issue: his father did not agree with assisted dying, but his mother did. We are lucky in Oxfordshire that we have some of the best palliative care in the country. He described how her care was exemplary—she died without pain and was well looked after—but he felt that her wishes were not respected while his father’s were, and there were consequences to her not being able to access assisted dying, as her brother could not be there at her bedside when she passed. For those constituents who want a real choice at the end of life, I will tirelessly continue to want to improve palliative care, but I will also be supporting the Bill.
Andrew Lewin (Welwyn Hatfield) (Lab)
Thank you for calling me, Madam Deputy Speaker. I mean that sincerely on a day when so many colleagues want to speak. I promise you that my remarks will be brief.
Our debate today is about who has choice and agency in our society both in respect of the authority of this elected House of Commons and what limits should exist on the role of the other place, and, more fundamentally, in respect of the right of a terminally ill person to exercise choice at the end of their life and whether the state should be able to override that. We are back here for a Second Reading of the Terminally Ill Adults (End of Life) Bill not because the question before us has changed since November 2024, but due to the actions of a small number of Members of the other place.
Sarah Smith (Hyndburn) (Lab)
Will my hon. Friend confirm how many amendments were accepted in the House of Lords, and that it was about 90 peers who were involved in supporting all the amendments tabled?
Andrew Lewin
I am grateful for my hon. Friend’s intervention. I do not have that number; what I do have is the number of amendments that were proposed. There were 1,286 wrecking amendments.
There are many thoughtful and compassionate critics of the Bill who I respect deeply. I want to put on record my admiration for my hon. Friend the Member for West Lancashire (Ashley Dalton) and for her astonishingly brave speech. However, what I cannot condone is the actions of Members of the other place whose motivation in the last Session of Parliament appeared to be to block the democratic process.
Dr Ben Spencer
Is a requirement to ask someone why they want to have a physician-assisted suicide a wrecking amendment?
Andrew Lewin
The point I was making, which I believe many colleagues will recognise, was that having over 100 hours of debate and more than 1,000 amendments was not conducive to the idea of making serious progress with the Bill; it was, to all intents and purposes, a filibuster.
Our role today extends beyond debating the Bill. It is also to reaffirm the will and primacy of the House of Commons.
Jess Asato
If the primacy of this place is the most important point, why has the Bill’s promoter said that she will not allow amendments in this House at this stage?
Andrew Lewin
The right hon. Member for North West Hampshire (Kit Malthouse) made it clear that it is because of the actions of a very small number of peers, and he has no faith—and neither do I—that that would not be repeated this time around.
Andrew Lewin
I am going to make some progress.
This is the first time that I have spoken on this subject, and I want to set out briefly why I have consistently supported choice at the end of life. First, there is the simple principle that, faced with a terminal diagnosis, it should be the right of the individual to choose how they leave this world. If we offer the choice of an assisted death in the circumstances detailed in the Bill, as my hon. Friend the Member for Bury St Edmunds and Stowmarket (Dr Prinsley) said in 2024, we will be
“shortening death, not life…This is not life or death; this is death or death.”—[Official Report, 29 November 2024; Vol. 757, c. 1048.]
Our choice is whether we want people to have the choice of a dignified death or to force some people to endure painful and traumatic last moments, as my hon. Friend the Member for Filton and Bradley Stoke (Claire Hazelgrove) set out in her astonishing speech.
Andrew Lewin
I will not at this moment.
My second reason is the medical reality that some conditions are beyond good palliative care. Driving improvements in palliative care should be a moral imperative for all of us in this place, but doing that does not resolve the question before us today. Another doctor, the hon. Member for Hinckley and Bosworth (Dr Evans), again speaking in November 2024, said that there are some conditions for which we “cannot provide” good palliative care. He said that for
“the likes of the inoperable neck cancer, eroding away into the carotid artery”,
there is
“no alternative to that terrifying death.”—[Official Report, 29 November 2024; Vol. 757, c. 1070.]
If we fail to pass this Bill, we do so in the knowledge that we are making an active choice to allow people to continue to die in this way, when we know that an alternative is possible.
Finally, I cannot support a status quo in which the state decrees that it knows better than a terminally ill person who has expressed their wish. That is the reality today—people who are dying are denied their wish to end their time on this Earth on their terms. I am voting for this Bill today because I believe in the primacy of the elected House of Commons, and above all because I believe that someone who is terminally ill should not have their last moments dictated to them by the state. Just as in life, in death an individual deserves to choose their own path.
Dr Andrew Murrison (South West Wiltshire) (Con)
I congratulate the promoter of the Bill, the hon. Member for Rochester and Strood (Lauren Edwards). For her, and for the hon. Member for Spen Valley (Kim Leadbeater), this is a remarkable feat of political endurance; I pay tribute to them for that.
I start by declaring my interest as a registered medical practitioner and an active doctor, but far more importantly, as somebody who has sat by relatives in their final hours and minutes, as many in this Chamber have done. That really has an impact, and is certainly germane to what we are discussing.
Although he is apparently not voting today, the new Prime Minister has said that he wants to improve palliative care before we weigh up this extremely difficult matter, which will affect a relatively small number of people at the end of their life. I do not agree with the Prime Minister on much, but I do agree with him on that. Happily, the hon. Member for Glasgow South West (Dr Ahmed), who is no longer in his place, agrees with it, too. If I may paraphrase the Prime Minister, I want good palliative care to be available in every postcode. The criticism we have of it in this country right now is that it is not universally available to all. I believe that if it were, many of the considerations that we are deliberating on today would be profoundly altered, and that is one of the reasons why I will not support the Bill today.
Rachael Maskell
I led the independent commission on palliative care, and the data shows a worsening of palliative care; 170,000 people do not have access to the care that they need, and even those who are able to access palliative care may not have access to specialist techniques such as neuromodulation and palliative radiotherapy, and to nerve blocks. Does the right hon. Member not recognise that we need to look at the skills available, as well as the access points?
Dr Murrison
I certainly do, and I expect that those sort of things were on the mind of the Prime Minister when he made his remarks recently.
The first reason why I will not support the Bill today is that I seriously do not want to live in the kind of society in which the frail, elderly and vulnerable feel coerced into “doing the right thing.” We can set up panels, and involve judges in chambers, social workers and all the rest of it, but as humans, we know how humans work. We know the light side and the dark. Often, the currency that passes between vulnerable adults and their influencers is things that are not said; some of the contributions today have touched on that, and none of it is captured in clause 34.
We know that certain groups particularly like to please, to acquiesce, to oblige. We all know constituents like that, and they are often among the most vulnerable. They are people with Down’s syndrome, and people like the lady who featured in the advert for simple cremations, cited by my right hon. Friend the Member for Staffordshire Moorlands (Dame Karen Bradley)—quiet people, if you like. They are among the people who are not adequately protected by this Bill. Can we genuinely say that there would be a level playing field for them? Our first mission in this place must be to protect the most vulnerable.
Speaking of the vulnerable, Canada has seen the most appalling mission creep, particularly into mental health. That is probably why the Royal College of Psychiatrists is so wary of the Bill, and it is in company with the most impressive array of medical, disability and charity groups—count them off! Do not turn a deaf ear to them.
I do not want the tone and texture of my profession, or of any other, to be changed irrevocably by its involvement in termination. Nor do I want others in the NHS or elsewhere in our care system who are unprotected by codes of ethics and opt-outs, and who will not be explicitly protected by the Bill, to feel obliged to be involved in termination. Clause 31 is all very well, but if this Bill passes, the pressure on those in the palliative care sector in particular to facilitate assisted dying will be substantial. Earlier in my career, I considered being an obstetrician; it was a career to which I was attracted, but one of the reasons why I did not take that route was that I did not feel comfortable being involved with a very large part of that practice, which is termination of pregnancy. I feel that this Bill will irrevocably change the nature of palliative services in this country.
The previous Health Secretary pointed out the tedious business of opportunity costs. Five per cent of deaths in Canada, where the law we are debating has been in place for a decade, are now assisted.
Lizzi Collinge (Morecambe and Lunesdale) (Lab)
Will the right hon. Gentleman give way?
Dr Murrison
I will not, because of time. I would get the evils from Madam Deputy Speaker.
One in 20 deaths in Canada is assisted. If that were translated to this country, it would mean a huge extra cost, and the money would have to be found from other frontline services. Which ones? Likely it would be taken from Government support for hospices, which are already reeling from national insurance increases that have yet to be fully offset.
In my view, the moral, ethical, legal and practical issues that we are discussing today, complex as they are, are well beyond the scope of a private Member’s Bill. The only way to achieve a halfway safe and competent Act is to make this a Government Bill, mentioned in a manifesto. So far, no major political party has wanted to do that.
It is true that, each day, lives are shortened by interventions aimed at easing pain or suffering, which is what the caring professions do. That is quite different from a deliberate and systematic state-sanctioned and delivered programme to end the lives of people approaching death. At the end of the day, we can rationalise the pros and cons of assisted dying, but most of us will go with what we feel in our guts. My instincts tell me that giving the state or its agents leave to end life in this way is wrong. They tell me that, however well intentioned, it would lead in one direction, and would, over time, leave a grisly trail of unintended and unforeseen consequences. That is why I oppose this Bill.
Sarah Champion (Rotherham) (Lab)
I have watched the assisted dying debate for many years, since it started in Oregon. Many countries across the world now have assisted dying, including some of our Crown dependencies, and I am pleased that this Bill builds on the good and rejects the bad that can be seen. I am also reassured that there have been hundreds of hours of debate and scrutiny, which has built the Bill in front of us, so I am very comfortable supporting it.
I know that people have extremely strong views on this Bill, and I respect them for that. I want to speak to the people who are undecided, because a lot of myths have attached themselves to this Bill, and I hope to knock some of them out. I am not sure if Members are aware that I ran a children’s hospice before coming to this place. I can say that the palliative care system is amazing. The end-of-life care it provides is absolutely incredible, but everything everybody has said about it being a postcode lottery is true. It depends on whether a facility is in your area, has space, and has funding. We need more funding, and we need universal palliative care, but that is not what this debate is about.
When the subject was first debated, I was deeply shocked by the number of disability groups and disabled people who thought that the Bill was targeted at them. I had not realised how vulnerable they felt in our society, and that they could believe that the Bill might be an attack on them.
Sarah Champion
I am not going to give way, because we are really pushed for time. I want to say to those people that the Bill is tightly drafted. It specifies that it is for people of sound mind who have a terminal diagnosis of six months or less, and that has to be verified by two clinicians and then a panel to ensure—
Sarah Champion
I am still not giving way. The two clinicians, followed by the panel, will ensure that the person is of sound mind, and will make sure that this is something that they want to do.
A lot of time has been taken up debating the issue of coercive control. I defer to my amazing hon. Friend the Member for Birmingham Yardley (Jess Phillips) on that subject; her entire career has been spent fighting against coercive control. As she said in her powerful speech, there are not robust measures in place for people—generally women—who are suffering domestic violence or coercive control, but in this Bill, there are some measures to try to ensure that there is no coercion of people who take this action.
What is this debate about? It is about choice. It is about giving adults of sound mind choice in the last six months of their life. Currently, the only choices available are these: if people have a lot of money and are physically able, they can go to Dignitas; otherwise, as was so powerfully and emotionally outlined by my hon. Friend the Member for Filton and Bradley Stoke (Claire Hazelgrove), they can take their own life. It is not acceptable for us to continue with that position.
The issue is not just about pain. However, I know from experience that there is some pain that is unmanageable, and not everybody gets the dignified death that they want. I would like adults who are able to make an informed choice to be able to choose the time. Let us look at what has happened internationally. Many people who go through the process and get to certification do not actually use it. It is a comfort blanket to them, an insurance policy. Let us not be under the illusion that as soon as people get their certificate, they are marched off, and that is it. That is absolute nonsense. The choice is there, all the way through. When hon. Members walk through the Lobby later today, I ask them to think about their constituents and their ability to have an informed choice. I genuinely believe that this legislation provides that.
Shivani Raja (Leicester East) (Con)
As Members of this House, our fundamental obligation, above all political considerations, is to protect those who are most exposed, most vulnerable and least able to advocate for themselves. I acknowledge that colleagues from all parties view this Bill as a measure of compassion, but if compassion is to truly serve the public interest, then it must be paired with rigorous scrutiny and an examination of all consequences of the intended legislation.
I voted against this Bill on Second Reading in 2024 and on Third Reading in 2025, and I intend to do so again today. I believe that Government should assist people to live, not to die. Our focus should be on providing hope and support to all those who feel that death is the only way out of a dark situation. That is the purpose of humanity—to preserve life.
We should prioritise the improvement of palliative care and end-of-life care, as opposed to directing taxpayer money away from those services and into assisted suicide. Around 60% of the public agree that we should first fix our NHS before even considering whether to introduce assisted suicide into law. I note that during his tenure as Health Secretary, the right hon. Member for Ilford North (Wes Streeting) concurred with that majority in June 2025, describing how such a measure would take time and money that is already in short supply.
In addition, our new Prime Minister has outlined his commitment to a new national care service and to implementing reforms to strengthen our existing services. I welcome the fact that this Prime Minister is acting to protect the function of our health and care networks to support our constituents in life, because ultimately the NHS should be saving lives, not taking lives. Our palliative and end-of-life care services are an essential part of our NHS and wider healthcare system.
I pay tribute to LOROS hospice, which provides free and high-quality care to terminally ill and adult patients across Leicester, Leicestershire and Rutland. It cares for around 2,500 people and plays an important role in our community in Leicester East, not only in its direct support for patients, but through its provisions to wider families and friends affected by such situations. In its evidence to the Public Bill Committee, it highlighted that there should be one specialist palliative care bed for every 12,000 people, but, with just 22 beds, it has one bed for every 55,000 people. How can I turn around to my constituents and say that they will have a choice other than assisted death against that backdrop?
Shivani Raja
Respectfully, I will not take interventions. Many colleagues wish to speak, and I am mindful of time—please forgive me.
I am disappointed and concerned that the hon. Member for Rochester and Strood (Lauren Edwards) has reintroduced an identical Bill to the House and ignored all the issues revealed, even the ones admitted to by the noble and learned Lord Falconer in the other place. This Bill’s failure is not just a sign of how inadequate the private Member’s Bill process is for a Bill of this magnitude; it is an alarm over the lack of safeguards for vulnerable people—the very demographic that we in this House are supposed to protect and support.
The purpose of this House is to legislate well. We are here to advocate for our constituents, share our differing opinions and use our privileged positions of influence to impact the outcome of legislation, but the methods and attitude of the hon. Member for Rochester and Strood completely discount the hours of debate that took place on the assisted suicide legislation in the last Session. The amendments tabled in the other place were not unreasonable; they were legitimate safeguards to protect those in our society who are vulnerable.
Many of those amendments were from external organisations, and 26 amendments were from the Law Society. Those amendments would have ensured the safety of those with eating disorders and Down’s syndrome and increased the chance of catching abusive situations in which an individual is being pressured to end their life. There were amendments from trade unions to protect the compensation rights of families of workers suffering from occupational or industrial diseases who seek an assisted death.
The Leader of the House told MPs before summer that lessons needed to be learned about how we take the public with us and build consensus, rather than just keep ploughing on. He said that Members should consider if the PMB route is really appropriate, but it seems that his words fell on deaf ears. We stand here in the mother of Parliaments as representatives of the millions of British citizens throughout our constituencies, and we have the right to debate issues, because generations before us fought tirelessly to secure that right. The threat of the use of the Parliament Acts to drive through this legislation completely disregards safeguards for vulnerable people. It requires us not to care if no further changes are made to the Bill. I am well aware that this subject of debate is not easy or straightforward, and that it is painful for a lot of our constituents and distressing for Members across the House.
Let me come to my last point. One of my many concerns with the concept of assisted suicide relates to coercion. As we have heard in the House, coercion can come in many forms. Members across this House will know that my constituency of Leicester East has one of the highest concentrations of non-white British and multi-ethnic populations in the country, and I will say again that I am enormously proud of that, but I will not support any Bill that leaves them vulnerable to coercion.
Legal experts gave evidence to the Bill Committee during the previous Session stating that in some cultures,
“decision-making is a collective process involving family and community members.”
We cannot allow the fear and distress of people experiencing palliative care, end of life care or simply struggling with the prospect of living another day to be taken advantage of. It is dangerous that this House would consider creating legislation that would allow space for people to be encouraged and, in some instances, forced to take a decision to end their life when at their most vulnerable.
Let me conclude by reminding the hon. Member for Rochester and Strood that 59% of voters in her own constituency agree that this Bill should not be the priority of this Government. Does she sit here today to truly represent her constituents? If she does, and if she takes into account the situations of those in her constituency who are vulnerable, she will acknowledge that it would be morally void to support this Bill any further.
