Terminally Ill Adults (End of Life) Bill

Ben Spencer Excerpts

Friday 16th May 2025 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

I rise to speak to amendments 18, 30, 31, 17 and 32, which stand in my name.

I will start with amendment 18. Many moral arguments on the need for the Bill have been proposed both inside and outside this place. Some of those arguments have addressed the desire for greater control at the end of life, but the vast majority have focused on the prevention of irreversible suffering. The principle of bodily autonomy—which I strongly support in the context of full decision-making capacity, with certain important caveats—is used to justify the rights that the Bill will grant. However, let us put aside the debate surrounding the Bill and focus on the text of the clauses, which is the task that we face on Report.

The provisions are silent on suffering, silent on control and silent on all but a terminal illness with a prognosis of fewer than six months. If the principle is that we must prevent irreversible suffering, all those suffering irreversibly should be able to seek physician-assisted suicide. If the principle is that we should give people control—another level of expression of bodily autonomy—all adults who truly and freely consent with full decision-making capacity should be able to seek physician-assisted suicide. If those principles are circumscribed to an arbitrary definition of “terminal illness”, the inexorable conclusion must be that those patients’ suffering or autonomy are more important than those of others, or that their lives have less value. We have seen that position subtly imported into this debate. When requesting an assisted death is not framed as suicide because some perceive it as understandable, the underlying argument is, “If you’re terminally ill, of course you want to die—that’s understandable.”

We must ensure that we do not, by accident or otherwise, enshrine in our statute book value judgments on the worth of the lives of the terminally ill or on the protections that they should enjoy like everyone else. I tabled amendment 18 to expand the scope of the Bill as much as I can to reduce the discrimination inherent within it. The maximum I could do was to remove the six-month restriction, but I wish the amendment could go further. I know that some Members will wince at this provision, but I ask them to ask themselves what the principles and values in the Bill are, how they are being applied and whether they are being applied equally. I believe that the Bill as drafted is incoherent and discriminatory. My amendment would introduce some moral clarity to the Bill. If we do not do so, the courts will.

I turn to amendments 30 and 31. If we are to rely on the principle of autonomy to authorise physician-assisted suicide for terminal illness, the expressed choice must be true and free. Autonomy needs help, though. A true and free choice needs to be informed; a true and free choice cannot be made under coercion; a true and free choice requires decision-making capacity. I believe that, if we are to rely on the principle of autonomy for the most grave of decisions, there needs to actually be a choice. In the absence of relevant and available palliative care options, where is the choice? How can we rely on autonomy in the absence of choice? The prospect of people choosing physician-assisted suicide not because it meets their needs, but because their needs are unmet owing to a failure in the provision of palliative care, is a moral outrage. My amendments 30 and 31 would ensure that that does not happen.

[Neil O’Brien (Harborough, Oadby and Wigston) (Con)]

Will my hon. Friend give way?

[Dr Spencer]

I am sorry but I really cannot, given the time restrictions.

Amendment 17 pertains to the test of decision-making capacity. In English and Welsh law, we use the Mental Capacity Act 2005 to define capacity, and I believe it is right that the functional test of capacity is used in this Bill. We have common law tests of capacity in some circumstances, which arose before we had the Mental Capacity Act. However, the decision to end one’s own life was not permitted in the early case law leading up to that Act. There is no jurisprudence background or guidance. These capacity tests have not been done before. This test needs a bit more of a framework of support.

Amendment 17 lays out the minimum information that needs to be understood as part of the functional test of capacity. Critically, that would include information about the current treatment options, about doing nothing and about proceeding under this legislation. It would make clear that physician-assisted suicide is not a medical treatment, but a personal choice about life and death. Without amendment 17, this Bill will fundamentally undermine the doctor-patient relationship. Doctors do not prescribe death, and this Bill must make that clear.

I turn finally to my amendment 32. There has been some discussion about the inadequacies of the decision-making capacity test as gatekeeper. In effect, there may be circumstances in which, despite having capacity, the person is otherwise recognised as vulnerable. That is how our courts operate. The impact of depression or personality disorder on decision-making capacity can be subtle and elusive. I know, as I used to be a consultant liaison psychiatrist and did research in the area of decision-making capacity. This is tricky stuff to do, especially in the context of a request for an intervention, rather than a refusal.

We should have trained psychiatrists at an early stage assessing capacity. They are expert at picking up these subtle cues and all the other stuff that is going on. A request for physician-assisted suicide should not be taken in isolation, and that needs to be understood and supported. We need someone who knows how to use the Mental Health Act, because if a doctor is doing the assessment, and they have a patient in front of them with a mental disorder, expressing a desire to end their life, they need to make sure that that patient gets the right and appropriate treatment. That may well be using the Mental Health Act. We need to make sure that this happens; I hope it would happen as part of the process as usual, but there is no safeguard in the Bill to make sure that it does. Psychiatrists turning up on the panel at the end is not good enough; they need to be there from the start.

Finally, there are broader issues about the interaction with protections to save life, article 2, and a doctor’s duties. I will cover those in the debate on the second grouping, along with the incredible importance of the Bill’s interaction with the suicide prevention strategy.

[Daniel Francis]

I rise to speak to amendment 24 in my name, and I will start by thanking my hon. Friend the Member for Spen Valley (Kim Leadbeater) for inviting me to be a member of the Bill Committee.

I accept the principle that somebody given the devastating news that they have six months left to live should be able to choose the moment that they die, with their loved ones around them, but this is not a vote on the principle. We are not being asked to make an arbitrary yes or no choice, for we are legislators, and my experience on the Bill Committee tells me that this Bill, as written, still requires additional safeguards to address the concerns of so many people in this country.

For me, it was death, and my thoughts and concerns about what happens when I die, that drew me to my conclusions on this matter.

--- Later in debate ---

[Stephen Kinnock]

I thank the hon. Lady for her intervention. She may have noted the comment from the hon. Member for Bexhill and Battle: approximately 500 amendments were tabled in Committee, and approximately one third of them were accepted. There was a pretty robust process for looking at whether amendments were acceptable, and the Government were involved in commenting and advising on all of them.

[Dr Ben Spencer]

Will the Minister give way?

[Stephen Kinnock]

I will make some progress, if I may.

Amendment 87 would require the co-ordinating doctor to “take all reasonable steps” to establish whether a first declaration had previously been made, so it may slow down the process for accessing assisting dying.

Amendment 45 would significantly impact the operability of the Bill. It would duplicate the role of the assisted dying review panel, and place an additional burden on the co-ordinating doctor to convene the clinical panel. It would also require additional NHS and social care resources, particularly palliative care consultants. That could slow down a person’s access to an assisted death, because there is no requirement on when the panel must be convened, and it could take some time to set up, given the demands on health and social care professionals. The amendment does not specify who is to be on the clinical panel in situations where the co-ordinating doctor is neither a GP nor a consultant. Similarly, there is no provision for whether the clinical panel is to make its decisions unanimously or by majority.

Amendment 48 would require significant changes to the functions and focus of the bodies that are proposed to present arguments to the panel as to why a certificate of eligibility could not be granted. Where an official solicitor acts as an advocate to the court, their purpose is to assist the court on a difficult or novel point of law, not to perform an adversarial function. Similarly, there is no precedent for the Attorney General, His Majesty’s Procurator General or the Treasury Solicitor to intervene in a case in the way that is envisaged, as their roles are to act on behalf of, or provide advice to, the Government, and not to represent a specific argument. In the Government’s view, there are no existing public bodies that are well suited to undertaking this adversarial role.