Terminally Ill Adults (End of Life) Bill

Damian Hinds Excerpts

Friday 16th May 2025 Commons Chamber

[Damian Hinds (East Hampshire) (Con)]

For reasons of timeliness, I will speak only to amendment 101, which relates to adults with Down syndrome or a learning disability, although the amendment is directly relevant to new clause 1, as the right hon. Member for Hackney North and Stoke Newington (Ms Abbott) spoke about. Amendment 101 would disallow medical practitioners from initiating a conversation about assisted dying with a person who has Down syndrome or a learning disability. I speak primarily from my experience, along with others, on the all-party parliamentary group on Down syndrome and what we have heard from members of that community: people with Down syndrome and their families, and professionals specialising in the condition.

Many strong and deeply heartfelt arguments have been put by colleagues, and indeed to all of us by constituents in favour of the Bill, including by families in the most difficult circumstances to imagine—actually, they are sometimes unimaginable circumstances. Nobody could question the conclusions they have come to individually as a result of their circumstances. Equally deeply held and heartfelt points are made to us by people from the other perspective, also informed by their sometimes unimaginable own or family circumstances.

Of the arguments put against the Bill, I am particularly drawn to those around coercion. However, it is important to remember that coercion is not entirely a black-and-white matter. At the sharpest end, there are cases where an individual will directly bring pressure to bear on another for their own ends, but there are many gradations below that, and pressure can be felt differently by different people. It may be felt especially by people who worry they are a burden on their family, on caregivers, on the national health service, or indeed more broadly on society. Once assisted dying is an available option, over and above the question of pressure from others, I worry about the effect of pressure from oneself.

The Bill stipulates in clause 36 that the Secretary of State will issue a code of practice to ensure that the practitioner establishes that there is a “clear and settled intention” for the person to end their own life, including assessing that that person has

“capacity to make such a decision”.

That will have material challenges of its own. However, with regard to amendment 101, I am talking about the initiation, suggesting or raising of the matter specifically with an individual who has a learning disability or Down syndrome.

[Sir John Hayes]

The critical point about my right hon. Friend’s amendment, and indeed about new clause 16, is that they would put that on the face of the Bill. He is right to say that codes of practice and statutory guidance can be of value, but it seems to me that what is on the face of the Bill will be of fundamental importance, particularly in respect of coercion.

[Damian Hinds]

My right hon. Friend is right, of course. When we in this House are told that there will be secondary legislation, guidance or a code of practice, we can only ever take that on trust, and this subject is of such moment that what is on the face of the Bill is that much more important. Given the scale of the decisions that people could make as a result of this legislation, it is right that an additional layer of caution should be applied by legislators.

Obviously, it is important not to generalise—every single person is an individual—but it is the case that people with Down syndrome often exhibit distinct social characteristics, including great sociability, empathy, and a strong desire to please others and seek positive social feedback, while also being particularly sensitive to criticism or perceived failure, which can compound issues around communication and comprehension. We do not need to define what can result as coercion to worry about what might happen in that context.

Amendment 101 and new clause 1 are about initiating a conversation and ensuring that there are additional safeguards, and I urge the House to apply caution that is commensurate with the gravity of the path that could be embarked upon.

[Cat Eccles (Stourbridge) (Lab)]

I rise to speak against amendments 102, 80, 5 and 38, and new clauses 16 and 9. In my varied NHS career, I have seen all aspects of death and disease. As healthcare professionals, we commit first to do no harm. As medicine advances at breakneck speed, we are able to preserve life far beyond what could have been thought possible in the past. However, there have been many times when I have felt that preserving life can be harmful.

Life-prolonging treatments do not always improve quality of life, and patients suffer pain and discomfort, as well as mental distress. Friends and family have to watch their loved ones go through these difficult experiences, and I believe that patients should have a choice to end their life with dignity when faced with a terminal illness. The safeguards in the Bill have been significantly strengthened in Committee, so amendments seeking further to delay the process are simply unnecessary. In the oral evidence given by multiple experts, including Professor Chris Whitty, it was argued that we must be mindful not to overcomplicate the process to the point that no one can access an assisted death.

Amendment 80 seeks to impose an unnecessary restriction by requiring the terminal illness to cause

“severe pain and discomfort that cannot be reasonably relieved”

by palliative treatment. However, the Bill already requires that symptoms cannot be reasonably relieved, and it is important to remember that terminal illness is more than just pain alone.

Amendment 102 states that “remediable suicide risk factors” must be addressed before any preliminary discussion. Again, that is already covered in the Bill, with multiple checks on mental capacity and mental illness. Suicide risk is complex and fluid, and as I know from my own struggles, it is possible to feel suicidal but not want to die. This is another vague and unnecessary barrier without clear legal or clinical definition.

New clauses 9 and 16 and amendment 5 all seek to undermine multiple layers of assessment, independent oversight and professional accountability, where safeguards are already strong and multifaceted.

Amendment 38 calls for patients to qualify only if they have not refused further treatment or taken life-shortening steps. It is morally wrong to force anyone to accept medical treatment that they do not wish to have. The Bill is about choice and autonomy, and the amendment would undermine the freedom to make deeply personal decisions about one’s care. This is not a one-size-fits-all pathway, and there must always be a patient-centred approach.