Several hon. Members rose—
Madam Deputy Speaker
Order. Members can help each other by keeping their speeches to five minutes.
Noah Law (St Austell and Newquay) (Lab)
I have long said that my support for this private Member’s Bill is contingent on a commitment to improving, not sidelining, the palliative care system, and I pay tribute to the courageous and dedicated palliative care workers of our country, including those at Mount Edgcumbe hospice in my constituency. Despite being seen as charitable organisations that work alongside the NHS, hospices provide a vital line of support and reduce the cost of care in our NHS, which is something that should be considered.
Dr Opher
Does my hon. Friend acknowledge that, even with excellent palliative care, there are very similar rates of people demanding assisted dying? In fact, even in 2010, when we had probably the best palliative care in the world, people still went to Dignitas or took their own lives.
Noah Law
My hon. Friend makes a very important point.
Each year, independent hospices help around 20,000 people spend their final days outside hospital settings, and this saves the NHS an estimated 1.5 million bed days and more than £800 million annually. Our Prime Minister is right to say that we must fix palliative care, and I greatly welcome his commitment to work cross-party to end the decades of political drift on social care, too. Ballooning budgets have hit not just the NHS but local authorities, particularly those in Cornwall—they have hit us really hard. We need to fix the system so that it gives people dignity.
Noah Law
I will keep going, so that everyone has a chance to speak.
We must give people dignity, security and support when they need it the most. At present, palliative care remains lovingly—but to an embarrassing degree—funded through donations and by supporters who run marathons, charity shops and fundraising events for hospice charities across the UK. The National Audit Office concluded that, in 2023-24, around two thirds of the independent adult hospice sector’s total income was generated from those charitable sources, while around 29% of total income was Government funded, primarily through integrated care boards. I am all for social enterprises and charities using their assets to generate income, but the reliance on this model has to stop. Why not have a system in which the Government provide consistent, centralised support frameworks for hospices, reflecting the consistent and vital services that they provide to our NHS and people at the end of life?
It is in our Government’s gift to fix this. If we believe that high-quality palliative care is a fundamental service at the end of life, but recognise that it currently depends on commissioning decisions from integrated care boards, ad hoc grants and the fundraising of local hospices, is the system really fit for purpose? We must ensure that a consistent national minimum standard of provision is delivered by every integrated care board, to end the end-of-life postcode lottery.
Alicia Kearns (Rutland and Stamford) (Con)
Palliative and social care need fixing, and that is a concern that unites the House. It is a scandal that how well people die depends on where they live, but to suggest that this Bill should wait until palliative care has been improved is a fallacy for two reasons. First, the Bill gives us an opportunity to improve palliative care. It places a statutory duty on the Secretary of State to tell this House what the state of palliative care in this country is, and whether people can even access it. No Government have ever been required to answer that question, and under this Bill, they would be. I would go further and say that this assessment should be in place before the Bill comes into force and should be an annual update to Parliament, but that amendment cannot be made to a Bill that does not exist. If we vote down this Bill today, we will delay and deny the possibility of mandating a genuine assessment of the state of palliative care in this country.
The second reason it is a fallacy is that Hospice UK has told us repeatedly that it would be inappropriate to even imply that hospice and palliative care can address pain in all circumstances; we know that it does not, and honestly cannot. When we say that we will fix palliative care first, we are promising something that no palliative care system has ever delivered or will ever be able to deliver, and we are asking people to die in pain waiting for something that cannot be given. If we vote this Bill down, we will be no closer to understanding the state of palliative care.
I would also add that in this country, we already have “do not resuscitate” orders. Doctors suggest them, families agree, and a person who could have been revived dies, often without their voice featuring in any way. I have experienced this in my own personal circumstances—I had to run across to Guy’s and St Thomas’ hospital and tell them to lift a “do not resuscitate” order that they had put in place without consulting me—so let us not pretend that this line is sacred, because no one in this place seems to be saying, “While we’re at it, let’s scrap ‘do not resuscitate’ orders.” Those are on the same continuum.
Let me turn to the other place and the question of procedure. A great many peers were doing precisely their job; others were laying siege to the Bill. If anyone does not want to accept that both those things are true, I ask them to look at their own bias. On some issues—treatable depression, eating disorders and whether a hospice can decline to take part—the Lords were right. When this House passed the Bill, we expected it to be debated and that amendments would come back to us in the ordinary way. “Erskine May” provides that where a Bill proceeds under the Parliament Acts, this House may suggest amendments to the other House without inserting them into the Bill. That power does not sit with the Bill’s promoter; it sits with anyone sat in this Chamber. If the Lords agree to those amendments, they are treated as Lords amendments already accepted by the Commons—they do not even need to come back to us. There is precedent in the Hunting Act 2004 and the Trade Union and Labour Relations (Amendment) Act 1976, so the choice before us is not between an unamended Bill and no Bill. I am not asking the House to accept the Bill as it stands, and I myself will press amendments through that process, particularly regarding the audit of palliative care and treatable depression. The process can be improved.
As a Conservative, individual freedom, choice and personal responsibility shape my decision making until those freedoms cause harm to others. For years, I have listened to debates on this issue, waiting for the harm in the principle of giving us autonomy over our own bodies and our own deaths to materialise. There is no harm in the principle of assisted dying, and I am yet to hear an argument that exposes it. This Bill applies to those who have six months left to live—no one else—and I am arguing for a freedom that harms no third party, but will relieve a great deal of suffering.
During our last debate, I told the House that my mother’s last words were, “I cannot go on like this.” She died a few days later, and that was a great kindness to her, even if it was a great cruelty to me and my children. However, too many in this country—this great, compassionate country—go to sleep at night desperate for the pain to end. They wake the next morning knowing that they must endure another day of it—a body that betrays them or wracks them, and that no medication will soothe—and another day in which this House has denied them the option of bringing it to an end, with their families and on their own terms.
Alicia Kearns
I am going to keep going. Members have often spoken of unexpected recoveries that have led them to oppose the legislation. That is the news we wish for every person we love and for every loved person we have. Last year, I was told twice that I would die—most likely or potentially—given complications I had that I will not speak about at the moment. I know what it is to want to survive. I know what it is to fight. But for many, that day is not coming—there will be no reprieve of that kind—and we cannot write laws about the dying in the hope of a miracle that will not come for most. As such, I will vote for the Bill, because living in a perpetual state of torture cannot be right, and we cannot allow people to wait longer. I urge hon. Members who are undecided to vote for the Bill. I urge them not to end the argument, but to continue it; I will stand with them in tabling amendments in the other place.
Ms Julie Minns (Carlisle) (Lab)
The last time this matter was debated in this House, I was sitting at the hospital bedside of my dying mother. Consequently, I was unable to speak in that debate and unable to cast a vote. I am therefore grateful for the opportunity to speak and vote today, and I urge colleagues and the promoter of this Bill, my hon. Friend the Member for Rochester and Strood (Lauren Edwards), to ensure that this House has the opportunity to scrutinise the Bill, to amend it and to make it safe.
Accompanying someone you love through the final days of their life is one of the most profound experiences any of us can have. It confronts us with suffering, vulnerability and fear, and also with the importance of care, compassion and human dignity.
That experience did not make me indifferent to the arguments for this Bill—quite the opposite. It made me determined that before we offer people assistance to end their lives, we as individuals and, especially, as legislators have a responsibility—a duty—to ensure that they have access to every possible form of support to live their remaining days well.
As the friend to a mother whose child was failed time and again by the inadequacy of our mental health service, whose child by some miracle survived the swallowing of razor blades, anorexia, overdoses and self-harm, I know that access to every form of support was not there for them.
As a relative who saw the inadequacy of social care eat away at the self-respect of a once fiercely independent woman, leaving her to conclude that she was a burden and would be better off dead, I know that access to every possible form of support was not there for her.
As the daughter who sat at a hospital bedside, having agreed to the withdrawal of invasive treatment, only to watch my semi-conscious mother scream for water that was wrongly withheld and writhe in agony because specialist palliative care was only available nine to five on Monday to Friday, I know that access to every form of support was not there for her.
I ask colleagues: how, when we know that every possible form of support is not there for our constituents, when we know that mental healthcare is inadequate, when we know that social care is threadbare and palliative care is an unfunded lottery, and when we know that there is no going back when we vote for this, how can we prioritise and fund the resources, care and support for those choosing an assisted death but deny it to the mentally ill, the elderly and those who wish a pain-free natural death?
We hear much of choice in the context of this debate, but choice is only meaningful when people have genuine alternatives. In too many parts of our country, those alternatives simply do not exist. Therefore, before—not after, not over the next four years but before—we vote to facilitate death, we have a duty as legislators to ensure that the resource, funding and support is there for people. We need to know today, before we take this vote, that every possible effort has been made to treat suffering. This Bill does not do that.
Once we are over the edge, there is no going back. We know that in every country that has introduced assisted dying, its scope has subsequently expanded, sometimes without further legislative approval.
Ms Minns
I will not.
Despite knowing this, we stand once more on the edge. We stand on the edge, knowing all the Bill’s flaws. I ask colleagues to pause, to not step over the edge. Instead, we must ask ourselves the following questions. Are we certain that this Bill definitively safeguards against coercion, including self-coercion? Are we certain about mental capacity assessments? Are we certain about terminal prognosis? Are we certain that the safeguards and review mechanisms will be in place? Are we certain that we have ensured that our constituents have access to every possible form of support to live their remaining days well? If the answer to just one of those questions is no, then we should not—we must not—step over the edge.
Let me conclude with the words of the friend I spoke of, whose child was failed by our mental health service:
“My daughter had a history of serious mental health problems from the age of 13. Aged 22 she went to university and quickly realised she needed more support to manage the change.
Despite her history, referrals from her GP and multiple self harm instances that required A&E; community services kept saying she did not meet their thresholds.
It led ultimately to total deterioration and 2 years as an inpatient on a secure ward.
During this time she repeatedly said her life was not worth living and that she was in so much pain she wanted to die.
After much fighting with inadequate and unsafe services, she is now living in the community, back at University and has plans for the future.”
In countries such as the Netherlands, her wish to die would have been granted under the assisted dying rules. My constituent says:
“I have my daughter today because we do not have Assisted Dying. Please don’t change that.”
Monica Harding (Esher and Walton) (LD)
This Bill is not safe, and today the responsibility for this Bill falls on us and only us. If we vote yes today, unless the movers, who accepted no critical amendments in Committee last time, have a 180-degree change of heart, we can expect this Bill to become law as it stands. Despite hon. Members saying that they will press their own amendments, we have no assurance from the Government that Government time will be allocated for that. The only question we are left with is not whether we are in favour of the principle of assisted dying; it is whether we are 100% content with this Bill.
We no longer have the prospect of the second Chamber making it any safer. As somebody who is against an unelected second Chamber, that is a responsibility that I am determined to accept; but it is a daunting prospect, far more daunting than when we debated this Bill the last time, because the responsibility is now ours and ours alone. We cannot ignore the fact that none of the expert witnesses at the Lords Select Committee could confirm that the Bill was safe—none. Of the warnings, the one that resonated most from me came from the Royal College of Psychiatrists, which stated:
“Currently, needs can be identified but not necessarily met”,
and that somebody could proceed to an assisted death
“where they may have made a different decision had those needs been met.”
During the passage of this Bill, two of my siblings, who suffered with poor mental health throughout their lives, have died. I witnessed their struggle and the terrible fear and pain of cancer while their mental health worsened. In both cases, the medical staff could not get their mental health medication right because of poor handover between practitioners—a service design issue; because of the difficulties in assessing the mental health of patients in a palliative state—a clinical issue; and because the psychiatry resource was not available—a resource issue. None of those issues will have been resolved when this Bill becomes law.
This Bill is not contingent on making palliative care provision or mental health provision better, and there is no provision in this Bill to assess unmet psychological medical needs at any stage, nor to consult others involved in the patient’s care historically or involved through their life—family members like me, who had seen them failed by systems and processes throughout their life, and was desperately concerned that those systems and processes might also fail them at the end of their life. It is our duty to design the systems and processes that are safe for people like my brother and sister, and on this occasion I do not think that we have done so. Many professional bodies are clearly warning us that we have not.
There will be no amendments to protect people like my brother and sister. I would have wanted them protected. It is down to us now. The other place cannot help us or hinder us. The responsibility sits squarely on our shoulders. This is no longer about the principle—we have had that debate. It is about the practice of this Bill, which the movers have shown time and again that they will not permit to be amended. The experts, the clinicians, the groups speaking for the most vulnerable in our society are overwhelmingly telling us that this Bill is not safe. The offer of assisted dying to people in the position my siblings were in is the very opposite of autonomy.
Today, we must accept our grave responsibilities as MPs to those most at risk. Today is not about the principle; it is about the practice, and the Bill is not safe. Today, we must vote no.
Sadik Al-Hassan (North Somerset) (Lab)
I pay tribute to my hon. Friends the Members for Filton and Bradley Stoke (Claire Hazelgrove) and for Birmingham Yardley (Jess Phillips), and the hon. Member for Rutland and Stamford (Alicia Kearns), for sharing heartfelt stories, and showing the strength that I would not be able to —my mum passed away in November last year. Their stories, and what they shared with us today, are inspiring.
Like many across this House, I have spent a great deal of time thinking about this debate, reading constituent stories—many of them heartbreaking—and reflecting on what this Bill means to me personally, as well as what it means to the people of North Somerset who sent me here.
At the heart of this debate are autonomy, dignity and humanity. The question of whether someone who is terminally ill can choose the manner of their death is fundamentally one about agency. These people did not choose their illness. They did not choose the suffering that came with it. They did not choose the impact that it has on those who love them. But they might be able to have some say in how their story ends, and that, I believe, restores some measure of the dignity and control that illness has taken from them.
Many hon. Members will know that I practised as a pharmacist for nearly 20 years before my election. That means that I have seen the faces behind this debate. I have watched people collect prescriptions that offer nothing more than a sticking plaster over terminal illness—pain managed, but suffering not ended. A safe and legal route at the end of life would not replace good palliative care; it would sit alongside it, offering the small mercy of choice to those who want it.
There was another element of this debate that I had to consider: as a Muslim, this question sat alongside my faith in a way that I had to think through carefully. I have concluded that, while I personally may not choose to make use of this provision, my faith guides my own life; it is not my place to let it dictate someone else’s final chapter.
This debate is, at its core, about whether people have the right to choose. It is worth remembering that choice is itself central to faith. Belief has meaning only because it is freely chosen. If I were to use religion as a basis for stripping others of their choice, it would turn faith against one of its own foundations. My faith guides me to live my life and make my choices. That right to choose, I believe, should not be denied by any one of our beliefs, however sincerely held.
Sadik Al-Hassan
I will not.
Like so many North Somerset residents who have written to me on this issue, I believe that those who are suffering, often for long, unimaginable stretches of time, deserve to be offered a choice.
Mims Davies (East Grinstead and Uckfield) (Con)
There is no issue of conscience more capable of dividing constituents, families or, indeed, this House, than that of assisted dying. We can all agree that no one wants to suffer unnecessarily at the end of their life, and that no one wants to witness their loved ones suffering. We are all here in this place doing what we believe is best to achieve that end.
This debate means that the subject of death as a process is again out of the shadows, where we as a society have thrust it over many years. We have been unwilling to confront our own mortality, avoiding difficult discussions even with our own families until reality finally hits us, as it does—we just do not know how. It is a truth that the death of a loved one, and our own inevitable decline, can sometimes arrive with real fear, real pain and, sadly, too much unnecessary and unsupported suffering, but it does come to us all. It would be wiser for us to be ready to face it, to prepare for it and to be able to live with it as individuals, as families and as a society.
For those of us here today as lawmakers, the reality is that a change can happen in all our lives—whether a bolt from the blue, an accident, an incident, a tragedy, a violent attack, a diagnosis or simply being in the wrong place at the wrong time—that can mean life changes in an instant. Who you are, what you are capable of and what your life is now and onwards comes into focus.
My dad’s life and that of my family changed in an instant. He was attacked at work. Punches were thrown and he fell and hit his head on the kerb. He was saved by a passing man on his lunch break with first aid training. I was 11. Dad did not recognise us for several months. The financial impact was that we eventually lost our home, our family business and the surety that his hard work had given us.
Disablement can begin at birth, it can be acquired or it can come with a health condition—all determining what happens next. Yet we are legislating potentially to fundamentally change every person’s relationship with the state, their doctor and the NHS, depending on their health, their preparedness for what is next and the support they may or may not have.
