Terminally Ill Adults (End of Life) Bill (Twenty-ninth sitting)

Debate between Sarah Olney and Kit Malthouse

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[Sarah Olney]

I am grateful for that intervention, but the crucial point is the vote in Parliament, so that MPs get not only an opportunity to consider whether sufficient progress has been made—as per new clause 40—but a vote to confirm that they are content for the legislation to proceed.

[Kit Malthouse]

I am sure the hon. Lady understands that a vote of that nature would not necessarily be binding, or compel the Government to do anything, but there would be other opportunities for the House to consider the legislation in debate and vote on it. She knows that there are a number of ways to do that, including via a Backbench motion or an Opposition day.

[Sarah Olney]

I refer to my earlier comments: there are few enough opportunities for MPs to have any further control over how this legislation is going to be implemented. I do not think that it is asking too much to want a further opportunity to be mandated, and not left—dare I say it—to the vagaries of the Backbench Business Committee. There are Opposition days, but this is cross-party, conscience issue. I can speak only for my own party, but I think there are a number of other issues that the Opposition would want to use those debates to address. Taken together, these amendments would ensure that Parliament is properly informed if the Secretary of State decided to commence the scheme before the four-year auto-commencement deadline.

I want to address how the Bill will be implemented in Wales. On 23 October 2024, in anticipation of the Bill being published, Senedd Cymru debated a motion calling on the Welsh Government to

“a) support the principles of assisted dying; and

b) support Westminster parliament to introduce a compassionate assisted dying law in England and Wales.”

The motion was defeated 19 to 26. Among those who voted against were a number of Welsh Government Ministers, including First Minister Eluned Morgan, and I believe that in three political parties—Labour, Plaid and the Conservatives—there was a majority against. In that context—as Professor Emyr Lewis, who gave evidence to the Committee, has stated—it would be constitutionally wrong to pass the Bill without the consent of the Welsh Senedd. He believes that this is different from other instances where legislation has been passed by Westminster against the will of Wales:

“This is not the equivalent, for instance, of trying to re-base the UK’s internal markets following the chaos of Brexit. When the UK Parliament passed Acts ignoring refusal of consent from Cardiff or Edinburgh, it did so in what were considered to be the interests of the economic coherence of the UK. This Bill, however, is a different sort of creature. It is a Bill which would bring about a profound change in the law relating to life and death, where there are strongly held (and expressed) moral, religious and cultural views against as well as in favour. How can it be constitutionally appropriate for the UK Parliament to pass such a Bill for Wales, when the Senedd has indicated its opposition by democratic vote after a thorough debate?”

Terminally Ill Adults (End of Life) Bill (Twenty-eighth sitting)

Debate between Sarah Olney and Kit Malthouse

Committee stage
Tuesday 25th March 2025 Public Bill Committees

[Sarah Olney]

The issue is who is commissioning the service. The issue is not the doctors or how they are recompensed for the work that they do, but who is doing the recompensing and what their incentives are. If the process is part of an NHS-provided service where it is agreed that it is a compassionate end of life choice, and where it is properly regulated within the wider NHS service and connects with other NHS services, that is one thing.

If the person commissioning that doctor has any kind of incentive around making a profit—and any profit-making organisation will be incentivised to increase the amount of profits that it makes—then, however carefully regulated, there will be subtle influence, pressure, coercion or persuasion that assisted dying is an option that patients should choose, or possibly not-so-subtle influence, to take the example from the hon. Member for Bexleyheath and Crayford. Under other circumstances, in an NHS model, that may not have been a solution they would have been persuaded to choose. It is that issue of persuasion and of incentives that really troubles me.

[Kit Malthouse (North West Hampshire) (Con)]

I am not clear: is the hon. Lady suggesting that doctors who operate in the private sector are less ethical than doctors who operate in the public sector?

[Sarah Olney]

I think I said very clearly to the hon. Member for Stroud that it is not about the doctors. It is about the people who are commissioning them. I absolutely do not believe that about doctors operating in the private sector, who in my experience are often the same doctors as the ones in the NHS. It is about who is commissioning them and who is asking them to carry out this work, and whether those commissioners are motivated by a profit incentive as opposed to the incentive in the NHS to provide the best possible care.

--- Later in debate ---

[Sarah Olney]

It clearly remains to be seen, but that may be an outcome as we do not yet know what model we are proposing for the delivery of assisted dying. Perhaps doctors will feel pressured to deliver an outcome because that is how the model has been set up. If we have a model that incentivises profits, particularly if we do not have a similar service within the NHS itself, it is quite possible that that will happen. It will not necessarily affect the care that doctors give to patients at the end of life, but the point is that we do not know.

We cannot fully explore that matter in Committee, because we do not have the full clarity of exactly how the process will be delivered, so we cannot examine the proposed model and identify its potential risks and pitfalls. That continues to be a real concern. Perhaps doctors will feel that pressure; perhaps the service will be precisely designed to encourage them to, for example, diagnose someone with having fewer than six months to live even when it is a slightly more subjective judgment and a different doctor operating in a different system may come to a different view.

