Terminally Ill Adults (End of Life) Bill

Calum Miller Excerpts

Report stage
Friday 20th June 2025 Commons Chamber

[Kim Leadbeater]

I am just going to make some progress.

Patients must have

“an inevitably progressive illness or disease which cannot be reversed by treatment”

and a person is not considered to be terminally ill only because they have a disability or a mental disorder. These clear, strict criteria, plus the multiple capacity assessments, exclude possible serious mental health disorders such as anorexia.

I was also very pleased to support the change advocated for by Marie Curie and Hospice UK, which would ensure an assessment of palliative and end-of-life care as part of the first report on the Act. We know from other countries, in no small part due to the 14-month inquiry by the Health and Social Care Committee, that palliative care and assisted dying can and do work side by side to give terminally ill patients the care and choice they deserve in their final days. It should not be an either/or for dying people, and we need to channel our energies into supporting all options for terminally ill people.

[Calum Miller (Bicester and Woodstock) (LD)]

I am very grateful to the hon. Lady for giving way. As she knows, the leading experts in palliative care have come out to oppose the Bill, and they point to the fact that hospices are underfunded and do not have the same ability to serve patients. I therefore gently question whether we are in a position today to make a judgment that patients truly would have a choice at the end of life.

[Kim Leadbeater]

I thank him for his intervention, but I would say, as I have said previously, that people working in palliative care have a mixed range of views on this subject. I have met with palliative care doctors, and some are very supportive of a change in the law because of the suffering they have seen.

--- Later in debate ---

[Kevin McKenna (Sittingbourne and Sheppey) (Lab)]

I thank everyone who has contributed to this debate, both inside and outside the House. There has been a great deal of passion, and sometimes that passion flares up while we debate this really intense and personal subject, and obscures the deep and profound compassion that we all feel. How each of us faces death is deeply personal, and the decisions surrounding it must honour every individual’s dignity and choice. Our goal must be to ensure that all patients are protected, while we empower people at their end of their life with greater autonomy and agency to make the choices that are right for them.

Having spent many years as an intensive care nurse in the NHS, I have witnessed the realities of end-of-life care countless times. I have seen patients find peace in their final days, but also patients who have been unconscious or unaware that their death was coming. I have seen others endure pain and anxiety that no palliative intervention—none—would alleviate for them. Those experiences have deeply influenced my perspective on assisted dying. They have reinforced my belief that individuals should have the autonomy to make decisions about such a personal and profound part of their life—the end of their life. That is fundamental to dignity at the end of life.

Consent must always be freely given, fully informed and revocable at any time, as it is right now for anyone who agrees to, or decides not to, undertake onerous, painful treatment that medical and clinical staff say might save or extend their life. Every one of us can refuse treatment. It is so important to understand that, because we have had lots of discussion about coercion. I have to lay it out for the House: there is a lot of coercion in the system currently. Well-meaning families and clinicians provide a degree of coercion. Clinicians, clinical teams and multidisciplinary teams are set up to try to detect that, and to have conversations with patients to get to the nub of their real wishes. I have a lot of faith in my clinical colleagues, and I have faith that this happens, as a result of collective action by multidisciplinary teams—that is how healthcare works today. I am really pleased that after extensive debate on this Bill, particularly in Committee, we have gone from a judge making the decision to having a panel, because that reflects best practice in clinical work. We now have a multidisciplinary team and a multidisciplinary approach to assessing what the patients wants.

[Calum Miller]

Will the hon. Member give way?

[Kevin McKenna]

No, I will not.

Many colleagues have talked about whether this debate has been too short, too long, too complicated or not complicated enough. I have heard questions about whether the Bill is ready to for us to hand on to the House of Lords. To be clear, I believe that it is. It is really important to remember that we have been debating this issue not just during this Parliament; the debate has gone on for decades. I remember being taught by a really strong advocate for palliative care when I was a student nurse; he was dead set against assisted dying. His argument was that if we bring in assisted dying, it will mean that palliative care will never get the funding and resources that it needs—something that so many people have said. That was nearly 30 years ago, and we have not grasped that nettle as a country.

At the end of this debate, I really hope that we can finally bring to fruition the ambition of almost every Member of this House: the ambition to ensure that palliative care works and is accessible to everyone in this country. However, if we do, that is not a reason not to have assisted dying. Assisted dying is the choice of many people in this country, and I want it to be a choice for me. If I get to that point in my life, I want that choice available to me, and that will be true for some other Members. Still others do not want to ever have that choice, but it needs to be there. I want people to think about themselves as well.

Terminally Ill Adults (End of Life) Bill

Calum Miller Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Dame Siobhain McDonagh]

Its potential is to alter everything in a very undemocratic manner. In this very Chamber, Nye Bevan told us that the NHS would

“lift the shadow from millions of homes...keep very many people alive who might otherwise be dead...relieve suffering...produce higher standards for the medical profession”

and

“be a great contribution towards the wellbeing of the common people”.—[Official Report, 30 April 1946; Vol. 422, c. 63.]

We have a duty in this place to defend that promise. We cannot allow the promise to be reworded without the full voice of Parliament. We owe it to the public, to patients and to the NHS staff who dedicate their lives to this service, to stand firm and protect what is sacred.