Over the past two years, I have listened carefully to my colleagues from all parts of the House who have made personal arguments for and against. I have read the many briefings sent to me by charities, organisations, groups and representatives from right across our society. I have heard, too, from 1,000 or so of my constituents, who I thank deeply for sharing their own stories and thoughts. I have reflected back on my own experience, and that of my father, friends and loved ones, as one does when one witnesses an accident or incident, a health condition or, eventually, the death of a loved one. We know that many people are fighting for—and come to this place to fight for—better lives, better treatment, updated drugs, better knowledge and empathy. They often live longer, and push to live longer, than the initial prognosis they have been given.
My father lived a longer life than my mum, who became his main carer. She had previously worked with disabled young adults, helping them into work and helping them to thrive. As someone who previously had the honour of being the Minister for Disabled People, Health and Work, I roundly appreciate that some of our most vulnerable often feel under-acknowledged, undervalued, unheard and screened out of life and work in wider society. In that role, I had to learn not base policymaking on my own thoughts and my own family experiences, but to put good lawmaking at the heart of what I did. People must not feel pressured, worthless or subject to coercion, defined solely by what they cannot do.
My dad too often felt worthless. Long term, he felt less of a man, no longer a provider or a business owner. He went back to his farming roots, but a head and neck injury meant that that was not sustainable. An unseen disability saw him succumb to early onset dementia, with trauma-induced epilepsy and diabetes. He far too often felt he was worth more to us dead than alive. That was long before social media and the additional pressure that that entails.
I therefore believe, sadly, that this process is completely wrong. It is wrong to use the vehicle of this Bill to bring forward such societal consequence and change—changing the relationship between patient and doctor, and individual and state, and changing significantly the connection we all have with the NHS.
Dame Meg Hillier
Is the hon. Lady not, like me, puzzled that the promoter brought back the same Bill, despite there being many amendments that the sponsor in the Lords agreed needed to be made and the promoter today acknowledged needed to be included?
Mims Davies
Absolutely; we are here to make good laws. Today’s vote, as we have heard, is not simply on the principle of the Bill, but on the detail—or, frankly, the lack of detail. Good intentions are not enough. We are voting not on what we want to happen because of the Bill, but on what will happen. We cannot continue to divorce it from reality. It will have an impact right across Government and our communities, and intertwine us swiftly in new challenges. Too often in this place, we have good intentions but no delivery plan. We cannot continue in that way. The Bill’s sponsor in the other place felt the need to bring forward 70 amendments of his own.
Mims Davies
Let me make some progress.
I have four main concerns: funding, the assessment process, the lack of institutional opt-outs and, crucially, the auto-commencement clause. Can we all look our local NHS teams in the eye, knowing that we are ultimately taking more resources from them?
The equality impact assessment explicitly acknowledges the impact on disabled people and those from ethnic minorities—people we often speak about in this place, because we are the ones who can speak up for them. This Bill is at odds with that. There is much more I would like to say, but I need to conclude.
This Bill, although well intentioned, is simply a mixture of naivety, idealism and wishful thinking. There is no delivery plan, and it greatly raises the hopes of our constituents in their hour of need for care, good support and understanding. We are being asked to send this Bill back to the other place and perhaps to use the Parliament Act to force it through, regardless of its fitness for purpose and with full knowledge of its flaws and lack of workability, just to get it done. However, that means we are not listening even to the doctors who have spoken in this place today. I cannot subscribe to this type of lawmaking, no matter how well intentioned.
I am grateful that we are talking about life and death, end-of-life care and the value we put on people and loved ones. We are fighting for better palliative care, and we are doing what we can to give people all they need as death approaches. However, I cannot in good faith support an unsafe private Member’s Bill or the process we are undertaking today.
Hilary Benn (Leeds South) (Lab)
This is a very difficult moral and practical question, but for me it is fundamentally about whether we can act to relieve human suffering. We have heard a number of profoundly moving speeches in the debate, and I highlight in particular the speeches of my hon. Friends the Members for West Lancashire (Ashley Dalton) and for Filton and Bradley Stoke (Claire Hazelgrove). We are talking about people who fear or face unbearable pain, choking or gasping for breath, or loss of control at the end of their lives. Are they not vulnerable, too? For me, that is an important point.
The question is, can we really look these people in the eye at the moment and say, “I’m very sorry, but I am not prepared to vote to support your being given the means to remove that fear”—not everyone will take advantage of the provision, but for them it is an assurance—“or to relieve that suffering, even though that is what you wish”? Are we going to say, “I’m sorry, but I will not give you the means of determining the manner of your passing from this world, surrounded by those whom you love”?
Hilary Benn
I will not give way because of the constraints of time.
I do not think we can any longer justify the contradiction that is at the heart of this debate. We know that people with terminal illnesses are already killing themselves. That happens. It is not at all covered by the protections contained in the Bill that my hon. Friend the Member for Rochester and Strood (Lauren Edwards) has proposed. The biggest contradiction of all for me is the fact that there are those who travel abroad. We know that is happening, and I think it is a very uncomfortable fact for those who oppose the Bill for this reason: it is a gaping hole in the argument against the Bill.
The truth is that the Crown Prosecution Service faced a terrible dilemma. It could see the number of people going to Switzerland, and it had to ask itself, “Are we actually going to prosecute mums, dads, spouses, lovers, friends, brothers and sisters for going with those whom they love to be with them at the end?” That is how the CPS came to draw up its guidelines. For me, they are full of common sense, because they say that in these circumstances, it is not in the public interest to prosecute someone. If we look at the figures, the vast majority of family members who have accompanied their loved ones to Switzerland have not—rightly, in my view—been prosecuted for what I would regard as a final act of love. Indeed, it would be an outrage to prosecute them.
Despite those guidelines, some people are fearful, because they get questioned when they come back, and some have not gone to Switzerland with their loved ones, to hold their hands at the last, for fear of what might happen to them. The question I put to the House is this: if we have in effect legalised assisted dying for British citizens who have the money and means to do it abroad, and that is what we have done—I have heard no one in the debate criticise that—then why are we not prepared to provide the same means to people who are terminally ill to bring their lives to an end here in the United Kingdom?
Coming to terms with our own mortality is about the final journey that we will make. We talk about awe and wonder; I never fully understood what awe and wonder meant until I was present at the death of those I loved most dearly. When the previous Bill was given its Second Reading, and the result was declared, there was this extraordinary moment—complete silence in the House. Why was that the case? Because we understood the significance of what we had just done and the consequence of the Bill that we would eventually vote to send to the other place.
Today we are once again called on to make our choice. I have made mine. I will cast my vote to enable those who are terminally ill and who want to take control of the moment of their death, who want to be able to relieve their suffering, and who want to feel that they do not have to fear what is coming, to take that decision, if that is their choice. I urge the House not to deny those people that choice.
Rosie Duffield (Canterbury) (Ind)
Rarely do we debate legislation that represents such a seismic shift in the relationships between individuals, the state, health providers and civic society. There is so much at stake. When Members believe strongly that a Bill is flawed and could be abused, resulting in serious harm, we have an absolute duty to implore others not to simply let it pass and hope for the best, but to consider it fully and deeply and to accept that our duty is first and foremost to protect lives. The potential consequences of poorly drafted legislation without robust safeguards are ultimately the responsibility of every single Member in this Chamber.
I come to this debate wearing several hats. I come as the representative for Canterbury, the home of this country’s Christian faith. Rather than removing that aspect from this debate, as others may have chosen to do, I must consider the views of the Church, and the archbishop has made her view clear again this week. There have also been representations from our sizeable mosque and that community. I come as a daughter who, this week last year, was sitting at my father’s bedside as he was dying from early onset Alzheimer’s, which so cruelly began when he was not much older than I am now. I come also as the partner of a filmmaker who directed the BBC documentary “Better Off Dead?”, which was led by Liz Carr and based on her decades of disability rights activism. I was already aware of Liz’s work through her Not Dead Yet campaign, but the opportunity to learn much more by discussing this subject at home in depth for so many months was invaluable.
Lifelong campaigner Baroness Jane Campbell has seen off so many attempts to pass assisted suicide legislation in the other place that she likens it to groundhog day. In the documentary, she says:
“People are decent, kind. They think that they’re doing us a great favour by giving us this choice. But what they don’t realise is how deadly that choice can be.”
It is worth repeating that not a single disabled rights organisation or professional body supports this legislation. If this place were truly representative of the UK’s population, there would be almost 100 physically disabled Members of Parliament, but we are nowhere near that.
Marsha De Cordova
I thank my hon. Friend for the very powerful speech she is giving; she truly sets the tone when she talks about disabled people. There was a poll out this morning of thousands of disabled people, and many of them rightly said that they need assistance to live. We have to get our palliative care and social care right, with the right investment, before we can even begin to engage in a debate about assisted death and assisted suicide. Does she agree that those should be our priorities, not trying to push through legislation that is flawed and not fit for purpose?
Rosie Duffield
Absolutely, and I thank my hon. Friend for her contribution and her considerable experience in this area.
We hear a lot about coercion. Those with learning disabilities are surely extremely vulnerable to that, as well as the elderly and people with dementia. Before my dad lost the ability to speak, he could absolutely have presented as being capable of signing on the dotted line to medical professionals who did not know him like the family did. In reality, he would have forgotten almost immediately what had just taken place, but he retained an ability to be jovial, and to mask his confusion and memory issues, for quite some time.
As for the slippery slope, every single example in other nations proves without a doubt that at the start, the intention may be that assisted dying legislation will apply only to terminal illness—dementia and Alzheimer’s are, of course, terminal—but the scope ends up expanding alarmingly, as it has done in Canada, and in the Netherlands, which is so much closer to home.
Lizzi Collinge
I am sure that the hon. Lady is aware that the law in Canada was brought in after a Supreme Court judgment, whereas our Supreme Court and the European Court of Human Rights have repeatedly refused to rule on this, saying quite rightly that it is a matter for Parliament. Does she accept that this jurisdiction is different, and that this is a matter for Parliament, and can be changed only by Parliament?
Rosie Duffield
We talk a lot about Canada, but the Netherlands is practically next door to my constituency and has a democracy very similar to ours. People in their 20s have been allowed to take this path there, which is absolutely shocking. Mental ill health, and even solvable temporary social problems, have entered the fray in those other nations; I am talking about depression and homelessness. There are young people opting to end their life. Those in favour of this Bill may dismiss that as scaremongering, but it happens in one of our neighbouring democracies.
One of our most powerful speakers here, the hon. Member for Bradford West (Naz Shah), this week hosted Alicia Duncan, whose story featured in “Better Off Dead?”. Her mother was put on the Canadian MAID—medical assistance in dying—system’s track 1, which is for those who have a terminal health diagnosis, despite her not having one. Alicia’s family believes that she was essentially coerced, through an abusive relationship, and her children were not able to prevent her death. These horrifying cases may seem isolated, but there are many, many more stories, trust me, that did not make the final cut of the documentary—stories not told to anyone. We make laws based on worst-case scenarios every single week, so why is this Bill so almost uniquely optimistic?
If we have any doubt, we must vote against this Bill today. It does not mean that we believe that the principles of it are entirely wrong, but I urge colleagues to listen to disabled activists like Liz Carr, Tanni Grey-Thompson and Jane Campbell, and experts in palliative care in the other place, such as Ilora Finlay and Professor Katherine Sleeman. I ask them to please vote against this Bill if they have any doubt.
Sarah Smith (Hyndburn) (Lab)
I am sure that I am not the only Member who came to this place because I felt that the voices of the people I wanted to represent are seldom heard, and I felt a duty to ensure that they were heard in decision making at the highest level. While I am the Member of Parliament for everyone in Hyndburn and Haslingden, and I recognise that many people in my constituency might support the principle of an assisted death, when I vote today, I must consider the perspective of the many hundreds of people who have written to me for whom this Bill is a terrifying prospect.
Many of those who have written to me are disabled; caring for severely disabled children or family members; people who are getting older, and who worry that they will become a burden; or people who know that because of the colour of their skin, they will face different treatment in our NHS, and who worry about what that would mean for them or their elderly parents. We must all consider the privilege that we in this place hold. We have the confidence to challenge a doctor’s assessment, and to turn down the suggestion of assisted death, and the belief that we might be able to afford the care that we need when we are older, and so can make a true choice about how we might die. However, we must remember that this is not the experience of most people, and certainly not the experience of those with lower levels of education, those from ethnic minority backgrounds, those with disabilities, or those who are struggling to make ends meet. For them, the suggestion made by a doctor may easily sound like a decision based on what is best for them. The likelihood of their mental capacity being accurately assessed is far lower than it would be for many of us. For them, and indeed for most of us, the assessment of how long they have left to live is often hugely inaccurate.
Sir John Hayes
The hon. Lady is absolutely right. This debate illustrates a difference across this House. It is a difference between those who feel that individual agency is always supreme, and those who, like her and me and many others, believe in social solidarity and our responsibility, indeed our mission, to protect the very people she describes, who will be at risk. There is no doubt that they will be at risk from this Bill.
Sarah Smith
I could not agree more. Those people cannot escape the often unintentional prejudice that they face every single day in their engagement with our health services. They know that the Bill would treat them unequally, and they are begging us not to pass it into law. Disability rights groups have shared with us that introducing assisted dying devalues the lives of disabled individuals by framing dependence as an intolerable condition, and one not intrinsic to all our lives. Relying on each other is what makes our society strong, and we must not tolerate a situation in which individuals make decisions from which they cannot return on the basis that they perceive themselves to be a burden.
This law, if passed, will almost certainly further increase the gap in life expectancy between the richest and poorest, given that people living in more deprived areas are likely to acquire complex multi-morbidity seven years younger than those in the richest areas, and are far more likely to feel that they are a financial burden on their family. It is reasonable to anticipate that this will lead to people with less money dying younger. Is that the legacy that those voting for this Bill today want?
In Hyndburn and Haslingden, I have seen how systemic failures in social and palliative care have added to the suffering and challenges that many in my community have faced. Like many of us, I have sat with loved ones as they were dying without the palliative care that they needed. According to Marie Curie, one in three people die without good palliative care. During these debates, we have heard so many horrific stories of death, and of course we must do all we can to avoid those situations.
I spoke with one of the most highly regarded palliative care nurses in the world, who has spent most of her career in South Africa with children who have AIDS and who die far too young. She told me that, in her decades of practice, in which she has cared for thousands of patients, she could bring to mind only two patients whom she was unable to offer a good death, with the right treatment and care.
Assisted dying is not a choice if palliative care is not provided as an alternative. As it stands, the cost of assisted dying is supposed to come from the existing health budget. Research by Sue Ryder found that if we offered consistent palliative care to every patient who needed it, we would need to double NHS funding for that care; it would cost around an extra £300 million a year.
We have to be clear about the priorities and honest about what is possible. This Bill intends to force the NHS to implement assisted dying within four years. Given the budget constraints and capacity limitations, it is just not realistic to say that we can simultaneously improve palliative care and introduce assisted dying. We are taking 10 years to implement the proposed SEND reforms, yet we expect to do this within four. This Bill should provide that assisted dying will not be introduced until palliative care is fixed, and it fails to do that. Furthermore, the evidence from other countries is overwhelmingly that introducing assisted dying leads to decreased investment in palliative care.
In closing, it was a Labour Government who introduced the national health service, with the aim of securing
“improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness”.
It is that mission that NHS staff have signed up to deliver. Let this Labour Government not be the one to bring in a Bill that effectively entirely undermines and changes that founding purpose of the NHS, and let us instead vote today to kill this Bill.
Tom Gordon (Harrogate and Knaresborough) (LD)
I pay tribute to the hon. Members for Rochester and Strood (Lauren Edwards) and for Spen Valley (Kim Leadbeater) for their hard work on this Bill and the Bill introduced in the previous Parliament. I was a member of the Bill Committee for the previous Bill, and I tabled many amendments, sometimes much to the frustration of the hon. Member for Spen Valley.
I want to talk about a number of people who died without dignity and without choice. As a teenager, I remember my mum telling me the story of her uncle. He was terminally ill, and she cared for him at the end of his life. She went round to his house to check on him, knowing that the end was getting near, and tragically stumbled upon him; he had collapsed on the floor and died. That stuck with her to this day and informs her views, and my views, on assisted dying. The reason I use the words “stumbled” and “collapsed on the floor” is because my mum was led to believe that, in his final moments, he was making his way across the room to pick up the shotgun on the back of the door to end his life. That is the reality for people like my mum’s uncle and many others.
