Terminally Ill Adults (End of Life) Bill

Anna Dixon Excerpts

Friday 13th June 2025 Commons Chamber

[Dr Sandher]

I do apologise, Mr Speaker.

What I meant to say is that new clause 6 would introduce a special representative for ethnic minorities, and I am trying to explore why we do not need one. A duty to consult is already included in clause 51.

[Anna Dixon (Shipley) (Lab)]

This is a very sensitive issue. There is data to support the fact that people from minoritised ethnic groups are less likely to trust their health professionals—the figure is 18% among the general public, but as high as 30% among those groups. Does my hon. Friend not think it is necessary to make sure there are additional protections for those who face additional barriers, such as people from minoritised ethnic groups?

[Dr Sandher]

My hon. Friend makes a powerful point, and other hon. Members have also spoken powerfully about the impact that the Bill could have on ethnic minorities. Does any hon. Member know how many ethnic minorities access assisted dying in other nations? I will give way on this point; the hon. Member for Richmond Park (Sarah Olney) raised it earlier.

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[Paul Waugh (Rochdale) (Lab/Co-op)]

I rise to speak in support of the amendment in my name, which seeks to strengthen new clause 14 tabled by my hon. Friend the Member for Spen Valley (Kim Leadbeater). Why do we want to restrict advertising about assisted dying? It is not just because such adverts could appear crass or insensitive, or because we worry that private companies could profiteer from death, but because advertisers know that they influence choices. The issue of choice, whether it is informed choice, skewed choice, self-coercion or coercive control, as has already been mentioned, is, in many ways, at the heart of the Bill and whether its safeguards are sufficient.

My brother works in advertising and he knows its power. It is why companies spend billions of pounds on it, why Google is the giant that it is, why we see lots of adverts at Westminster tube station trying to influence every single one of us, and why X is full of ads. Advertising works because we human beings are suggestible, and prone to messaging, visual cues and hints. Older people are bombarded with adverts for everything from stairlifts to care homes. One person’s advert, though, is another person’s public information campaign. It is not impossible to imagine a future Secretary of State, who passionately believes in the merits of assisted dying, authorising such a campaign. It could be a Government-approved plotline in a soap opera, or an ad read out by a podcaster that ever so subtly sounds like a news item, or even their own opinion. Many in this House rightly try to protect teenagers from online harms, but the online harm of an ad for a website about assisted dying shared on TikTok could be a reality without the tighter safeguards in my amendment.

[Anna Dixon]

I thank my hon. Friend for speaking so clearly about the issue of advertising. Does he recognise that this country has banned pharmaceutical advertising because we do not want to have the situation that exists in America where people are popping pills all the time? There is a reason that we are protecting patients and we need to do the same with assisted dying.

[Paul Waugh]

I completely agree with my hon. Friend. The dangers of what is happening in America provide a real lesson for us here.

As the hon. Member for Reigate (Rebecca Paul) put it, conversations about assisted dying should happen in person—between the relevant doctor and the patient. They should not be prompted by a TV ad, or something seen on a bus. My hon. Friend the Member for Bexleyheath and Crayford (Daniel Francis) spoke very movingly about the way that IVF services have been commercialised, leaving people who are, as he says, “already on their knees” vulnerable to exploitation, so that someone else can profit.

I am certain that nobody in this House believes that passing this Bill into law should mean the rise of a similarly aggressive market for assisted death, but it is our role—indeed our responsibility—to deal not only in intended consequences, but in unintended ones, too. The real risk in the drafting of new clause 14 is that it allows exceptions that are not specified in the Bill. A future Secretary of State will be empowered not only to make the necessary regulations, but to amend them at any time; and a future Secretary of State, who does not share the concerns of this House, would have the ability to draw the exceptions so widely as to make the ban worthless. There are a number of similar advertising bans already in place on tobacco products, surrogacy and the latest cancer drugs being marketed to the public. In every case, the legislation sets out the exceptions, leaving no room for doubt as to how Parliament intended to protect the public.

Why should the services that this Bill would legalise not be subject to that same legal clarity? Do people who have less time to live not deserve all the protection we have the power to give them from a death they do not truly want? I cannot believe that this Parliament would be content to have that power taken out of its hands, and the rights of our most vulnerable constituents left for someone else to decide on some other day.

My amendment therefore sets out that exceptions to the advertising ban should be limited to cases where a person has requested information and where the materials are intended for health professionals and not for their patients. New clause 14 would allow a future Secretary of State to make provisions that would usually have to go through the House in legislation. It is not at all clear to me why that power is needed to introduce a ban on advertising.

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[Dr Caroline Johnson (Sleaford and North Hykeham) (Con)]

I refer right hon. and hon. Members to my entry on the Register of Members’ Financial Interests—I am an NHS consultant paediatrician.

The debate so far has focused primarily on ethical considerations, legal frameworks and who will be eligible—the who, the when and the why—but I want to focus my remarks on the how. As a doctor, I know that various drugs in different combinations can be fatal; in other words, there is more than one way to kill people. Which would be the best drug, if that is what we wished to do? Which would be the most comfortable, and how do we know?

Some forms of assisted dying use neuromuscular blockades, which, in common parlance, means that they paralyse the body. Imagine a situation where someone in a lot of pain is given such a drug; from the outside they would look relaxed and peaceful as their muscles relaxed, but inside they would be in a lot of pain, and unable to express that to anybody else. Do we want people to be comfortable and to know that they are comfortable, or only to appear comfortable to us? Clearly, we want them to be comfortable inside as well. We therefore need to have drugs that are properly understood and regulated for this purpose.