[Kit Malthouse]

That is an extraordinary claim to make against doctors.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

I am just trying to wrap my head around the argument. We already know that integrated care boards and other commissioning bodies have incentives given to them when they commission services, so it would be in their interests to diagnose or produce a demand for a service in a particular area. There is already an analogous situation within the NHS; I do not see how that is any different.

Terminally Ill Adults (End of Life) Bill (Twenty-seventh sitting)

Debate between Sarah Olney and Kit Malthouse

Committee stage
Wednesday 19th March 2025 Public Bill Committees

[Kit Malthouse]

Obviously the hon. Lady is a London MP, but I gently point out that particularly in a London context—and in other urban areas—someone’s postcode is actually a very poor indicator of socioeconomic status. I represented central London as a London Assembly member for eight years and, in large parts of central London, there is social housing in the same postcode as extremely expensive houses running into the many millions.

[Sarah Olney]

I know: the Barnes ward in my constituency is one of the most unequal wards in the country, so I fully appreciate the right hon. Gentleman’s point. As I say, that is the socioeconomic indicator that I have for now, thanks to the failings of our predecessors to include it in the Equality Act, but I am open to amendments on Report if anybody has something more compelling. I do think that it really matters that we look at the socioeconomic status of people who are seeking an assisted death, and I welcome feedback—and, as I say, further amendments—on how that particular part of clause 29 could be improved.

Lastly, I included whether someone has a disability, which obviously has come up many times in the written and oral evidence. That is why I specified those characteristics in response to the evidence that we received, and why I am keen to press amendment 273 to a vote.

Amendment 273 agreed to.

Terminally Ill Adults (End of Life) Bill (Twenty-third sitting)

Debate between Sarah Olney and Kit Malthouse

Committee stage
Wednesday 12th March 2025 Public Bill Committees

[Kit Malthouse]

And the panel.

[Sarah Olney]

The point is that we want to preclude the possibility, at whatever stage it might happen, that somebody could deliberately render themselves terminally ill by the voluntary stoppage of eating—

[Kit Malthouse]

But they already are terminally ill.

[Kit Malthouse]

Forgive me, Sir Roger. Will the hon. Lady give way?

[Sarah Olney]

I will.

[Kit Malthouse]

I share the confusion of the hon. Member for Spen Valley. By the time we get to clause 13, my understanding is that the two doctors and the panel are already satisfied of the person’s eligibility, so they are by definition terminally ill. I do not understand why they would then seek to render themselves doubly terminally ill by adding the characteristics the hon. Lady is talking about. Maybe I am getting confused. I could understand the hon. Lady’s case if she had made it way before, but at this stage the person has been through two doctors and the panel and got permission to go ahead. I do not understand why they would then starve themselves.

--- Later in debate ---

[Sarah Olney]

The point is that they may take the opportunity to use the further provision that exists for people whose death is expected within one month.

[Kit Malthouse]

But they do not need to if they have got to this stage.

[Kit Malthouse]

Sorry, Sir Roger.

[Sarah Olney]

I take the point, but I still think it is necessary to have this additional safeguard to close a loophole that means that people could render themselves terminally ill within the space of a month and use the opportunity presented by the additional provision in the Bill for reducing the 14-day waiting period. This is a real concern of people who have reviewed this legislation. There is a possibility, as has been seen in other jurisdictions, that people could—I do not necessarily want to adopt the right hon. Gentleman’s language—hasten their eligibility for assisted dying through this particular method. All I am asking is that we close the loophole so that people will not be tempted to follow that very damaging path.

Ordered, That the debate be now adjourned.—(Bambos Charalambous.)

Terminally Ill Adults (End of Life) Bill (Nineteeth sitting)

Debate between Sarah Olney and Kit Malthouse

Committee stage
Wednesday 5th March 2025 Public Bill Committees

[Naz Shah]

Is the hon. Member aware that in nine of the 10 cases that went before the Court of Protection, the young ladies were deemed not to have capacity, but the judge still decided that it would not be in their best interests to feed them, and they were put on palliative care pathways?

[Kit Malthouse]

They did not have capacity.

[Sarah Olney]

I am grateful for that intervention and, dare I say it, for the one from the right hon. Gentleman. That is the whole point about eating disorders: there is a very fine line to be trod between people who have capacity, people who lack capacity and people who have capacity but who can still be allowed to make an unwise choice, which is obviously a huge risk for people with eating disorders. I find that risk very much magnified in the Bill as it is currently drafted, which is why it is of the utmost importance that it provides specifically for the possibility that somebody is suffering from any kind of mental health illness, and particularly from an eating disorder—but I do not see such a provision at the moment. I heard the arguments that were made when I raised this issue in earlier sittings, and I very much welcome amendment 6, but it deals only with capacity; it does not talk about mental illness.