A number of years ago, I ended up dealing with a not dissimilar situation. I was living back home with my mum, next door to my gran, when we heard a loud bang. I ran across the road with my gran, and we found the neighbour, John, a pig farmer. He had been suffering unbearably with a chronic life-ending condition, and had decided to take matters into his own hands. That is the status quo—it is the reality for people who are in pain, have unbearable suffering and are terminally ill. We do nothing to protect them. That is why I am in favour of a change in the law. One of the things that has driven me to this place is the conviction that a law like this has to be better than what we have, which offers no safeguards or protections to people in their final moments. No one wants to die—it is not a choice they make—but we can give people a choice about the end of life and how they may see that end.
This is not just a choice for terminally ill people, but for people in remission, like my mum. A number of years ago, she had breast cancer. She had two independent tumours—stage 1 and stage 3—in the same breast. In my mid-20s, I faced having to have a conversation with my mum about what would happen if she, a single parent, were to pass away and leave me with my then five or six-year-old sister. That is not a conversation that I will ever forget, and it is one of the things that motivates me to talk about this issue as prominently and as much as I do. My mum made it clear that if the cancer came back and she were to end up with secondary breast cancer, she would not want to go through the ordeal and the trauma of the surgery and the chemotherapy that she faced. She has lasting nerve damage and a reduced quality of life as a result of the original cancer. It is something that causes her great concern every single day. Every time I speak about this issue, either in this Chamber or in Committee, I ring her first and ask for her advice. She has routinely said that when she goes to her breast cancer support meetings with friends who are also in remission, time and again they say that having this choice would bring them great comfort, even if they decided not to use it. That is why I have such clarity on this issue. The people who are living in those circumstances, and who did not have a choice, guide my views on this subject. If we were in that situation, I would fight tooth and nail for my mum to go through with surgery, chemotherapy or radiotherapy—whatever the treatment might be—but I respect that it would be her decision to make, even if I did not like the consequences.
As we revisit this conversation and this legislation, let me say that I do not see this as a final say on the Bill. Instead, we are restarting a process that was abruptly ended by those in the other place. We have heard a lot today about amendments not being accepted, but with the greatest respect for the hon. Members for Rochester and Strood, and for Spen Valley, although I am a supporter of the Bill, I consistently tabled amendments to the Bill in the last Parliament, including amendments to make it better reflect the realities of people with neurogenerative diseases. When we look across the globe, we can see that this Bill is the most restrictive and narrow legislation. To suggest that it will somehow cross a new frontier that has never been crossed before is simply untrue. We are lagging behind international comparators, and lagging behind in giving people choice. We know that people who have the means or the money can have that right now by travelling abroad, and we know that, all too often, people who do not have the money tragically have to take actions into their own hands and are robbed of a good death.
Today, I encourage all hon. Members, and in particular those who are genuinely undecided or wavering, that a vote for the Bill on Second Reading will continue the debate and allow hon. Members to table amendments on Report. Importantly, one thing that people keep ignoring in the debate is that if the Lords operates in good faith and sends us sensible suggestions, we will end up in ping-pong, where we will be able to pick up amendments that would strengthen the Bill further and allay those fears. The idea that that cannot happen is simply untrue. I encourage all hon. Members to ensure that we can continue the debate, and give opportunity and choice to people at end of life.
Ruth Cadbury (Brentford and Isleworth) (Lab)
I supported this legislation first in 2015 and will do so again as it goes through its processes. I am truly grateful for all the work that so many hon. Members here and in the other House have done on the detail of the Bill. I am confident that it has been improved significantly and that we have learned from the experiences of jurisdictions across the world, many of which have had assisted dying for many years. Let us remember that in most of those jurisdictions only about a third of people who choose the option of assisted dying actually go ahead and need to use it.
My resolve has been strengthened by those I have heard from with direct experience. I will mention just two such experiences, told to me by people I know well. One is a constituent who asked me to support the change in legislation. His brother was diagnosed with cancer, and after an operation that proved unsuccessful, he was admitted to a hospice for end-of-life care. About his brother, he said:
“He was very philosophical about what was going to happen. His one request and hope was that his death was not going to be prolonged and painful. He received excellent care from an amazing team at the hospice. Sadly, when the time came, he suffered in a way no human should have to…We don’t allow our pets to suffer the way he did. His acute suffering and pain lasted 4 days. When he was able he pleaded for help for the pain to stop. The hospice did everything possible to help, but there are legal limits to what they can do. If he could only have received a life-ending intervention 5 days before he died, as he wanted, he would not have had to suffer the indignity and agony of a painful and long, drawn-out, horrific death.”
The second experience is that described on several occasions in the House by Paul Blomfield, the former MP for Sheffield Central, about his father’s death. Paul continues to be a powerful advocate for the right to choose. His full speeches are preserved in Hansard, so I will quote just a small part about his experience.
Paul received a phone call that his father had been found dead in his garage after receiving a terminal diagnosis of inoperable lung cancer. In Paul’s words,
“He had had his share of health problems, but he faced them all positively, until a terminal diagnosis of inoperable lung cancer clearly led to his decision to take his life. He could not talk to me or his partner about it, because he would have made us complicit. The current law forced my father into a lonely decision and a lonely death. And he died prematurely, because I am sure that what drove him to end his life at that point was the fear that if he did not act when he was still able to do so, he would lose the opportunity to act at all.”—[Official Report, 4 July 2022; Vol. 717, c. 231WH.]
Those potentially facing unimaginable pain or suffering after their terminal diagnosis, despite the best palliative care, currently have options that are unbearably lonely—like for Paul’s father—or involve an arduous and costly journey by going to Switzerland; or they have no choice, like my constituent’s brother.
Dr Marie Tidball (Penistone and Stocksbridge) (Lab)
Will my hon. Friend give way?
Ruth Cadbury
I will not. The many people who have shared their experiences of facing death soon have told us that they want to die on their own terms. We also know, through various credible polls, that the majority of people in this country want that choice for themselves. I do not want to deny them the right to be able to make that choice.
Martin Vickers (Brigg and Immingham) (Con)
Thank you, Madam Deputy Speaker, for giving me the opportunity to speak in this important debate. Understandably, we have heard some passionate and courageous contributions, such as the one from the hon. Member for West Lancashire (Ashley Dalton), who is no longer in her place. She made a remarkable contribution to the debate.
In this House, we discuss a whole range of issues week in, week out. Many of them are rather mundane, but nothing is more important than issues of life and death. To be honest, I would have thought that the mountain of briefings, reports and individual letters, particularly from a number of clinicians, would have been sufficient to persuade most people that this is an unsafe Bill, but I want to speak about the wider implications. Other Members have mentioned the impact on society. I claim no particular insight; indeed, I see through a glass darkly.
Some of us believe that life is God-given, and others do not, but I am sure we can all agree that it is uniquely precious and that we should do all we can to preserve it. I do not in any way question the motives of hon. Members or members of the public who take a different view. As we have heard today, many will have reached their conclusions having witnessed the slow and sometimes painful death of a loved one. I am of the firm view that if assisted dying is legalised, we will be poorer as a society. We will have crossed a line. We will have accepted that, to adapt the phrase I used earlier, life is not uniquely precious and, importantly, we will have changed the relationship between doctor and patient. That relationship is crucial, and it could be compromised if a patient was anything other than 100% certain that their doctor or clinician was striving to maintain life. When we are old, weak and seriously ill, we need compassion and support, not the nagging doubt that the treatment that we are receiving is not entirely—
Martin Vickers
No, I cannot give way. There is no time for interventions.
As society has evolved and civilisation has advanced, care of the vulnerable, those who are sick and those who need comfort as they near the end of their lives has become a higher priority, and rightly so. In preparation for this debate, I re-read an article that the former Supreme Court Justice, Lord Sumption, published in the Sunday Times in November 2024. We cannot produce legislation that meets every circumstance. Lord Sumption stated that
“the decision to allow doctors to help bring about the death of a human being crosses a major moral threshold.”
I think that is sufficient warning that we should be very confident that the Bill has the necessary safeguards, and I do not believe it does. As I say, we cannot produce legislation for every individual circumstance, so we are left with the alternative: to include sufficient safeguards. Even for those who support the Bill in principle, it does not have those safeguards. 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.
Both of my parents died of cancer and suffered in their final months. I well remember the telephone call from the consultant after the tests on my father, when he said, “We must hope that God is merciful and does not allow him to suffer for too long.” Although he did suffer, he lived for a further six months after I received that fateful call, and in that six months I saw him enjoying life and sharing time with his then four-year-old granddaughter. In his final weeks, he spent time in St Andrew’s hospice in Grimsby. I saw then what comfort could be offered through palliative care. No longer did he suffer the periods of pain that he had had in earlier weeks. That happened as long ago as 1988, and things have improved dramatically since that time.
Dr Hudson
I am very grateful to my hon. Friend for giving way. Quite rightly, when we enter this life, the NHS and the state support us through obstetrics, gynaecology, maternal health, neonatology and paediatrics. However, at the other end of our life, when we leave this world, the charitable sector picks things up, and the majority of support is delivered outside the NHS. Surely that cannot be right as a society. Surely we have to fix that and sort out palliative care before we go anywhere near this Bill.
Martin Vickers
My hon. Friend makes an important point.
Let me go back to St Andrew’s hospice in Grimsby. My mother died in hospital on the day that she was due to be moved into that hospice—how I wish that only a day or two earlier she had been able to do that, and to receive the care that I know from subsequent visits the hospice has provided.
We all have to cope with the loss of loved ones, and such experience raises in the mind of any right-thinking person the question of how we minimise suffering. If someone has previously indicated their wish to hasten their death, I acknowledge that it is extremely difficult to say, “Sorry, that is not possible.” However, I believe that moves to legislate for assisted dying would be yet another step that lessens the value that we as a society place on human life.
I suggest to the House that the expert opinions and personal stories we have all received must, even if Members favour assisted dying in principle, make us think seriously about whether this Bill is the right vehicle. In my view, it is not. Too many safeguards are lacking, and the Bill must be rejected. Life is precious, and we should recognise that.
Ms Abena Oppong-Asare (Erith and Thamesmead) (Lab)
Before I begin, I declare an interest as a patron of my local hospice, Community hospice. I want to be clear from the outset that I am not opposed to assisted dying in principle; I understand why many people support a change in the law, and I recognise the compassion that motivates those views. However, today I will set out why I remain unable to support this Bill.
This debate evokes deeply held views across the House. I respect my colleagues who have reached a different conclusion, but the question that has troubled me throughout remains the same: can a choice ever be truly free if the support, care and dignity that people deserve are not equally available to all? Through my work with my local hospice, I have seen at first hand what excellent end-of-life care can achieve. I have seen dignity, comfort and compassion, and I have seen how much those final months, weeks and days can mean to individuals and families. That experience leaves me convinced of one thing: dignity at the end of life is possible, and it is our challenge to make it available to everyone.
I have listened carefully to constituents on all sides of this debate. One constituent wrote to me about caring for both her husband and her former partner after they were diagnosed with terminal cancer. Both were told that they had no more than six months to live, but both lived for more than a year beyond that prediction. During that time, they were able to reconnect with family, spend precious time with loved ones and continue to live meaningful lives. Her message was simple: prognosis is not certainty, and diagnosis is not the end of the journey. That does not mean that doctors are wrong, but it does mean that when Parliament considers legislation built around predictions of life expectancy, we must take that uncertainty seriously.
Ms Oppong-Asare
I will not.
I believe the concerns raised by organisations such as the Royal College of Physicians and the British Geriatrics Society about the uncertainty of the end of life, safeguarding and the definition of terminal illness deserve careful consideration.
I cannot separate this debate from my own experiences. Members of my family have experienced discrimination in the healthcare system. Those experiences leave a lasting impression; they remind us that trust, access and outcomes in healthcare are not always experienced equally by everyone. Those inequalities do not disappear when people become seriously ill.
Sir John Hayes
Under the Bill, what we would be saying to those clinicians is, “We want you to do much, much more. We want you to gauge whether people are being coerced. We want you to make a definitive judgment about how long someone has to live.” That is an unbearable pressure on those who have a mission to save lives, not to take them.
Ms Oppong-Asare
I thank the right hon. Gentleman for his intervention. I also want to talk about data from the King’s Fund, which shows that in 2023-24 local authorities received more than 2 million requests for social care support for new clients, but only 859,000 received publicly funded, long-term social care, nearly two thirds of them older people. That means that 58% received no support.
Furthermore, the Government’s equality impact assessment gives me pause. It acknowledges concerns that people from ethnic minority backgrounds may face higher risks because of poorer access to healthcare, poverty, lower quality of care and higher levels of abuse. Disabled people and disability organisations have also spoken powerfully throughout this debate about their concerns and the risks they believe this legislation could pose. We should listen carefully to those voices, because for many people the question is not simply whether they have been coerced; it is whether they are making this choice in circumstances none of us would want for ourselves.
Daniel Francis (Bexleyheath and Crayford) (Lab)
I thank my hon. Friend and constituency neighbour for giving way. This week we have seen evidence from Kingston University reinforcing that people with learning disabilities see advice from a doctor not as advice, but as a recommendation. We know from their experience during covid that they were five times more likely to have a “do not resuscitate” order placed on them. Does she share my view that those issues in the equality impact assessment reinforce the point that for people with learning disabilities, this legislation would remain unsafe?
Ms Oppong-Asare
I thank my hon. Friend, and I do share those concerns. I have met with constituents who have also been impacted, and I have seen that in the equality impact assessment.
My point is whether people would be making this choice in circumstances none of us would want for ourselves: the person unable to access the social care they need, the person worried about the financial consequences of their illness, the person who feels like a burden to those they love, or the person facing loneliness, dependency or abuse. Where evidence identifies greater risks for particular groups and where respected voices continue to raise concerns about whether existing safeguards are sufficient, I believe Parliament has a duty to take those concerns seriously and to test whether more can be done, because access to death should never be easier than access to dignity in life.
I want every person approaching the end of life to receive the dignity, support and compassion that I have seen provided by our hospices across the country. But, having considered the evidence before us, I am not persuaded that these serious concerns about inequality, disability, safeguarding and end-of-life uncertainty have been adequately resolved. Until I can feel confident that the safeguards are strong enough to protect the most vulnerable, I do not believe that Parliament should create a legal route to an assisted death.
Christine Jardine (Edinburgh West) (LD)
I thank the hon. Member for Rochester and Strood (Lauren Edwards) for reintroducing this Bill and giving us another chance to debate the issue—although part of me regrets, as I will explain, that we have that chance. I respect everyone who has taken the responsibility of coming here today to debate this again, and I particularly respect those who have shared their very moving personal stories with us all.
Most of all, though, I respect and I would like to apologise to those who are again going through the trauma of waiting to find out whether they will have the choice. I have huge sympathy for them, because they believed when we originally passed this Bill and sent it to the other place that, if they needed it, in four years’ time they would have the choice. It would be in their hands. That hope has been snatched away from them—and not by us.
We fulfilled our responsibility to the electorate. We spent hundreds of hours in Committee, in private discussions, in debates and on Report, going over this Bill in minute detail until we could, with confidence, send to the other place the best Bill we thought possible. Of course, we thought that it would amend it and bring things back, but we had fulfilled our role and respected the will of the British public. Unfortunately, when the Bill went to the other place, that was not what happened. A handful of peers blocked it.
Christine Jardine
Sorry, I will not take interventions.
Those peers did not show the same respect for the repeatedly expressed will of those who face the end of their lives.
Sam Rushworth
Does the hon. Member acknowledge that the handful of peers she refers to include the former presidents of the British Medical Association and Royal College of Psychiatrists, a leading professor of palliative medicine, a former chief executive of NHS England, two former Attorney Generals and the former president of the family division of the High Court?
Christine Jardine
I do, but they are each one individual, and each of the professional organisations is neutral, and believe me, I envy them on that.
We have the responsibility to make the decision. The majority of us have already said that this is the best Bill we can produce. We—the majority of us—have made that decision once already, and we sent it to the other place. If we do that again today, I hope that those in the other place listen and take that on board and that the handful of peers who blocked it—
Rachel Taylor
The hon. Lady speaks with great passion. Does she agree that members in the other place bringing forward amendments such as suggesting that women who had been through the menopause, or men, needed to have a pregnancy test before they could be eligible for an assisted death, was a deliberate attempt to wreck the Bill, as opposed to undertaking their important role of scrutiny?
Christine Jardine
I completely agree, and it did the other place no credit at all that they did that.
There is something interesting and noticeable about all the experiences we have heard today. I have personal experience, which I admit influences my view. I saw my mother go through a very painful death and wished that she had had the choice. I do not know what she would have done, but I wished that she had had the choice. What is interesting is that we have all taken different things from those experiences. Some of us have said that we cannot do it because of that experience, and others have said that we must do it because of that experience, because we have all made decisions. We all have the right to make decisions for ourselves, and that can surely be no more important than when we face the final decision that we will face. It is for that reason—to respect that choice, to respect a decision that has already been made in this place, to respect the will of the British people—that I ask the House to send this Bill back to the Lords for approval.