Assisted dying is often portrayed as safe, peaceful and controlled, but the reality in comparable countries where it has been legalised so far is more complicated. Technical difficulties frequently arise, leading to complications causing greater suffering, requiring intervention and potentially leading to a prolonged and painful death.

A report in The BMJ by Dr Suzy Lishman, former president of the Royal College of Pathologists—who, I should say, works at the same trust as me—showed that there is a lack of reliable data on the effectiveness and safety of the drugs used, largely due to inconsistent reporting in jurisdictions where such dying is legal. In Belgium it is estimated that only 52% of euthanasia cases are reported to the Federal Commission for the Control and Evaluation of Euthanasia.

During a Select Committee visit in the last Parliament to Oregon to discuss assisted dying, which I and two other hon. Members from the Labour Benches went on, we heard about the complications being unknown in 71% of cases. No healthcare professional was present when the drugs were given so we could not really know, and we did not even know if the drugs had been taken in some cases. Where we did, we found a history of seizures, vomiting and prolonged deaths. On having been given the drugs, patients in nine cases in Oregon in 2023 had reawakened later. How they felt in the intervening time is difficult for us to know.

In Washington, a 2018 report found that 31% of patients took more than 90 minutes to die. I also remind hon. Members that an absence of evidence that things are not going well is not evidence of an absence of things going wrong.

[Anna Dixon]

I thank the hon. Lady for so eloquently describing some of the variation in the use of drugs in the case of assisted dying. In normal practice we have a yellow card scheme, which allows for any adverse events from ingestion of prescribed medication to be reported. Is it her understanding that, under the current proposals, that would not happen for assisted dying? Is she also aware of a review that shows a great variation in the range and dosages of drugs used?

[Dr Johnson]

I think one of the key problems with this form of intervention, compared with others, is that we cannot ask the patients afterwards how that felt. We cannot get their feedback, because they are dead. If we are going to give them things such as neuromuscular blockers or sedatives, we may not be able to tell what they feel. There are physiological ways in which we can monitor patients and get some idea—perhaps in their heart rate or blood pressure—but we will not be doing that. That is, therefore, one of the reasons for my tabling the amendments, to ensure that the drugs are properly regulated by the MHRA, so that we know that they have been properly tested on the purpose for which they are to be used.

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[Anna Dixon]

My hon. Friend makes a strong argument for excluding private, for-profit providers. He may know that I tabled an amendment in Committee that would have limited the provision of assisted dying to charities; unfortunately, it was rejected. Will he clarify where and how he thinks assisted dying should be provided, and his understanding of the Bill in that respect, given the lack of clarification we have had from my hon. Friend the Member for Spen Valley (Kim Leadbeater)?

[Blair McDougall]

My hon. Friend makes an important point. Amendment 15 seeks to recognise that there is a difference in where private providers’ income stream comes from and that that raises moral issues.

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[Lloyd Hatton]

I share my hon. Friend’s sentiment. I firmly believe that we should protect bereaved families against such a distressing ordeal happening automatically, particularly when the process, as set out in the Bill, will already be legal and transparent.

With that in mind, it makes practical sense to support new clause 15. If we pass legislation to permit assisted dying with the full weight of the law behind it, we must also respect that choice in the way that we classify and record such deaths. Those deaths would not be in any way unexpected or suspicious, so to classify them as such would simply be inaccurate.

As has already been touched on in great detail today, if the Bill is passed, it would implement the most robust assisted dying framework anywhere in the world. It already includes multiple layers of oversight. In my view, the process is cautious, thorough and robustly safeguarded. A retrospective investigation would be to duplicate the process, and risks suggesting wrongdoing when none has occurred.

[Anna Dixon]

I wonder what my hon. Friend’s view is of the opinion of the Royal College of Pathologists—the body responsible for medical examiners—which is that:

“deaths following assisted dying should be notified to the coroner, just as other deaths following the administration of drugs, prescribed or not, must be.”

[Lloyd Hatton]

I respectfully disagree with that position. I believe that there are already levels of safeguarding in the legislation.

New clause 15 is a compassionate and practical clause that would ensure the law works not only with the individual making the choice, but for the family they leave behind.

I move now to speak briefly on new clause 5, which I would strongly encourage Members to vote against. Tabled by my right hon. Friend the Member for Walsall and Bloxwich (Valerie Vaz), the new clause would require the Government to publish a report on any impact the Bill might have on civil procedure rules and probate proceedings. As has already been pointed out, the chief medical officer has warned that we are at serious risk of creating a “bureaucratic thicket” with this legislation. In my view, new clause 5 would do just that: requiring the Government to publish such a report would create unnecessary bureaucracy and divert resources without adding any material value.

As Members will be aware, the Government have already published an impact assessment on the relevant impacts that they deem the Bill could have. There is nothing in the Bill likely to result in any changes to civil procedure rules, so there is no obvious justification for producing a formal report on that issue. It is important that we remain focused on practical and meaningful safeguards, rather than procedural requirements based on immaterial impacts. Introducing extra reporting requirements based on speculative impacts risks creating unnecessary red tape without delivering any practical benefits. I therefore urge Members to reject new clause 5 and accept that no additional reporting in that area is needed.

As we rightly scrutinise the Bill today, on top of nearly 97 hours of scrutiny so far, which is more than many Government Bills receive, we must keep dying people at the centre of the debate. I speak today in support of new clause 15 and its consequential amendment 54 and in opposition to new clause 5 for exactly that reason—to keep terminally ill people at the centre of this discussion, and at the centre of this piece of legislation. No matter where we stand on this pressing matter—whether Members support it or have reservations—it is crucial that we collectively ensure that the Bill is workable, compassionate and truly centred on the dying person. As legislators, that must always be our chief concern.