Assisted Dying

Danny Kruger Excerpts

Monday 4th July 2022 Westminster Hall

[Danny Kruger (Devizes) (Con)]

It is an honour to serve under you, Sir Roger, and I welcome the debate. I should declare that I am chair of the all-party parliamentary group for dying well.

Let me start by saying how much I recognise the good faith, integrity and powerful arguments of the hon. Member for Gower (Tonia Antoniazzi), all hon. Members speaking in support of the petition and all the campaigners who support it. I recognise the extreme distress and anxiety felt by families who have been through the agonising death of a loved one who experienced suffering that no human being should go through. I will address the issue of bad deaths in a moment, but first I want to look at the implications of assisted dying as I see them, and what would happen if we did it in this country, based on our experience and that of other countries.

I do not have a suite of powerful personal stories, although I recognise the enormous moral value of them all; I invoke the nameless and numberless people who will be affected if we introduce this law. The main argument for assisted dying is the simple one of autonomy. I think a lot of the support for assisted dying comes from the simple and natural resentment that anybody should try to stop people doing what they want, especially about something as important as this—literally a matter of life and death. But in this case, things are the other way around for many people. In my view, we need to keep assisted dying illegal because, as a matter of practical fact, for many people, it would narrow their autonomy. It would reduce their freedom substantially, because it would put them on a path with only one destination. That is because of the incentives that assisted dying would introduce.

The first incentive would be in our healthcare system. The simple, blunt fact is that it is cheaper for the system to help people end their life early than to care for them for weeks, months or years. That is not an argument we hear for assisted dying, but it is compelling. The cat was let out of the bag rather when the Member of the Scottish Parliament who is trying to legalise assisted dying in Scotland cited research from Canada showing that the health service there has saved hundreds of millions of dollars in care costs. We see, in contraction to a point made by the hon. Member for Gower, that where assisted dying is introduced, investment in palliative care stalls or recedes in comparison with countries where assisted dying is illegal.

Meanwhile, in Oregon, we see people being refused palliative care on cost grounds and then choosing assisted dying because there is no other option. I know we pretend that we do not have rationing in the NHS, but obviously, with finite resources, we do. Do we really imagine that assisted dying will not become an option that doctors and medical managers will not tacitly—even unintentionally—encourage?

[Kevin Hollinrake (Thirsk and Malton) (Con)]

My hon. Friend is making some very interesting points, although I am on the other side of the argument. With such controversial issues, we tend to point to facts on either side of the argument. Would it not be sensible to have an independent inquiry, by the Health and Social Care Committee or otherwise, to look at the points that he raises and the points that others would raise on the other side of the argument?

[Danny Kruger]

I recognise the force of that point, but the fact is that Parliament has debated the topic repeatedly over the last 20 years. We have devoted considerable hours of parliamentary time to it already.

[Lucy Allan (Telford) (Con)]

We had the opportunity to vote on the matter in 2015, but that was a great many years ago and many people who are Members of Parliament today were not present. Does my hon. Friend agree that “repeatedly” was perhaps the wrong word to use in that context?

[Danny Kruger]

As I understand it, we have had 14 hours of parliamentary time devoted to the topic in this Parliament alone. I suggest that there are other topics that we could address. I recognise that assisted dying is worth discussing, but there is something that we should do first, before we consider it. I will come to that point in a moment.

Members who think we can prevent people from being put on the pathway to assisted dying by good drafting, or because doctors are good people—obviously, they are—should think about the “do not resuscitate” scandal we had during the pandemic, and about the Liverpool care pathway, and then suggest there is no risk. I think there is a risk. I know that doctors are good people who want the best, but if we force them to make utilitarian decisions about the best use of resources, will they not push people in this direction?

As well as the pressure on the healthcare system to take this route, I worry even more about the pressure on patients themselves to request assisted dying if it is an option. It will be an option for almost everybody approaching death—that is the proposal. Clinical guidelines for many terminal or chronic illnesses will likely require doctors, at an early stage of planning treatment, to ask patients whether they would wish to have assistance in taking their own life. What a question to ask. Whatever the guidelines, every family will be required to have the conversation, in whispers or openly. In some families, we know how that conversation could all too likely go.