Liz Kendall (Leicester West) (Lab)
This is the first time during this Parliament that I have been able to speak publicly about assisted dying and why I support a change in the law and, indeed, this Bill—a decision I voted for 11 years ago when the then MP for Wolverhampton South West, Rob Marris, put his assisted dying Bill to Parliament. I think of all the people who have suffered unbearable pain and loneliness since that first debate took place.
I will make three brief points, and forgive me if I do not take interventions—I know so many people want to speak. The first is why I support a change in the law in principle. I have always believed that so long as it does no harm to others, people should have as much control, say and choice over their lives and the decisions that matter to them as possible, no matter their background or situation.
That power should be in people’s hands to live or die as they choose, not as anybody else thinks they should or tells them they should. It should not just be the privilege of those with money, knowledge or resources. For me, that applies as much to the end of life as it does throughout the rest of life, and arguably more so—to choose as best we can how we leave this mortal coil on our own terms, in as little pain as possible with grace, humanity and dignity, surrounded by the people we love and who love us in return. That is not the case at present.
As my hon. Friend the Member for Filton and Bradley Stoke (Claire Hazelgrove) so bravely and movingly set out, the principle of choice is deeply important to the people and families who have suffered unbearable deaths or are worried about unbearable deaths, whether or not they use that choice. Many have talked about having the option as a kind of insurance policy or as a comfort for them when they are going through those difficult times.
That principle of choice and how important it is leads me to my second point, which is that we need better palliative care and social care before any change in the law. The truth is that for people who genuinely believe in choice, it is not either/or—better palliative care and social care or the option of assisted dying—but both. Even the best-quality universal palliative care will not alleviate unbearable suffering for some people. We know that from respected research institutions, hospices and patients themselves, and we should listen to their voices.
Back in 2000, the then editor of the British Medical Journal wrote a powerful article entitled, “A good death”. I remember reading it and thinking how amazing it was. In it, he argued that medicine in particular and society as a whole do not give the attention that we should to helping people die a good death. With our ageing population, increase in long-term chronic conditions and the fact that sudden death is no longer the norm, we need a new approach.
We must look at the broad spectrum of support that is needed to provide a good death. The support needs to be based on clear principles, including people being afforded dignity and privacy, having control over pain relief and symptom treatment, and having choice over where death occurs and who is present and shares the end with them. People need to be able to leave when it is time to go and not have their life prolonged pointlessly. I see today’s debate very much within that context: what makes for a good death.
Alongside a change in the law on assisted dying, we must also improve palliative care and social care for families. I have campaigned for that for years, including campaigns for more beds in my local hospice LOROS and for free social care and for choice at the end of life. As Richard Smith argued all those years ago, we as a country and society can bring death more into life. That is entirely within the power of this Government and this House. I know that my dear and honourable friend on the Front Bench, the Minister for Social Care, cares passionately about those issues.
My third and final point is about trust in our democratic process. I pay tribute to the right hon. Member for North West Hampshire (Kit Malthouse) for the very powerful speech he gave earlier on this point. I have the greatest respect for the many knowledgeable, experienced and highly principled Members of the House of Lords, but it is not right and not acceptable that a tiny minority should be able to talk out the Bill with hundreds and hundreds of amendments—a Bill that has been scrutinised far more than many Government Bills—with the sole purpose of scuppering it. It is the most scrutinised Bill I have seen in my 16 years in Parliament, and it was passed by this House of elected Members.
The Lords should vote on this Bill, amend it if they see fit, send it back to us—just like we do with all other Bills. We have done our job. Now the House of Lords needs to do theirs to give people dignity, respect, choice and control over how, where and when they die, which so many hundreds of people have not had in the decades since we last faced this issue.
Dr Kieran Mullan (Bexhill and Battle) (Con)
I welcome the opportunity to give my personal views on this Bill, as colleagues in health have taken over responsibility for it.
I have spent most of my life as someone who was highly sympathetic to the cause of assisted dying and imagined that I would support it if I ever was an MP, but that changed in 2018 when I read the Gosport War Memorial hospital independent panel report published in that year. The report should be more widely read, and I often wonder why it did not get the attention that it deserved. It found that between 1987 and 2001, more than 450 NHS patients had their lives prematurely shortened by healthcare staff. They were mainly elderly—the average age being 81—but some were as young as 61, and more than 70% of them had been admitted to hospital not needing palliative care or being at the end of their lives.
The report describes what happened to some of them. One patient was admitted for respite care but deteriorated and became confused during his stay. Staff asked permission to give him diamorphine, but his daughter refused as he was not in pain. However, his wife later agreed, and he was started on diamorphine via syringe driver. He died the same day. A man admitted for dementia was started on a diamorphine syringe driver; staff asked his son for permission, and he gave it, but he felt that there was no explanation of what it meant to be given diamorphine. The dose was doubled, and his father died five days later. His son felt that the diamorphine had effectively killed him.
Why did that happen? It happened because the staff in that hospital and on that ward had developed a culture of prioritising convenience in looking after patients over the value of their lives. It speaks to something that we often do not like to talk about and might feel guilty about: looking after people is not only challenging but can sometimes be deeply unpleasant.
As a doctor, I have helped to look after people who, when someone approached them to give them care, would scratch or hit out at them. I have helped to look after patients who refuse to stay in bed even though it is in their best interests, and who continually wander the wards and need to be monitored all the time. Then there is something that perhaps seems benign but is sometimes very challenging: the patients who continually call out for help again and again and again, perhaps asking for a medicine or a meal that they have already been given, and refuse to be consoled.
Most of the time, that brings out the best in our nature, as we would want—to be kind, caring and compassionate —but it can sometimes bring out the worst in our nature: our impatience, our intolerance and even our cruelty. While I have seen that happen in hospitals, I know that it goes on in private homes up and down the country every day.
Dr Mullan
I will not; there is not time.
While I do not seek to say that the Bill will be used in that way—to deliberately bring about an end to the lives of confused or elderly patients—my worry is about how it will insert itself into that battle in our country between the best and worst of our natures, in families, conversations and settings where people, as much as we do not like to believe it, actively, for selfish reasons, wish that their relatives were dead, and where those relatives know that their family wish that they were dead. I do not want a Bill, or a message from this Parliament, to go out to the wider country to say that not just Parliament but the mechanisms of the NHS—a wing of the state—will sometimes support and help them to end their lives.
I remain deeply sympathetic to the scenarios and circumstances that people have described, and I can personally foresee a situation where I would want to make use of this Bill and feel that it would benefit me, but we should not legislate for what we might want. We have to legislate for what is in the broader interests of our constituents and our country, not least because, as many have articulated, the Bill has serious flaws. There is, in particular, the arbitrary decision to implement it in four years’ time, regardless of what might be happening with our palliative care services, which have, even recently, faced new and very real funding challenges.
While I understand why people think the Bill would bring benefits for some people, and I acknowledge that it would, I think that the price we are asking some of the most vulnerable and in-need people in our society to pay, and the risk we are asking them to face, is simply too high.
Mary Kelly Foy (City of Durham) (Lab)
We have heard much today about the legal, medical and ethical questions being raised by this Bill. For me, the idea of ignoring the warnings of the medical professions is absolutely baffling, but my remarks today will focus on poverty, inequality and what dignity really means at the end of life.
My daughter Maria has been in my mind throughout my considerations. Maria lived with severe cerebral palsy. She was non-verbal and required round-the-clock care. From the day she was born, we were told that she might have just six months to live, but she defied that and lived for 27 years, bringing immense joy to our family. It is because of Maria that I approach this debate with concern; I fear for non-verbal or vulnerable people, and I worry about those who do not have a trusted person to protect them or speak out for them.
I am sure that we all want to see dignity for those at the end of life, but we must ask ourselves what dignity really is. In these circumstances, dignity means being well cared for and supported, receiving the best possible treatment, and knowing that your life is valued. It is not dignified to feel pressured towards death because of the burdens of cost, or the social and economic pressures that accompany serious and terminal illness. When we talk about coercion, we often think of pressure from individuals, but the greater risk may be social coercion driven by inequalities that exist in our society.
Mary Kelly Foy
Briefly, because my hon. Friend has made a few interventions already.
Mary Kelly Foy
I thank my hon. Friend for that intervention, but he will find that there are statistics on that. In America, 8% of those who have been deemed to have chosen to end their life have faced huge financial difficulties.
Daniel Francis
The Kingston University research that I referred to earlier shows that in the Netherlands, people with learning disabilities cited being coerced into an assisted death. Does my hon. Friend share my concerns about that?
Mary Kelly Foy
I could not agree more—these issues have come to light in similar jurisdictions around the world.
We know that there is a greater risk of social coercion driven by the inequalities that people face. Under the current proposals, will the panel of experts be able to adequately assess the impact of the wider pressures of life? The truth is that when we talk about choice, the reality of making such a choice is very different for the wealthy than it is for others. Inequality shapes health outcomes throughout our lives, as well as the options available to people at the end of their life. The choices facing someone who is financially secure are very different from those facing someone on a low income, relying on benefits or struggling to make ends meet. As I say, evidence from other countries starkly highlights that such social and economic factors—including inequality in the provision of healthcare—are significant for those who are deemed to have chosen to end their life. We should not ignore that.
For more than a decade, we have seen public services come under strain, disability support reduced, and rising hardship for many families. During covid, we witnessed immense pressures on our health system, and I worry that we risk telling people that we cannot always guarantee the support needed to live well, but we can offer greater choice in death. Real choice can only come with high-quality care, strong support services and access to excellent palliative care. That would provide dignity, and it is our job—and a challenge for society—to deliver the chance of real dignity for those facing terminal illness.
The people most exposed to the risks within the Bill are often those who already face disadvantage: older people, women, those living in poverty and those with poor mental health. We live in a very unequal society; the wealthy are better protected from hardship, while others face pressures that can profoundly influence their decisions. I cannot be clear enough in saying that poverty should never be the reason for someone to choose to die.
I conclude by returning to Maria. While she will not be able to hear my remarks today, I know she would be pleased that I finally got to make my case, and I urge colleagues to bear in mind people like Maria when they cast their votes. If we are serious about dignity and choice, our first duty should be to improve care, strengthen support and tackle the inequalities that shape people’s lives.
Several hon. Members rose—
Madam Deputy Speaker (Caroline Nokes)
I encourage Members to think of colleagues when making their contributions, and not to speak for too long. Obviously, I cannot introduce a time limit.
Carla Lockhart (Upper Bann) (DUP)
I commend the hon. Member for West Lancashire (Ashley Dalton) for making one of the most powerful speeches we have heard in this place today.
The words we use in this debate matter, and if I have learned anything in my 20 years in politics, it is to be honest with people and the public we represent. The soft language of “assisted dying” is misleading the public, because it obscures the stark and very dark reality of what is actually being proposed. We should always have the courage to call things what they are.
Of course, we all want assistance when we are dying, but that is not what this Bill provides. It is not about an extra shot of morphine to ease someone on their way; it is a Bill that allows doctors to provide lethal drugs for a patient to end their life. Let the reality of that sink in: our great NHS, the principles of which are to protect and to save lives, would be responsible for state-sponsored suicide. That is what it is. Yesterday was World Suicide Prevention Day; the irony should not be lost on any Member of this House.
Healthcare professionals and charities work tirelessly to prevent suicide. They seek to reassure people in despair that their life has value, that help is available and that hope remains, but what would this Bill do? It would weaken the principles that underpin our suicide prevention strategies. I ask supporters of the Bill: what message does a system of state-sanctioned death send to those already wrestling with suicidal thoughts? How can we genuinely regard suicide as a tragedy to be prevented while allowing it to become a medical intervention to be facilitated by the state?
One of the deepest concerns is that the Bill does not require a proper exploration of why a patient wishes to end their life. What if their wish is driven by financial worries, poor access to care or the fear of being a burden on family members? Sometimes a desire to die is actually a cry for help, yet under this legislation, death will be presented as an acceptable response to hardship.
The lines get particularly blurry when it comes to certain manageable conditions, such as type 1 diabetes. If a person decides to refuse treatment, such conditions could end up meeting the Bill’s definition of terminal illness. When the definition is this broad, it is easy to see how the law will expand over time. Those who oppose my view will hate the words “slippery slope”, but that is the reality in every country where this legislation has been approved: Oregon’s similar legislation now covers diabetes and arthritis; in Belgium, it covers children and people with autism; and in Spain, a lady who was gang raped ultimately went on to end her own life.
I also have grave concerns about those who may be quietly pressured into choosing assisted suicide. The Bill allows doctors to discuss assisted suicide with patients, but it makes no exception for those who may be especially vulnerable.
Tim Farron
Coercive control is by definition insidious, and we do not find out about it until years later—the victim themselves might not even be aware of it until years later. With assisted dying, a victim of coercive control would have no “years later”, would they?
Carla Lockhart
I could not agree more with the hon. Member.
Especially vulnerable people include those with learning difficulties, those with a history of suicidal feelings or those detained for their own safety under the Mental Health Act 1983. To give just one example, people with Down’s syndrome rely heavily on parents and carers to navigate complex decisions. They are deserving of every possible safeguard, and the Bill does not provide it. Instead, according to the National Down Syndrome Policy Group,
“The Bill presumes the best, rather than legislates for the worst.”
That is not good legislation. As one member of the group said,
“I worry that I and others with Down syndrome, and our families and supporters, might be pressured to consider ending our lives when we face the effects of aging. Haven’t we enough stigma to deal with already?”
Carla Lockhart
No, I will not.
The Bill would fundamentally alter the patient-doctor relationship. For generations, people have looked to healthcare professionals for treatment and care. That trust is precious, and should never be diluted. The Bill drives a coach and horses through that relationship. The role of our health service should be to do no harm and to stand alongside patients in their darkest moments. I am not wearing rose-tinted glasses; I know that too many people struggle to access the end-of-life care that they deserve, but the answer to that failure cannot be to make death more available. The answer is to make care more available instead. We should be focusing our energy and resources on strengthening palliative care services and ensuring that nobody faces their final days without proper support.
My opposition to this Bill is not only practical but moral. Life is precious, and it deserves protection from its beginning to its natural end. That is what my Christian faith teaches me, and that belief is shared by many of my constituents, and by countless people across this great United Kingdom. This House was founded on Christian principles, and this legislation is so far removed from those Christian principles.
The true measure of a compassionate society is not how easily it facilitates death, but how faithfully it cares for those who are suffering. As I watched my dad take his last breath on this earth, tears rolled down his face. His pain had often been unbearable, but our NHS stepped up. His consultants, pain nurse and those caring for him rallied around him, because he wanted and deserved to live. He did not need help to die; he needed help to live, and when death came naturally, he needed care, compassion and dignity. That is what every vulnerable person deserves. I cannot support a law that would allow the state to be involved in ending human life, and that is why I and my Democratic Unionist party colleagues will vote against this Bill today.
Janet Daby (Lewisham East) (Lab)
Surprisingly, I will not try to persuade hon. Members how to vote today, because I think they know by now how they will vote and why. However, I feel I need to share my thoughts and views with my constituents, and to set out why I am voting the way I am. I say this because there is a significant change from how I voted previously. If hon. Members are influenced by my contribution, so be it.
I will get right to the point. I previously voted for assisted dying. I recognised then, as I do now, the deep turmoil that family members experience when they know that their loved ones are dying, or see them die. The agonising distress or pain that they experience is something that no one wants for themselves or their loved ones. However, I cannot shake from my mind a conversation I had with someone some time ago about assisted dying. They had been diagnosed with HIV/AIDS before the time of advanced medication for this illness. Their body was breaking down, and they had been informed that their prognosis was bleak. They said that had assisted dying been an option for them then, they would have taken it. However, it was not an option, and they have since been stabilised on medication and are in full-time work. Although they do have side effects and feel tired, they are living a meaningful life, and, as Members can imagine, they are no longer an advocate for assisted dying.
When I previously voted for assisted dying, the way I voted on the amendments to the Bill varied, as I was trying to navigate my way through this issue while ensuring that I was considered in my approach, but the question of inequality was always on my mind, and how this would impact poorer communities, isolated individuals, people with mental and physical disabilities, and those in controlling and coercive relationships; how this system would work in our society now, and how it would change in years to come; and, of course, how it would impact black and minority ethnic communities, who already experience deep inequalities in the health service, as shown by years of impact assessments and reports on the issue.