To conclude, amendment 363 is a crucial safeguard that would prevent assisted dying from becoming an unintended route for people suffering from mental health conditions, such as eating disorders, to end their lives prematurely. It would ensure that requests for assisted death are based on genuine, rational decisions, rather than symptoms of a treatable disorder. By aligning with best practice from other jurisdictions and addressing a critical gap in the UK’s current approach, it would strengthen the ethical foundations of the assisted dying Bill and better protect vulnerable individuals.

Terminally Ill Adults (End of Life) Bill (Eleventh sitting)

Debate between Sarah Olney and Kit Malthouse

Committee stage
Wednesday 12th February 2025 Public Bill Committees

[Kit Malthouse]

I will make two points in response to my hon. Friend. First, I am not sure that it is entirely accurate that burden is the primary purpose. It is certainly the case that when people going through this process in other jurisdictions are surveyed and rank their reasons, burden may be one. We heard that in some of the evidence that we had from overseas, but as I said at the start of my remarks, it depends what we mean by “burden”. Personally, I think it is perfectly legitimate for me to want to spare my children from witnessing, knowing or even learning that I may have died in a particularly unpleasant way. I may therefore wish to go a few weeks before that eventuality and say goodbye to them, gathering them around my deathbed—we heard very movingly about this from one of the witnesses—to say farewell while I still can, before my body is ravaged by the final stages of the disease that is destroying me. I do not think that relieving them from a traumatic burden is anything negative.

[Sarah Olney (Richmond Park) (LD)]

Does the right hon. Gentleman not accept that “burden” here encompasses many different types of burden. One that weighs heavily on many of my constituents is financial burden—in particular, the cost of care at the end of life. That is very directly something that they would wish to relieve their children and descendants of. Does he not accept that the word “burden”, while I hear what he says about it being imprecise, nevertheless contains many different examples, rather than just the one to which he referred?

[Kit Malthouse]

The hon. Lady is quite right, and she makes my point very neatly for me: the language here is so wide-ranging that it could be anything. Other provisions in the Bill deal with exactly the concerns she expresses. A specific part of the Bill talks about people benefiting financially and how they may not participate. We had a long discussion about coercion and pressure.

--- Later in debate ---

[Kit Malthouse]

I am grateful to the hon. Lady, who has made the case much more eloquently than I could have done. She is quite right. We have heard endlessly from witnesses and others that simplicity is best, and that by inserting this kind of complexity, we create yet more difficulty.

I have two other things to say. From the point of view of autonomy, the amendments are trying to police the thoughts of the individual who comes forward in a way that, as I said, may mean that they become guarded in conversations with their physicians. One of the things that I have learned over the past 10 years or so, and that we have heard from witnesses, is that many people who are in extremis at their end are very determined that they will achieve a death other than what nature has laid out before them. That determination comes through from those who go to Switzerland, often in the teeth of the wishes of their family. They will go in secrecy, not telling anyone, because they do not want to put anyone else under threat of criminal prosecution.

We have heard lots of stories over the years—some were mentioned on Second Reading—of people who have killed themselves in terrible circumstances, again, secretly determined that they will not go through that end. My concern is that if we insert such amendments into the Bill, we start to police the conversation in a way that means that people determined to achieve an assisted death will do other than have a free and frank exchange in a sensitive way with their physician. Instead, they will try to tread the path to get what they want.

For example, if the issue was physical pain, the conversation might go: “Why do you want an assisted death?” “Well, of course it is just the pain. It’s all the pain. That is all I want—I’m just frightened about the pain.” “Are you doing it for the benefit of others?” “No—absolutely not! I am doing it completely for myself.” We can see how people might start to modify their conversation, rather than having what should be a sympathetic, empathetic, conversation between doctor and patient about where they should go.

My concern is that, as with a previous grouping, this attempt to micromanage and police the conversation, at the same time as attempting to police the way people should be thinking, threatens the whole concept of assessment and relationship, which we have heard about from many physicians—that is done on a daily basis in not dissimilar circumstances, where life and death is at stake. That complexity and those extra layers, in my view, start to make the Bill less safe.

[Sarah Olney]

I want to pick up on the right hon. Gentleman’s point about wanting patients to be able to have a free and frank conversation with their doctors. In a hypothetical scenario, someone suffering from a terminal illness and in the last six months of their life might say to their doctor, “I would like to explore an assisted dying option.” The doctor asks, “Why is that?” They say, to hark back to my previous example, “Because I want to save my children the cost of my end-of-life care bills.” How does the right hon. Gentleman think the doctor should react in that circumstance, given that that is a free and frank explanation of the person’s reasons?

[Kit Malthouse]

The Bill makes it quite obvious that the doctor would not regard that as a legitimate reason to give people an assisted death, if that was their only purpose. As we said before, however, most people have a range of purposes for seeking an assisted death. In my view—certainly in my experience—the primary one is always having the option of control at the end.