The amendment is simple but its impact is profound. It would ensure that any future changes to the core principles of the NHS must be debated openly, transparently and with the full consent of every Member—no short cuts, no sidestepping, no ministerial overreach. I urge colleagues across the House to support amendment 12, to stand with our NHS and with the people it serves. I urge my side—the Labour side—not to allow the assisted dying Bill to be the trojan horse that breaks the NHS, the proudest institution and the proudest measure introduced by our party in 120 years.

[Calum Miller (Bicester and Woodstock) (LD)]

I rise to speak in support of amendments 21, 103, 104 and 42, tabled by my hon. Friend the Member for Twickenham (Munira Wilson), the hon. Member for Newcastle-under-Lyme (Adam Jogee) and my hon. Friend the Member for Wimbledon (Mr Kohler). As other Members have said, this is a deeply consequential Bill. I want to record my thanks to the hon. Member for Spen Valley (Kim Leadbeater), to all members of the Bill Committee, and to all those who have contributed to its careful scrutiny through the tabling of amendments and debates over them.

The Bill is about the end of life. It is an emotive and sometimes painful topic, and I am grateful to the many constituents who have generously shared with me their experiences and opinions. I have also taken some time to consult palliative care practitioners, including those providing hospice care in my constituency. Those conversations reinforced the awe and admiration I hold for these caring professionals. Their expertise and deep commitment are always impressive. Contrary to the points made by the hon. Member for Gosport (Dame Caroline Dinenage), they are adamant that they can provide sufficient pain relief to the vast majority of those receiving end-of-life care. The issue is about not the efficacy of treatment, but access to it. In this, I echo the powerful points of the hon. Member for East Renfrewshire (Blair McDougall) on the present inequality of access to palliative care.

Amendment 21 would ensure that the availability, quality and distribution of palliative and end-of-life care is published within one year of the Act being passed. When assessing the provision of end-of-life care, it is critical that this House and the public can see how palliative care is being delivered. For the measures in the Bill to provide a genuine choice to those at end of life, palliative care must be much more widely available.

The hon. Member for Spen Valley (Kim Leadbeater) argues that there should be no false choice between palliative care and assisted dying, yet she and health Ministers know that there is a choice as resources are limited. When so many hospices have closed beds due to funding shortages and receive more than 70% of their funding from donations, I am concerned that we may see significant expenditures on a new regime for assisted dying, funded by the state as a health treatment, while the palliative care sector and hospices in particular remain chronically underfunded.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

rose—

[Calum Miller]

I will not give way.

Only by having the assessment of the palliative care system that is proposed in amendment 21 can we be confident of knowing whether access to palliative care is sufficient. If we are to provide a true choice at end of life, that is critical.

I also stand in support of amendments 103, 104 and 42. Amendments 103 and 104 would give this House a say over the key decisions that still remain to be taken on the implementation of the Bill. Given the significance of the Bill and the importance of the many questions still to be resolved, these amendments are critical.

Amendment 42 would ensure that we do not career towards the enactment of this Bill in four years whether or not the system is ready to operate safely and fairly. Taken together with amendments 21, 103 and 104, this would ensure that this House has the chance to consider whether those at end of life can access the full range of support, advice and protections intended by the Bill, and which they deserve from palliative care services across the country.

Like so many in this House, I have direct personal experience of the issues addressed by the Bill. My father was diagnosed with stage 4 cancer in May 2002. Over seven weeks, he and my family benefited from the incredible care of our local hospice. Sharing my dad’s life, care and death has shaped me, so I fully understand why so many of my constituents have asked me to vote on this legislation in the light of their and their loved ones’ experience.

Yet our task is to legislate for a new system that will affect thousands of people and society as a whole. However this House votes on this Bill, our debates must result in a new focus on the provision of palliative care, so that all people at end of life truly have options in the management of their care and death.

[Dr Rupa Huq (Ealing Central and Acton) (Lab)]

I rise to support amendments 34 to 36 and new clause 6, tabled by my right hon. Friend the Member for Walsall and Bloxwich (Valerie Vaz), who sadly cannot be here today.

Health inequality shapes life expectancy and outcomes —covid deaths illuminated that—but it is absent from the Bill. A younger me would have been 100% behind this Bill. I am very pro body autonomy when it comes to abortion, but 10 years of being an MP has exposed me to coercion, duress, the billionaire price of London property, and elder abuse. It is no coincidence that, like me, the majority of London MPs and of black and minority ethnic MPs oppose the Bill.

Let us look at amendment 34. The experience of my aged parents—now no longer with us—opened my eyes to a world of pills, incontinence pads, hoists, power of attorney, key safe boxes and carer worries. I saw how non-native English-speaking pensioners—I am not talking about Welsh speakers—have their agency denied, perhaps unconsciously, by health professionals in a stretched system. My mum’s GP had a clear contempt for her accented words. At every appointment she would say to her, “One question only”. As my mum grew frailer and began to lose the power of speech, she reverted to her mother tongue and was seen by hospital teams as an annoyance, a time waster, and bed blocker. Similarly, the disabled are often written off. People cannot see beyond the wheelchair or the non-verbal. Amendment 34 would place a duty on the chief medical officer to provide information at every step of the way