As chair of the APPG on sickle cell and thalassaemia, I am constantly reminded of the health inequalities and suffering that people with this disorder continue to experience. They are constantly undermined and ignored, and their disorder is grossly lacking in research funding. Among the new evidence is the Government’s own equality impact assessment on the effect of assisted dying on the health service. This recent report suggests that people from ethnic minority backgrounds may be more susceptible to coercion due to structural pressures such as poverty, lower-quality care and domestic abuse. The impact assessment states that as a result of those pressures, ethnic minority people could disproportionately choose
“to have an assisted death to avoid financial hardship or escape abuse.”
This relates to broader concerns regarding the availability and quality of social and palliative care, particularly for already disadvantaged communities. Earlier this year, up to 60% of hospices reported that they were having to make cuts to frontline services as a result of financial pressures. While the Government have increased funding for the sector, it is clear that far more work is needed before those in need of support at the end of life receive the dignified care and choice of treatment they deserve. Alongside that are the additional pressures on the broader health service and the legal sector resulting from this Bill; they reinforce my decision to vote against it. I implore the Government to invest in hospices and palliative care across the country, to make them the best they can be for all postcodes.
Following my vote in favour of assisted dying, I had nightmares about dying and death for two nights. I had to wrestle with the knowledge that I was not entirely comfortable with the decision I had made. My conscience was not at peace, and I cannot again in good conscience vote for the Bill. In fact, I wish there was a Bill before this Chamber that we could have all got behind, as there is so much that needs to be done in our society. I decided that if the opportunity arose again, I would vote against assisted dying. I do not judge the conclusions that other hon. Members and hon. Friends reach, but I ask that we respect each other and act in a respectful way.
Andrew George (St Ives) (LD)
It is an honour to be called to speak in this debate. Indeed, it is the first time that I have. I am a sponsor of the Bill and a member of the Health and Social Care Committee. I congratulate the hon. Member for Rochester and Strood (Lauren Edwards) on how she introduced this debate, and the hon. Member for Spen Valley (Kim Leadbeater) on her outstanding work and championing of this issue over all this time.
If this Bill is defeated today, it will leave us with a significantly unsatisfactory and dangerous status quo. All the legitimate concerns about safeguards and coercion raised by those who oppose the Bill will simply continue, but problems will probably be increasingly driven behind closed doors, as things will, I fear, only get worse. Defeating the Bill would also reward the worst of the reprehensible behaviour of those in the other place who blocked this legislation last time. If the purpose of the shocking behaviour of a small minority of peers towards this Bill earlier this year was simply to make a powerful case for their own abolition, they certainly hit the jackpot. If we reward them with victory today, we weaken the relationship between the two Houses and cede more power and influence over our democracy than is healthy or wise.
A theme that has run through the debate is the implication that the Bill is insufficiently perfect. Indeed, “perfect is the enemy of the good” syndrome runs through this and a lot of our other debates and legislation. As I think my hon. Friend the Member for Esher and Walton (Monica Harding) described it, the concept of a 100% perfect Bill is simply in the minds of those who believe it possible to get to that point. When have we ever had a perfect piece of legislation?
Andrew George
I am sorry, but because of time, I will not. If the hon. Member wants, he can send me a postcard with the answer to my question: when have we ever had a perfect piece of legislation? We would be perpetually restrained from making progress if perfect legislation was the aim, because we only produce compromises, not the utopian perfection that we all want. If we were all sent off at the beginning of this process two years ago to look at how best to handle end-of-life considerations, and given a pen and paper and put in a room without a mobile phone to draft a piece of legislation, we would have 650 “perfect” Bills, written according to the opinions of each of us in this Chamber.
Several hon. Members rose—
Andrew George
I cannot give way, because of the time constraints. All Bills are necessarily a compromise. That does not mean that we simply have to make do with bad legislation, but the Bill that was sent down to the other place was in fact an excellent compromise that actually achieved all of the matters—
Several hon. Members rose—
Andrew George
I am sorry to be stirring up Members at this stage of the debate, particularly as time is very short.
Another theme is that people somehow believe that there is a binary choice available to us on palliative care: that we should either have 100% palliative care, or can go down the route of backing the Bill—or rather, that we should not support such a Bill until we have 100% perfect wraparound universal palliative care around the country. The Health Committee, of which I am a member, has produced a report on this issue, and it is clear that it will actually help the case for improvements to palliative care if this option is also available—a point a number of Members have made.
The point about the limitations of palliative care has been made very strongly by others, as have the points around coercion and safeguarding. After all, the current situation regarding coercion and safeguarding is certainly not satisfactory. The Bill provides safeguards where presently there are none. It is irresponsible and scandalous that some people promote scare stories about risks to disabled people, anorexic children, Down’s syndrome children and the vulnerable, when in fact those risks currently exist, and the Bill actually provides the safeguards that I think many people want.
Last time we had a vote on this issue, on Third Reading, I thought it was this Chamber at its very best. There was no choreographing of the response. You could hear a pin drop when the result was announced. It was a very good debate, followed by MPs coming together in silence. People on both sides of debate embraced behind the Chair in tears, because they understood the gravity of the decision. I do not think that was respected by the way the Lords treated the Bill. That is why it is vital that we send the Bill back to the Lords and do not allow them to have the victory that they seek.
Dr Peter Prinsley (Bury St Edmunds and Stowmarket) (Lab)
I have cared for patients with advanced cancers of the head and neck, and I have seen patients at the end of their life. It is that experience above all that convinces me that we must introduce this humane and dignified option to assist those who are dying, so that they can die in peace at a time of their choosing and avoid the loss of autonomy and dignity that so many people fear. I fear it; perhaps other hon. Members also fear it, for none of us can know when we will die until we are dying ourselves. This is not a measure that chooses between life and death; it chooses between death and death, between dying and dying. That is the truth of the matter.
I did not always think like this, but I have seen the limits of even the most skilful palliative care. I have seen the look in the eyes of the patient reconciled to the end of their days, and the pleading expression of the poor soul who wants to put an end to suffering. That is what we are debating—suffering. Assisted dying is complementary to palliative care; it is not an alternative. Others will say that assisted dying is unconscionable, and I respect that. I am asking the House to vote to support choice; that is all I am asking. We voted for the Bill before, and hon. Members in the other place sought to prevent its passage, but we are not misled or deceived by such a parliamentary device, and neither are the public, who will not forget this moment. I urge Members across the House to support choice. That is all I am asking.
Siân Berry (Brighton Pavilion) (Green)
I am here because we do need to change the law, so that dying people have the choice of a better death than too many horrible progressive terminal diseases allow for now. I am here because of my own conscience; I am a humanist and a patron of Humanists UK. I am also here with the support of so many of our citizens who desperately want to see a change in the law. Many of my constituents have written to me to tell me their personal story of losing people under the worst circumstances because the status quo did not allow them another choice.
Two weeks ago, I heard from my constituent, Julia, who told me about her mother, Jane, and asked me to speak about her case. Faced with a progressive terminal neurological diagnosis at 92 and unable to travel alone for help, Julia’s mother decided in secret to end her life in a very distressing way that I cannot bring myself to describe today. Julia said:
“I had no idea that she was going to act on her oft-stated desire, although in retrospect I realise that a phone call we had in the morning of that day she said goodbye in her own way, and she also made sure that it would be her friend and carer who would find her.”
That was instead of Julia herself the next morning.
Julia continued:
“While I miss her terribly, I am proud of her for her determination, and grateful that, the manner of her death apart, she has left me with positive memories of her, rather than the gradual eroding of her self that she (and I, to be honest,) were both dreading… Now I am coming out of the weeds of my grief at her loss, I am determined to help make her legacy the right for people in her situation—when they are faced with losing all agency—to have the choice to take the ultimate act of agency over their life.”
That is what we are here for. We are here to make something more humane than the situation that Julia and her mum Jane faced. Examples like these are real people—brave for telling us their stories—who have demonstrably been harmed by the law as it stands.
People are raising concern about potential harms if we change things. We have debated this so many times, and now, for every concern I have heard expressed that this new law might be used by someone who is ineligible or by someone who is not choosing freely the way that their terminal illness will play out, I believe we see real safeguards in the Bill before us. They are very, very strict. These requirements will be too much for some dying people, in fact. Some people will be denied the service in this Bill today, but others will benefit, and there is a clear moral case and duty for Parliament as a whole to act to progress this issue.
Now, there is not just a moral case for this Bill, which we have debated before, but a democratic case, too. The serious, careful work we started here must be completed in the normal way in the upper House for the democratic process to be complete. Last year, we voted and voted again on the principle, in Committee and on Report. The promoter of the previous Bill, the hon. Member for Spen Valley (Kim Leadbeater), listened and proposed over 100 of her own amendments and accepted more than 30 from opponents who wanted to go maybe further than she or I would have liked. She worked with civil servants to make its workability crystal clear, and a Minister reported back to us that the Bill was workable.
Other amendments were voted on in this House on Report. On Third Reading, we debated what we had designed, and voted again. We passed a sound piece of legislation last year, and I believe we sent the Lords a good Bill and a safe Bill—a compassionate and workable change in the law that they could refine if they wished. We must now say to the Lords that they must collectively do as MPs did and consider the Bill with the seriousness it deserves, do their duty in putting their votes on the record—vote, just as we did—and bring it to a conclusion in that place.
I ask hon. Members to please vote for this Bill to continue so that its progress and all the work we have done so far to build something better than the status quo for dying people does not end today.
Dr Marie Tidball (Penistone and Stocksbridge) (Lab)
This week, death has felt rather too close to home for me. My dad, John—my constituent, my great political hero and, indeed, my hero in life—had surgery for lung cancer, followed by a cardiac arrest the next day. Thanks to our wonderful NHS and its outstanding care, the CPR and treatment performed on him were successful. He is now in the process of recovery, to such an extent that I was able to have a detailed conversation with him at his bedside, in which he insisted that I come here to this place to speak and vote in this debate. My dad is determined to live. Nevertheless, he told me that if circumstances were different—if his condition was terminal, if he had six months left to live and if he had capacity to make that choice—he would want to have the option to choose an assisted death to give him dignity.
Access to the choice of assisted dying, as tightly drawn in the Bill, enables the terminally ill adult who chooses it to live a good death. On Second Reading of the Bill previously brought forward by my hon. Friend the Member for Spen Valley (Kim Leadbeater), I said that my support was conditional on further safeguards being embedded in it, because too often control is taken away from disabled people.
Dr Tidball
I will continue, if my hon. Friend does not mind.
Clause 2(4) of the Bill before us today says:
“For the avoidance of doubt, a person is not to be considered to be terminally ill only because they are a person with a disability or mental disorder (or both).”
As a member of the previous Bill Committee, I worked for over 90 hours to ensure that all the changes that I requested were made, and they are now on the face of the Bill brought forward by my hon. Friend the Member for Rochester and Strood (Lauren Edwards). My amendments, including two new clauses, were unanimously supported by that Committee. The first, clause 48, establishes a disability advisory board made up of disabled people and our organisations in order to embed a long-term and iterative structure in law to report on the Bill’s implementation and its impact on disabled people. The second, clause 22, sets out provisions to put in place independent advocates for people with autism and mental health conditions, enabling them to effectively understand their options around end-of-life care.
Further, I ensured that clause 8 provides for specific, up-to-date training for registered practitioners on reasonable adjustments and safeguards for autistic people and people with learning disabilities. I also secured an expanded duty in clause 28 to collect additional information about whether, immediately before death, the person seeking assistance has a disability—as defined under section 6 of the Equality Act 2010—other than a disability amounting to terminal illness, as defined in this Bill. Together, these measures create a solid foundation to enable disabled people to have a strong voice when advocating for themselves about their choices on end-of-life care and, importantly, to have a seat at the table so that they can scrutinise and monitor the implementation of this Bill.
Spending nearly two years thinking about death in relation to this Bill has been life-changing for me, because the thing about considering choice in death, understanding what dignity in dying involves and what living a good death really means, is that it makes you think deeply about the meaning of living a good life, too: to love ferociously and to live passionately, experiencing every single moment as if suspended like a vignette woven from “Charlotte’s Web”. As E. B. White’s eponymous character points out:
“After all, what’s a life, anyway? We’re born, we live a little while, we die.”
Each of these stages of human life requires us to treat ourselves and fellow humans with dignity and to value ourselves, to enable us to feel and to perceive our own worth. This Bill not only anchors that dignity at the final stage but, in doing so, compels us to embed dignity in each and every other stage of our lives as well. This Bill lays a counterweight alongside the Government’s plans to improve the quality of and access to palliative care, to drive urgent reform on social care, and to build a new system that gives people the dignity, security and support they deserve. Driving quality in these areas together can and must be done contemporaneously.
My friend, the incredible assisted dying campaigner Nathaniel Dye, passed away this year. He squeezed every single drop of joy out of life and taught me so much about why living a good death matters. In setting the bar high for dignity in death, we set the bar even higher for dignity in life.
Dr Ben Spencer (Runnymede and Weybridge) (Con)
As a former mental health doctor and someone who has done research on decision-making capacity, I want to talk about stigma in the brief time I have today. I have looked after many hundreds of people—perhaps thousands—who have self-harmed or attempted suicide. Of course, a desire for one’s life to end can be entirely reasonable and an understandable wish, but it is often a manifestation of a treatable mental disorder. With the right intervention, care and support, people can get better. They can look back and say, “What was that about? I’m so thankful I didn’t succeed” when they get the care and treatment they need.
The Bill refuses to acknowledge that. It frames the debate—the intervention—as shortening the death process or some form of assisted dying rather than what it is, which is physician-assisted suicide. The Bill is designed to take at face value an expression of a wish to die as an absolute fact—an expression of autonomy—and not a possible manifestation of mental illness. That is its blind spot. That is its most tragic flaw, and it is from there that I believe all its problems derive.
Mental disorder can be very tricky to detect. There is nothing stigmatising about mental disorder. If someone in hospital expressed a wish to die, if someone in a care home or an outpatient clinic expressed a wish to die, if someone here in the Chamber expressed a wish to die or if a loved one expressed a wish to die, the first person I would want them to see would be a psychiatrist, not an assisted dying practitioner.
Dr Simon Opher (Stroud) (Lab)
May I praise the House for some fantastic speeches all round, including from my hon. Friends the Members for West Lancashire (Ashley Dalton) and for Filton and Bradley Stoke (Claire Hazelgrove), and indeed just now from my hon. Friend the Member for Penistone and Stocksbridge (Dr Tidball) and the hon. Member for Runnymede and Weybridge (Dr Spencer)? I am proud of our House and the way in which we have debated this matter.
I have been involved in delivering palliative care and end-of-life care—they are actually quite different—for over 34 years and I continue to do so as a GP. Given the time, I will cut my speech short, but I want to say that this is really about choice. Choice exists for people in France, in Spain, in the Netherlands, in Belgium, in Australia, in the US and in Canada, and indeed in Jersey and the Isle of Man. It also exists for people in this country if they have got 15 grand. However, we do not give access to it at the moment.
To all the doubters, I say that this is the safest assisted dying Bill in the world—full stop. That is a fact, because it has got so many safeguards: many more than the ones in Australia or any other place.
Dr Opher
No, I will carry on if that is okay.
It is a great thing to offer end-of-life care and palliative care. In 2010, the UK system for palliative care was at the level of the best in the world, yet still people went to Dignitas. Still, 600 people who were suffering from terminal diagnosis killed themselves. Indeed, in Oregon, 92% of patients who opted for assisted dying were receiving good palliative care. They are different things.
Dr Opher
I am going to carry on; I will be very brief.
There has been a lot of concern—quite rightly—about disabled people and people from black and Asian minorities and whether they will be harshly dealt with. In fact, the evidence from other jurisdictions is that these people do not go for assisted dying—it is actually a white, middle-class, able-bodied thing—so in a way we have the opposite problem to deal with.
Let me also say, to answer a point made earlier, that studies done in California showed that where people with terminal illness and depression were treated for their depression, it made no difference to their choice on assisted dying. Assisted dying is different because, as my hon. Friend the Member for Bury St Edmunds and Stowmarket (Dr Prinsley) said, it is a choice not between life and death, but between someone’s death from natural causes and death under their own control. I say to all hon. Members that we have a choice to make in five or ten minutes, but we must give other people that choice. Is it our right to deny those people that choice? I will end my remarks as Madam Deputy Speaker is giving me some black looks.
Madam Deputy Speaker (Caroline Nokes)
That brings us to the Front Bench contributions.
Damian Hinds (East Hampshire) (Con)
Today is once again a day of heavy responsibility for all of us to decide on what we in this House call “conscience issues”. Many of the people who we represent hold strong and immutable views, and we hear from them. However, we represent many others who hold much more nuanced views and we are less likely to hear from them. They are the ones who say “Yes, but…”, “Well, it depends…” or “I’m just not sure”. Others evolve their views over time, and most can do so in private, but there is no such option for Members of Parliament: our names are publicly recorded in a column marked “Aye” or “No”.
