Terminally Ill Adults (End of Life) Bill

Blair McDougall Excerpts

Friday 13th June 2025 Commons Chamber

[Robin Swann]

I think the hon. Gentleman said in an earlier intervention that those medicines would then be used off licence, to the risk of the prescribing doctor and the person using them. That is where the risk falls back on the individual rather than being covered by anything in the Bill. That is where my regret comes.

I understand the need to treat the substances as medicinal products in England and Wales if it is the will of the House to change the law here; what I cannot understand is why the law should change the situation for the rest of the United Kingdom. That is the basis of my amendment to amendment 77. The House is not voting for assisted dying in Northern Ireland, so it has no locus to change the definition of a medicinal product in Northern Ireland in order to accommodate this Bill, which we have been told applies to England and Wales only. Or is it the intention of the Bill’s sponsor or those behind her to extend it to Northern Ireland at a later date, using some of the Henry VIII regulations in it?

There is a further issue in Northern Ireland. We are still in part subject to EU law, and I would be interested to know whether the Government have considered that aspect. Can the Minister really change, by ministerial diktat, EU law in Northern Ireland when it comes to the use of these substances? If so, why is he not being granted such power in other areas of significance to Northern Ireland? Why only this? Why has so much Government time previously been spent on medicine regulation and supply for Northern Ireland? Why did the right hon. Member for Melton and Syston (Edward Argar), as the Minister of State for Health, and I, as the Minister of Health in Northern Ireland, spend so much time on that? To that extent, I ask the hon. Member for Spen Valley (Kim Leadbeater) and the Minister: what engagement has there been with the Department of Health in Northern Ireland or the chief pharmaceutical officer for Northern Ireland? Or is this another part of the Bill that is being put in to meet the promoter’s needs without any background or engagement?

In conclusion, the application of those provisions to Northern Ireland also has implications for the conscience protection. If, as a result of regulations made under those provisions, pharmacists in Northern Ireland are required to be involved in the manufacture or preparation of such substances, they will not have the benefit of the conscience clause, as that clause has not been extended to Northern Ireland. I therefore oppose the extension of those provisions to Northern Ireland and Scotland. I will also oppose amendment 77 and ask hon. Members to support amendment (a) to amendment 77 in my name.

[Blair McDougall (East Renfrewshire) (Lab)]

I rise to speak in support of amendment 15, which is tabled in my name. I will minimise my comments to maximise the time available to other hon. Members.

Owing to the widespread unease among NHS practitioners and the growing number of concerned voices about the Bill’s shortcomings, if it is passed by the House—I still hope that it will not be—it is likely that assisted deaths will take place away from the public sector. Indeed, the Bill does not prevent assisted deaths from being outsourced to private companies, and there is no definition of what “reasonable remuneration” means in return for helping to end someone’s life. My amendment seeks to ensure that providers publish annually the number of people to whom they have provided those services, the costs of doing so, and the revenues received in return.

Many hon. Members will be guided by their religion when they vote on these issues. Although I deeply respect that, I am not a person of faith. If there is a booming baritone voice appealing to my conscience, it is not that of God, but that of Nye Bevan, who was concerned about the commodification of care. In his time, the worry was about the role of the market in extending life. Today, my concern is about the potential role of the market in ending it.

Throughout the Bill’s passage, we have discussed different kinds of coercion by individuals on the lives of people whose protection is entrusted to us. As a Labour MP, I do not think that we can have this debate without addressing the economic coercion experienced by the vulnerable in our society. As someone who has sat beside a bed and prayed for mercy, I genuinely understand the attraction of arguments around freedom of choice, but arguing for that as a fundamental principle in isolation, without also acknowledging the economic, social and cultural context in which people make such choices, is not a Labour approach to the issue.

[Shockat Adam]

Does the hon. Member agree that no matter how many new clauses we introduce, we cannot militate against people being vulnerable, particularly financially? According to the charity Mind, 2.7 million people in this country have considered suicide because of financial hardship. How could we militate against that?

[Blair McDougall]

The hon. Member makes an important point that we have to consider. We must recognise that, as he says, people’s choices are limited by the unfair distribution of wealth, the injustices that disabled people face throughout their life, or the attitudes of the powerful in society towards those who are less fortunate.