On issues like this, Members from across the House cast their vote after very serious consideration, personal reflection and sometimes deep turmoil. Members who support the Bill should not have their motives questioned, Members who oppose the Bill should not have their motives questioned, and Members who have reached a different conclusion from one they reached at an earlier stage should not have their judgment questioned either.
At the previous Second Reading, we were voting on the principle of the Bill, as is usual on Second Reading. Colleagues knew that amendments could be made in Committee and, as has been discussed, a number of such amendments were made. On Third Reading, many MPs voted in the expectation that further changes would be made in the other place. Today, we vote on the Bill as it is today, which is almost exactly the same as it was at that previous Third Reading.
If there is the prospect of the Parliament Acts being used, that would increase the importance and the salience of the text as it is now. Today, it is reasonable and entirely in order for hon. Members to consider information that is available now that was not available in those previous parliamentary deliberation. Colleagues have alluded to a number of such pieces of information. We now have the evidence that went to the Lords Select Committee on safeguards and procedures, the updated impact and equalities impact assessments, and the reports from the Delegated Powers and Regulatory Reform Committee and the Constitution Committee covering the extent of delegated powers. We have heard from royal colleges and other professional bodies, many of whom have a neutral stance on the principle but raise significant questions about particular aspects. We know from Ministers that there would need to be some reprioritisation of NHS resources, but we do not know the extent. None of these things decide the question for Parliament, but they may help inform us.
If any provision in the Bill has not been fully brought into effect within four years, it comes into force automatically. Different views will exist among us as to whether that can confidently be said to be time enough in considering workforce, training, operational readiness, and the design and implementation of safeguards. The Government have said, rightly, that the time taken to implement other schemes is not directly comparable, because none are as in this Bill.
This is a free vote on a matter of conscience—there is no party line on either side of the Chamber. No one, I suggest, finds this issue easy. I, like all of us, have received countless representations from constituents, often informed by the most heartbreaking family circumstances. Their arguments are sincere, earnest and deeply moving, and in equal measure on both sides of this issue. We can say the same for the heartfelt speeches we have heard once again today from Members from all parties represented in the House. There are moments in debates like the one we have had today that are difficult to sit through and listen to, but it is the most immense privilege to be a Member of Parliament and to hear some of these testimonies.
There are moments in debates like the one we have had today that are difficult to sit through and listen to, but it is the most immense privilege to be a Member of Parliament and to hear some of these testimonies. We have had, again, a good and respectful debate in the very best traditions of our Parliament. Whatever the result of the vote a little later today, that respect must endure, for that is why we are put here—to take difficult decisions about the law. Somebody has to take those decisions, not because it is obvious to everyone what to do, but precisely because these issues are hard to resolve. That also involves recognising that good people with the best intentions can and do reach different conclusions on the same question.
Each of us now can only make our own judgment in good faith. Each of us bears the responsibility that can only fall to us as parliamentarians to consider the arguments, the evidence and, crucially, the legislation before us as we cast our votes.
The Minister for Social Care (Alison McGovern)
Not for the first time this week, I find myself wholeheartedly agreeing with the right hon. Member for East Hampshire (Damian Hinds). He and I agree that we will all act according to our conscience and respect others if they come to a different conclusion.
I thank Members on both sides of the debate across the House for their consideration of this legislation and their thoughtful contributions to the debate. By my count, 40 Members have spoken in the debate; I have listened to all that they have said with great interest, and I thank each and every one of them. It has been a difficult debate to speak in at times. We have heard of people’s own family and private experiences, and that is hard to bring to this House. I really thank all colleagues across every corner of this House for doing so.
The issue of assisted dying has been subject to extensive and detailed consideration over a number of years, most recently in this House and the other place in the previous Session, as well as outside Parliament. We think today of all those who feel strongly on both sides of this debate and what they are thinking about as they listen to our discussions. We send our care to all those who are struggling with grief.
Let me reiterate that the Government are neutral on the question of assisted dying and on the passage of the Bill. As the Prime Minister has said, this is an incredibly important and personal debate, and it is right that it is a matter for Parliament, not Government, to decide whether the Bill should become law. However, the Government have a duty to the statute book. It is on that basis that I am speaking at the Dispatch Box today as the Minister responsible for helping to ensure that the Bill, if passed, is workable and effective.
I must explain to Members that in the interests of time, I am going to keep my remarks purposefully brief, and I will not be taking any interventions; I apologise to Members wholeheartedly for that, as I would normally take interventions. I am happy to discuss with Members any issues that they have.
I have listened to the entire debate today and heard Members’ views, questions and many interventions, and I want to turn briefly to a couple of important issues. On procedure, like any private Member’s Bill, this Bill will proceed through the usual parliamentary stages, subject to Parliament’s will. With respect to questions to the Government on the Parliament Acts, I refer Members to the Acts themselves, which set out conditions under which legislation may pass without requiring the consent of the House of Lords. That is a matter for Parliament, and it is not for the Government to decide whether to pass this Bill. As is usual with any constitutional questions, Members may approach the Clerks for further advice, as I am sure you would agree, Madam Deputy Speaker.
Alison McGovern
I have said that I am not going to take any interventions. I am sorry to be discourteous to the hon. Member, but I am going to stick to that.
I want to make a few comments on the matter of social care and palliative care, having recently taken over responsibility for these most important issues. In my opinion, social care has been ignored for far too long—both the 1.5 million people, mainly women, who work in it and the families who need it. We have heard that across the House today. The Prime Minister has made social care a personal priority, and I am working with my right hon. Friend the Secretary of State to deliver changes now, alongside the work being done by the Casey commission, which we have expedited by a year.
Building a national care service will mean that people know where to turn when they need help and that care workers are given the status and the respect they deserve. We are pushing ahead with workforce changes, including career progression, training and job security, and we have made £4.6 billion of additional funding available for adult social care by the end of this Parliament, including £500 million for the first fair pay agreement for care workers. We will strengthen social care now—we are not just waiting for the Casey commission—and provide greater choice and independence as we do so.
Turning to palliative care—
Dame Meg Hillier
On a point of order, Madam Deputy Speaker, I have huge respect for the Minister, but she has said that she will not take any interventions. She is a very good Minister, and I trust that she will answer in detail the points that have been raised in the House today; having discussions with her and the Government after the debate is too late for today’s vote. I know she is a thorough and assiduous Minister and I am sure she will do her best to do that, but it is important to make that point to the House.
Madam Deputy Speaker (Caroline Nokes)
As the hon. and very experienced Member will know, that was not a point of order and not a matter for the Chair, but I am sure the Minister has heard her.
Alison McGovern
I also respect my hon. Friend and, though it was not a point of order, the House will have heard what she said. I am attempting to address the points that have been raised in the debate, particularly on procedural matters, on social care and palliative care, which I turn to now.
Palliative care is extremely important and has been raised many times within the debate. As the Chair of the Select Committee set out, we are developing a modern service framework for palliative and end-of-life care. The framework is clinically led and evidence-based, to support sustained improvements in outcomes for patients and carers, including by systematically identifying, measuring and reducing health inequalities and reducing unwarranted variation in access, in experience and in outcomes. As part of that work, we expect all integrated care boards to complete a needs assessment so that we can get a detailed understanding of their current and future population, including people of all ages with palliative care and end-of-life needs. That is vital in order to commission services that best meet the need while providing value for money. Many hon. Members raised the importance of doing that, and particularly of reducing unwanted variation. I acknowledge that and I will be working with Members across the House to deliver that modern service framework.
Members quite rightly mentioned the hospice sector. We provided a £125 million capital boost to funding for adult and children and young people’s hospices. I say to hon. Members that I have heard the points that they have made, and I know we have more to do. Many hon. Members and friends will know that in July, I lost my own mum, so I had a very practical education in this topic, and that experience will shape how I take this work forward.
To conclude, I thank all hon. Members once again for all they have said. They will understand how difficult it is when we are sharing personal experience, as many of them have done today, and I am really proud of everybody who has done so, difficult and challenging though this issue is. I thank all Members who have given me their sympathy over recent months and weeks. It has been so appreciated.
The Government remain neutral on whether the Bill should become law, but it is our serious responsibility, should Parliament pass it, to ensure effective implementation within the framework provided by the legislation. On that basis, we would provide technical support to the promoter if Parliament chooses to progress the Bill.
That said, I will repeat the comments made by the right hon. Member for East Hampshire from the Opposition Dispatch Box, which I now say on behalf of the Government. This is a deeply challenging issue for us all, for the public and for the constituents we represent. In discussing this issue, we must model the best behaviour of this House—having respectful, thoughtful, careful debate, listening to one another and understanding our very different perspectives. I think that we have done that today. I hope that, whatever happens in the Division, we will be able to continue to show those behaviours and give this serious subject the deep respect it deserves.
Kit Malthouse
claimed to move the closure (Standing Order No. 36).
Question put forthwith, That the Question be now put.
Division 74
Question accordingly agreed to.
Ayes: 293
Labour: 209
Liberal Democrat: 52
Conservative: 21
Green Party: 4
Plaid Cymru: 3
Independent: 3
Noes: 218
Labour: 115
Conservative: 64
Liberal Democrat: 13
Independent: 8
Democratic Unionist Party: 5
Reform UK: 4
Your Party: 2
Traditional Unionist Voice: 1
Plaid Cymru: 1
Alliance: 1
Restore Britain: 1
Ulster Unionist Party: 1
Division 75
Question accordingly negatived.
Ayes: 270
Labour: 190
Liberal Democrat: 52
Conservative: 17
Green Party: 5
Plaid Cymru: 3
Independent: 2
Noes: 286
Labour: 153
Conservative: 90
Liberal Democrat: 17
Independent: 9
Reform UK: 5
Democratic Unionist Party: 5
Your Party: 2
Traditional Unionist Voice: 1
Plaid Cymru: 1
Alliance: 1
Restore Britain: 1
Ulster Unionist Party: 1
Business without Debate
Hon. Members
Object.
Bill to be read a Second time on Friday 4 December.
Hospitality Services (Value Added Tax Exemption) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 16 October.
Sporting and Physical Education Services (Value Added Tax Exemption) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 16 October.
Meat (Information About Method of Killing) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 16 October.
Covid-19 Vaccine Damage Payments Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 16 October.
European Convention on Human Rights (Notification of Withdrawal) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 16 October.
Lobular Breast Cancer Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 5 February 2027.
Controlled Drugs (Procedure for Specification) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 16 October.
In-person Banking Services Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 19 March 2027.
Home Cooling Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 5 February 2027.
Northern Ireland Troubles (Criminal Investigations etc) Bill
Resumption of adjourned debate on Question (4 September), That the Bill be now read a Second time.
Hon. Members
Object.
Debate to be resumed on Friday 16 October.
Multi-Storey Car Parks (Safety) Bill
Motion made, That the Bill be now read a Second time.
Hon. Members
Object.
Bill to be read a Second time on Friday 16 October.
Sale and Supply of Glue Traps (Prohibition) Bill
Motion made, That the Bill be now read a Second time.
25th Anniversary of 9/11
(1 day, 7 hours ago)
Commons ChamberRead Full debate Read Hansard Text Watch Debate Read Debate Ministerial Extracts
Alan Mak (Havant) (Con)
Twenty-five years ago today, on a clear Tuesday morning, 19 terrorists hijacked four passenger planes. Two were flown into the twin towers of the World Trade Centre in New York. A third struck the Pentagon, and the fourth, United Airlines flight 93, crashed in a field near Shanksville, Pennsylvania, after passengers and crew resisted their hijackers.
In a period of less than two hours, the twin towers fell and 2,977 innocent people from more than 90 countries were murdered. Of those killed, 67 were British citizens, more than from any other country apart from the United States. Thousands more were injured, and many survivors, emergency workers and people who took part in the recovery operation have lived with the physical and psychological consequences ever since.
Jim Shannon (Strangford) (DUP)
I commend the hon. Gentleman for bringing forward the debate. It is only right on this day that we remember all those who lost their lives, in particular the 67 British citizens. As someone who represents a constituency in Northern Ireland that knows all too well the cruel, devastating scourge of terrorism and the effect on loved ones and first responders, I know that grief is indeed the price we pay for love. Does he agree that this House stands resolutely shoulder to shoulder with our American allies in the ongoing fight against global terrorism, wherever it may be in this world?
Dr Scott Arthur (Edinburgh South West) (Lab)
The hon. Gentleman mentioned the loss of emergency workers in that brutal attack, and we celebrate and salute their courage. But we now know, since the attack, that more firefighters have died as a result of their work on the site than died on the day of the attack itself. When we remember those who died that day, we also have to think about the legacy of the attack, including those firefighters who have been lost.
Alan Mak
The hon. Gentleman is absolutely right to raise that point, and it is one that I will come to later in my speech. I was just saying to the hon. Member for Strangford (Jim Shannon) that it is right that we stand shoulder to shoulder with our friends and colleagues from the United States, because although the attack took place on American soil, it was a global tragedy. Its victims came from across the world. Its grief crossed borders and its consequences shaped the quarter of a century that followed.
The work of the 9/11 memorial and museum in New York is guided by three simple principles: to honour, to educate and to inspire. Those principles should also guide us in how we mark this anniversary in Britain: honouring those who are lost, educating those too young to remember and drawing inspiration from the courage shown in the face of terror.
For those of us old enough to remember that day, the events are seared into our memory. We remember where we were when we heard the news. We remember watching the images from New York and struggling to understand what we were seeing. We remember the shock of the second plane striking the second tower when it became clear that this was not an accident, and we remember the towers falling, knowing that thousands of people were still trapped inside.
But the passage of 25 years creates a new responsibility. Every child now at school was born after the attacks. Many young adults have no personal memory of 9/11. Indeed, one current Member of this House was not yet born when the attacks took place. In fact, across the United Kingdom, around 20 million people—close to three in 10—have been born since the attacks. For a growing number of our population, 9/11 is not a memory; it is something they encounter only in textbooks, in online videos or in brief references during foreign policy discussions. For them, it is history. That change is inevitable, but forgetting is not. We must ensure that future generations understand what happened, who was lost and why the attacks still matter.
Young people should understand that al-Qaeda’s terrorism was driven by a murderous ideology. They should also understand the extraordinary courage shown in response.
Matt Turmaine (Watford) (Lab)
We must also remember the families of those killed on this tragic day 25 years ago. I was working in the BBC press office at the time and remember everybody standing around watching the shocking scenes unfolding on television—horrific scenes, unseen until perhaps the covid pandemic. Does he agree that international efforts to promote tolerance and understanding to avoid another such incident of this type are vital?
Alan Mak
I absolutely agree with the hon. Gentleman. We should use this opportunity of the 25th anniversary to look forward and to educate young people.
As well as educating young people about al-Qaeda’s terrorism and its murderous ideology, there is an opportunity to teach them about the extraordinary courage shown in response to that ideology—from the firefighters climbing the stairs as others came down, to police officers, paramedics and office workers helping strangers to safety, and to the passengers and crew of United Airlines flight 93 whose resistance prevented many more deaths.
9/11 must never be reduced to footage of aircraft and collapsing buildings. The numbers “2977” were 2,977 individual lives—parents, children, husbands, wives, siblings, friends and colleagues, all of whom expected to return home that evening. That includes the 67 British victims, who were mentioned by me and the hon. Member for Strangford.
9/11 was an attack on the United States, but its grief crossed borders immediately. British families received the same unbearable phone calls, waited for the same news and experienced the same permanent empty place at family gatherings. I recognise those British families today. Their loss did not end when the cameras moved on. Anniversaries can bring public attention, but bereavement is lived privately day after day and year after year.
Earlier this year, His Majesty the King and Her Majesty the Queen visited the memorial in New York. They laid flowers beside the south pool, met bereaved families, survivors and first responders, and left a message honouring those who lost their lives. They expressed Britain’s enduring solidarity with the American people, and their visit was a fitting expression of the special relationship between our countries and a reminder that Britain continues to share in this remembrance.
That loss also reaches into my Havant constituency. My constituent Sally Taber lost her godson Oli Bennett in the attacks. Oli was 29 years old and a successful financial journalist. He was at the World Trade Centre on 9/11 to report on a conference. Sally told me that, when she saw the TV footage, she knew her godson had died. Oli’s family, his godmother and his school friends were determined that his life would be remembered not for the terrible way it ended, but for the values he had lived. They established the Oli Bennett Charitable Trust in his memory, offering grants to aspiring entrepreneurs.
Over nearly 25 years, the trust has helped 169 young people begin their dream of starting a business. The trust is now drawing to a close, but its closure does not bring Oli’s legacy to an end. It leaves behind scores of young people who were given an opportunity because his family and friends responded to an act of destruction by helping others create something new. Sally’s story reminds us that an atrocity committed thousands of miles away can leave an absence in a home and a community right here in Britain. It also reminds us why names, photographs, voices and personal memories still matter.
We must therefore continue to recognise that the human cost did not cease on 11 September. The destruction of the World Trade Centre released a vast toxic dust cloud, and more than 400,000 first responders, recovery workers, survivors, residents and others were exposed during the attacks and the nine-month recovery operation that followed, as the hon. Member for Edinburgh South West (Dr Arthur) rightly said, and this House pays tribute to all of them.
It is also right that this year, for the first time, the ceremony at ground zero will include a seventh moment of silence, dedicated to those who died from 9/11-related illnesses. This is an important recognition that the victims of 9/11 were not only those whose lives were taken on the day itself, but also those whose sacrifice shortened their life in the years afterwards.
That brings me to the role of technology in remembrance. 9/11 was one of the first great tragedies of the digital age. Millions watched it unfold live on television, and much of what survives was recorded by ordinary people using the technology available to them at the time: voicemails, telephone calls, photographs, emails, webcam recordings and amateur video. They all captured fragments of individual experience. Today’s technology allows those fragments to be preserved, connected and shared on a scale that would once have been impossible. A pupil in the Havant constituency who has never visited New York can examine a digital timeline of the morning, study primary source material and hear directly from a survivor, a bereaved relative or a first responder.
That work of preservation is increasingly urgent as people with first-hand memories of 9/11 grow older. The children who lost parents are now adults. Many of the firefighters, police officers, medics and recovery workers have passed away. We cannot assume that first-hand testimony will always be available, so we must record it while we can so that it remains accessible in the decades ahead.
No institution has done more to provide that access than the National September 11 Memorial and Museum in New York. Built on the site of the World Trade Centre, it combines the physical power of place with the evidence needed to understand what happened. Its collections preserve objects, images, recordings and personal accounts, and its educational work helps teachers to introduce pupils to an event that took place before they were born.
Anyone who has visited the memorial and museum, as I have had the privilege of doing with my wife, will understand the scale of its reach. It is not only an American place of remembrance. Around 97 million people have visited the memorial and nearly 28 million have entered the museum. Visitors have come from more than 170 countries, travelling to the place where history happened to pay their respects, understand the attacks and remember those who were murdered.
I thank everyone at the memorial and museum for the care and the seriousness with which they have preserved this history, supported families and helped a generation understand the attacks. I also thank the survivors, relatives, first responders and witnesses who have entrusted the museum with their memories. Sharing those experiences can carry a considerable personal cost, but it gives future generations something that no summary can ever provide: a direct connection with another person’s experience.
The museum’s work should prompt us to consider our responsibilities here in the United Kingdom. 9/11 is not a mandatory topic in England’s national curriculum and, while some schools do teach it, not every pupil will learn about it. I recognise that education policy does not fall within the Minister’s Department; nevertheless, 9/11 was an international event that profoundly shaped Britain’s relationship with our closest ally. I would therefore be grateful if she addressed three questions when responding.
First, will she work with the Prime Minister and the Education Secretary to examine how 9/11 is taught in schools and how resources from the museum can be made more readily available to teachers and pupils? Secondly, will she ask the British embassy in Washington and the consulate general in New York to support closer educational and commemorative links between the museum, British cultural institutions and victims’ families? Thirdly, how can the Government support British families to preserve their memories so they are not lost?
Today’s anniversary is an opportunity to reaffirm our faith in democracy and decency.
Sir Christopher Chope (Christchurch) (Con)
I congratulate my hon. Friend very much on bringing this debate to the House. What he has said is symptomatic of the importance of the special relationship, which he does so much to support in his role as a member of the executive of the British-American Parliamentary Group. Does he agree that a point that could be added to his list would be for the Government to promote the special relationship, ensuring that generations of children coming up realise that we are really close allies and shall remain close allies with our friends in the United States, irrespective of who happens to be holding elected office at any one time?
Alan Mak
I thank my hon. Friend for his very positive intervention and for his work as an officer of the British-American Parliamentary Group. I am proud to serve on its executive. The Minister will have heard his request, which I certainly agree with. I agree that today’s anniversary is an opportunity to reaffirm our relationship with the United States and our wider faith in democracy and decency.
The terrorists sought not only to murder innocent people on 9/11, but to destroy open societies, the relationships my hon. Friend talks about and the values that sustain them. They failed. The response to hatred was courage. The response to destruction was rescue and rebuilding. The response to human lives being lost is a determination to keep speaking their names.
Remembrance is not passive. Instead, it requires active choices: to teach, to preserve and to tell the stories of individuals, rather than allowing them to disappear into history. Those who remember that morning must now pass on its story to those who do not. We owe it to the people who were murdered, including the 67 British victims; we owe it to families such as Sally’s, who have carried their loss for a quarter of a century; and we owe it to future generations, who must understand both the hatred displayed that day and the courage that came in response.
Inscribed in the 9/11 museum’s memorial hall are words from Virgil’s “Aeneid”
“No day shall erase you from the memory of time.”
Inspired by Virgil’s poetry, we must ensure the victims of history’s deadliest terrorist attack are never lost to time. That is a responsibility carried by each generation, including ours, and it is one that we must always honour.
The Minister for International Development (Kirsty McNeill)
I am very grateful to the hon. Member for Havant (Alan Mak) for securing this important debate. He spoke movingly and has given the House an opportunity to mark the 25th anniversary of the deadly terrorist attacks of 11 September 2001.
Twenty-five years on, it can be tempting to think of 9/11 as a moment in history—an event, perhaps, for a textbook, museum or documentary. Those, of course, are important, and I will come to them later, but for thousands of families, 9/11 is not history at all; it is a memory deeply felt of someone who left home that morning and never returned. So today we begin with them. We remember the nearly 3,000 people killed in New York, at the Pentagon and in Pennsylvania. We remember the victims from more than 90 countries. We remember the 67 British citizens who lost their lives. We stand with those who lost people they loved and those who have carried that loss for a quarter of a century.
The hon. Member for Havant spoke movingly about his constituent Sally Taber and the loss of her godson, Oli Bennett. I pay tribute to Oli and offer my deepest sympathies to Sally, to all his family and to all those who knew and loved him. The charitable work established in his memory is a truly powerful example of how a life can continue to inspire hope and opportunity for others.
We should also remember and honour the extraordinary courage that was shown that day by the firefighters who climbed the stairs of the World Trade Centre while thousands of people were trying to escape, and by the police officers, paramedics and ordinary members of the public who did extraordinary things, putting the safety of others before their own. Passengers aboard Flight 93 acted with remarkable bravery. As my hon. Friend the Member for Edinburgh South West (Dr Arthur) said, many first responders lost their lives, but others have lived with the physical and mental effects of what they experienced. Their courage deserves more than our admiration; it deserves our lasting remembrance.
The courage we remember today was individual, but the response that followed was truly collective, as the hon. Members for Christchurch (Sir Christopher Chope) and for Strangford (Jim Shannon) have told us. For 25 years, the United Kingdom and the United States have stood together in remembrance, and we do so again as we mark this anniversary. The hon. Member for Havant asked about closer educational and commemorative links with the National September 11 Memorial & Museum. Our diplomatic network in the United States has worked closely with American partners and other stakeholders in support of this anniversary, and we will continue to look for opportunities to deepen US-UK co-operation in that regard.
My hon. Friend the Minister for the Americas represents His Majesty’s Government at commemorative events in New York today, including at the National September 11 Memorial at Ground Zero and at a special memorial at the Queen Elizabeth II September 11th Garden. There, he will join victims, families, survivors, first responders, American representatives and international partners.
Here in the United Kingdom, the anniversary was marked this morning with a special changing of the guard ceremony at Buckingham Palace. It echoed the special programme of music played there on 13 September 2001, when the British and American national anthems were played as a clear signal of our unity and support. Their Royal Highnesses the Duke and Duchess of Gloucester and my right hon. Friend the Foreign Secretary stood alongside the United States ambassador to the United Kingdom, Warren Stephens, to remember. They were joined by representatives of victims’ families and UK emergency services. Those events cannot undo the pain of the past, but they are a way of us saying that all lives that were lost still matter, their sacrifices still matter, and we will never forget what happened.
The hon. Member for Havant rightly focused on our responsibility to pass the memory of 9/11 on to a new generation. Many of us remember where we were when we heard the news, and my hon. Friend the Member for Watford (Matt Turmaine) reflected on that powerfully, but many young people have no memory of that day; many were not yet born. Future generations should understand what happened and why it mattered. Education should explain clearly the harm caused by terrorism. It should tell the stories of the victims, and it should recognise the courage of the first responders.
The National September 11 Memorial & Museum plays a vital role in preserving such stories and helping new generations understand both the scale of the attacks and the individual lives affected. Wider digital archives allow people around the world to hear testimony, see photographs and explore historical records, and the UK is playing its part too. Through institutions such as the National Archives, records connected to September 11th are being preserved so that future generations can continue to learn from them. The hon. Member for Havant asked about how 9/11 is taught and remembered in schools, and I will ensure that his points are drawn to the attention of my right hon. Friend the Education Secretary and the Minister for the Americas.
The attacks of September 11th demonstrated, with truly tragic clarity, why our collective security matters. Following 9/11, NATO invoked article 5 for the first time in its history, because our allies recognised that an attack on one was an attack on all. In the years that followed, British and American service personnel would stand side by side once again in Afghanistan. Many never returned home, and we remember them today, too, and recognise the lasting impact on veterans and military families.
Today, this House has come together to remember those who lost their lives, honour the courage shown that day, and stand with the families and communities whose lives were changed forever. As we mark this 25th anniversary, let us remember that behind every single statistic was a person, behind every headline was a family and behind every act of remembrance is a promise: “You will never be forgotten.”
Question put and agreed to.
Petition
West Bridgford Local Government
Written Statements
(1 day, 7 hours ago)
Written StatementsRead Full debate Read Hansard Text
Service Police Complaints Commissioner: Annual Report 2025
(1 day, 7 hours ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister for Veterans and People (Mr Calvin Bailey)
I am pleased to lay before Parliament today the Service Police Complaints Commissioner’s annual report for 2025 on the service police complaints system.
This report is published by Jonathan Rees and covers the operation of the service complaints system and the delivery of his functions as the commissioner.
The findings of the report will now be considered fully by the Ministry of Defence, and a formal response to the commissioner will follow once that work is complete.
Attachments can be viewed online at: http://www.parliament.uk/business/publications/written-questions-answers-statements/written-statement/Commons/2026-09-11/HCWS335/
[HCWS335]
Nepal-China Flash Flooding
(1 day, 7 hours ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Parliamentary Under-Secretary of State for Foreign, Commonwealth and Development Affairs (Chris Elmore)
My noble Friend the Parliamentary Under-Secretary of State for Indo-Pacific (Baroness Winterton of Doncaster) has today made the following statement:
I am sure the whole House will join me in expressing our deepest sympathies to all those who have lost loved ones, homes and livelihoods following the devastating floods on the Nepal-China border.
I am writing to update the House on the impact of the floods and on the support the United Kingdom is providing in response.
The flooding has caused significant loss of life and extensive humanitarian need. As of 8 September, Nepalese authorities report 1,357 fatalities, 5,326 people missing, 6,827 injured and 13,583 rescued. As of 6 September, Chinese media report 43 dead and 519 missing. Damaged infrastructure and disrupted communications continue to hamper the delivery of assistance and the assessment of the disaster’s full impact. Immediate priorities include emergency shelter, food, safe water and sanitation, healthcare, essential relief items and protection services.
The UK stands with the people of Nepal and China through this tragedy. I pay tribute to the emergency responders, Government authorities, humanitarian organisations and community volunteers working tirelessly in extremely difficult circumstances.
In the immediate aftermath of the disaster, the Prime Minister announced a £5 million package for lifesaving humanitarian assistance for Nepal. This support is being delivered through the Red Cross, Start Fund Nepal and UN agencies, providing clean water, sanitation, shelter, medical care and co-ordinated emergency support. A central part of the UK’s approach is to work through organisations that can reach affected communities quickly and effectively. UK contributions to pooled funds and multilateral development banks, including the International Federation of Red Cross and Red Crescent Societies disaster relief emergency fund, the World Bank and the Asian Development Bank, are also helping to mobilise large-scale financial support. A multidisciplinary UK humanitarian team has also been deployed to assess evolving needs and help ensure assistance is delivered effectively. The United Kingdom’s response is being delivered in support of, and in co-ordination with, the Government of Nepal’s relief and recovery efforts.
This support builds on the UK’s long-standing contribution to strengthening Nepal’s resilience to climate-related disasters, with more than £100 million provided over the last 15 years. UK-supported institutions, including Nepal’s National Disaster Risk Reduction and Management Authority and humanitarian logistics systems, are playing a central role in the current response. British science, research and technical expertise have also helped Nepal prepare for and manage natural disasters over many years, including through Met Office support on forecasting and work by Durham, Northumbria and Edinburgh Universities on early warning, contingency planning and glacier change.
The UK has not received a request for assistance from the Chinese authorities but stands ready to offer support to those affected.
I visited Nepal last week to demonstrate the UK’s solidarity and hear directly from those co-ordinating the response and recovery effort, including the Nepalese Government, the UN and other agencies.
The United Kingdom’s response has involved close co-ordination across Government, including the Foreign, Commonwealth and Development Office, the Ministry of Defence, the Met Office and other departments.
Our consular teams continue to work intensively to support British nationals and their families. UK police family liaison officers are supporting affected families. We recognise that families understandably want clear and rapid answers. We have written to affected families and spoken to diaspora representatives, and we will continue to work with the Nepalese and Chinese authorities to pursue every credible avenue, while avoiding unverified information or false expectations. Travel advice for British nationals is being updated regularly to reflect the evolving situation.
We have reinforced the British embassies in Beijing and Kathmandu with additional staff and deployed two disaster victim identification experts to Kathmandu. They are engaging with the Nepalese authorities and assessing what further support may be appropriate.
As recovery efforts continue, the United Kingdom will remain a steadfast partner to Nepal. We will continue to help meet urgent humanitarian needs, support vulnerable people and contribute to longer-term recovery and reconstruction.
The thoughts of the Government remain with all those affected by this tragedy.
[HCWS336]
Terrorism Prevention and Investigation Measures: 1 June to 31 August 2026
(1 day, 7 hours ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister for Security (Dan Jarvis)
Section 19(1) of the Terrorism Prevention and Investigation Measures Act 2011 requires the Secretary of State to report to Parliament as soon as reasonably practicable after the end of every relevant three-month period on the exercise of their TPIM powers under the Act during that period. TPIM notices in force (as of 31 August 2026) 4 Number of new TPIM notices served (during this period) 2 TPIM notices in respect of British citizens (as of 31 August 2026) 4 TPIM notices extended (during the reporting period) 0 TPIM notices revoked (during the reporting period) 0 TPIM notices expired (during reporting period) 1 TPIM notices revived (during the reporting period) 0 Variations made to measures specified in TPIM notices (during the reporting period) 3 Applications to vary measures specified in TPIM notices refused (during the reporting period) 0 The number of subjects relocated under TPIM legislation (during the reporting period) 3
The level of information provided will always be subject to slight variations based on operational advice.
The TPIM review group keeps every TPIM notice under regular and formal review. TRG meetings were convened on 1 June 2026, 4 August 2026 and 12 August 2026.
[HCWS333]
Terrorism Prevention and Investigation Measures: 1 March to 31 May 2026
(1 day, 7 hours ago)
Written StatementsRead Full debate Read Hansard Text Read Debate Ministerial Extracts
The Minister for Security (Dan Jarvis)
Section 19(1) of the Terrorism Prevention and Investigation Measures Act 2011 requires the Secretary of State to report to Parliament as soon as reasonably practicable after the end of every relevant three-month period on the exercise of their TPIM powers under the Act during that period. TPIM notices in force (as of 31 May 2026) 3 Number of new TPIM notices served (during this period) 1 TPIM notices in respect of British citizens (as of 31 May 2026) 3 TPIM notices extended (during the reporting period) 0 TPIM notices revoked (during the reporting period) 0 TPIM notices expired (during reporting period) 0 TPIM notices revived (during the reporting period) 0 Variations made to measures specified in TPIM notices (during the reporting period) 1 Applications to vary measures specified in TPIM notices refused (during the reporting period) 0 The number of subjects relocated under TPIM legislation (during the reporting period) 1
The level of information provided will always be subject to slight variations based on operational advice.
The TPIM review group keeps every TPIM notice under regular and formal review. TRG meetings were convened on 3 March 2026, 5 March 2026 and 7 May 2026.
[HCWS334]