[Dr Opher]

If my hon. Friend looks at the statistics, he will see that it is usually the better-off in society who choose assisted dying, not the less well-off.

[Blair McDougall]

I will come to that point shortly.

We have a duty to ask whether the poorest and most vulnerable will be coerced into choosing assisted dying over palliative care because of economic disadvantage. Will they be exploited by those with a financial interest in their choosing to end their life? Will their death become a commodity? If we are really going to pass legislation that allows someone’s death to become a matter of business, we must have full transparency on those financial motivations, and my amendment 15 would require that. If we are really going to pass legislation that allows someone’s death to become a matter of business, we must have full transparency on those financial motivations, and my amendment 15 would require that.

Carers in the private sector are not bad people any more than people working directly in the NHS, but private healthcare operates in a context. The evidence that profit influences the moral choices made in the care and treatment that is already provided in this country is overwhelming; this is not a hypothetical concern. For example, a systematic review published by The BMJ found that private equity ownership of healthcare is associated with lower standards of care. Around the wonderful miracle of IVF there is an industry profiting from people’s desperation as they start life rather than end it. Already, at the end of life—this relates to the point made by my hon. Friend the Member for Stroud (Dr Opher)—choice in palliative care is limited by economic status, with the wealthy more likely to die a good death than the poor. My amendment seeks to address the fundamental question of whether free choice really is free by bringing into daylight the financial motivations of those involved in individuals’ decisions.

[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.

[Dr Opher]

Will my hon. Friend accept one more intervention?

[Blair McDougall]

I do not wish to exacerbate your bronchitis, Madam Deputy Speaker, so I will continue.

Amendment 15 touches on a fundamental point at the heart of the debate. Disabled people and the sick, in every aspect of their lives, have to fight every day for resources from a state, a market and a society that view them as a drain on finances. Do we honestly believe that at the moment when the most vulnerable are least able to argue for themselves, under the most intense societal and cultural pressure, and at their most expensive, those same public and private sector institutions will succeed in making choice real for them when they have failed to do so throughout the rest of their lives? Even if we stretch credulity and convince ourselves that that will be true in the state sector, can we say that it will be true in the market? I do not believe that the Bill should be passed, but if it is, let us not make it worse by allowing unscrutinised profit from the loss of human beings.

[Simon Hoare]

I rise to speak in support of amendments (a) and (b) to new clause 14, new clauses 1, 2 and 16, and amendment (a) to new clause 15.

I will make two observations at the outset. I do so as a Welshman representing an English constituency, as a former Chair of the Northern Ireland Affairs Committee, and as the current Chair of the Public Administration and Constitutional Affairs Committee. I remain to be convinced, despite the confidence expressed by the Bill’s promoter, that the Bill honours, in spirit and letter, the devolution settlement. Based on the expression on the face of the Chair of the Scottish Affairs Committee, the hon. Member for Glasgow West (Patricia Ferguson), I do not think she believes that it honours the devolution settlement as far as Scotland is concerned either.

I also make the point that we are here to make law that has to stand the test of time. She was not the only one to do so, but the hon. Member for North Herefordshire (Ellie Chowns) shared a heartfelt anecdote about a conversation with her mother as a result of her mother’s professional work. I know how easy it is to do, because it is a trap that I have fallen into, but, particularly on an issue as emotive and literally life-changing as this, we should not base our decision just on anecdote. We must base it on cold analysis of what is before us.

It is almost six months to the day since the Bill was introduced and still I think it is best described as skeletal. We have been told time and again by the hon. Member for Spen Valley (Kim Leadbeater) and the Minister how busy officials have been looking at the practicalities of the Bill and how to operationalise it and make it workable. Yet this House is kept in the dark on what Ministers intend. Indeed, the hon. and learned Member for Folkestone and Hythe (Tony Vaughan) said in his earlier contribution that his understanding was that the hon. Lady was still prepared to work with colleagues to perfect the Bill. But, Madam Deputy Speaker, we are on the second day of Report stage and we could easily fall to Third Reading today. The time for that evolutionary conversation is long past. The time for detailed clarification is now. The Bill remains skeletal.