Over half the people in countries where assisted dying is legal choose it because they feel they are a burden to their family. Tragically, a lot also say that they are lonely. Is that not terrible—people getting the state to help kill them because they do not want to be a burden on a family that never visits them? Talk to any hospice manager about relatives and they will quietly confirm it. There are a lot of people who want granny or grandpa to hurry up and die.

[Christine Jardine (Edinburgh West) (LD)]

The hon. Member is making a number of points. Like the hon. Member for Thirsk and Malton (Kevin Hollinrake), I am on the other side of the debate. Is it not the case that many of the people who are being characterised as wanting granny or grandpa to hurry up and die, are in fact simply wanting their pain to end, and want a compassionate way to bring that to an end? They do not want them to die; wanting them to die is the furthest thing from their mind. However, they are going to have to die, and they want to make it a better death.

[Danny Kruger]

I really do thank the hon. Lady for that intervention. She is absolutely right, and I thank her for allowing me to make it abundantly clear what I hope I made clear earlier: I recognise the enormous power of the campaign, and that the overwhelming majority of people want it for the best of intentions. All of the people campaigning for this, and the overwhelming majority of the people who imagine making use of this law, do so for the absolute best of intentions. Please can we not have a deliberate misunderstanding of the points I make? I represent a lot of people who think this way, and I am making the point in all sincerity.

I challenge Members, many of whom must visit their hospices and know what is acknowledged as the fact of elder abuse. Tragically, we have a rising epidemic of elder abuse in this country. Half of elderly people who are victims of financial crime are victimised by their own adult children. It is not just the elderly we need to be concerned about. It is no surprise that no disabled organisation supports the proposal. It is the most vulnerable people, who by definition rely on the support of other people—their families and professionals—who are most at risk of assisted dying laws being misapplied, which is what I fear would happen. Suddenly, every controlling and coercive relative, every avaricious carer or neighbour, every overstretched or under-resourced doctor or hospital manager would have the means to cut their cost, and I do not believe it is possible to design out the risks.

[Sir John Hayes (South Holland and The Deepings) (Con)]

My hon. Friend is making a compelling case. We have heard a lot about quality of life, but who are we to judge what a quality life really is? Is someone who is profoundly disabled without quality? Is someone with profound learning difficulties without quality? Why do we assume that the only lives worth living are those that are perfect or of high quality in the eyes of others?

--- Later in debate ---

[Matt Hancock]

Yes, I think there is a lot in that. As Health Secretary, I met people on both sides of the argument. I admire so much those who give palliative care. I took the opportunity to put more funding into palliative care, although I also support the mixed model of funding because I think that the funds raised through voluntary efforts and philanthropy are important—I have raised money for my brilliant local hospice, St Nicholas Hospice in Bury St Edmunds. But the truth is that even the best palliative care in the world cannot stop the deep pain and trauma that comes with some diseases, especially but not only cancers, at the end of life. Medicine simply cannot stop the pain in every case.

As Health Secretary, I also heard from supporters of change. I want briefly to mention two examples. The first is Sir Paul Cosford, the former medical director of Public Health England—my hon. Friend the Member for Winchester (Steve Brine) will have worked with him—who gave enormous and great service during the pandemic. Everybody in this Chamber will have heard him on Radio 4. What most people will not know is that he was living with cancer for the entirety of the pandemic. The work from home provisions allowed him to keep serving right up until very shortly before his death. A month before his death, he asked for some time with me, one on one, and he explained to me that he was nearing the end. As a doctor, he had seen many, many patients go through what he was about to go through, and he did not want to go through that. He said to me, “The end, when it comes for me, will be brief, but others do not have that choice.” He asked me this question: “Would you want the choice of how to die?” I ask everyone in the Chamber that same question.

As a local MP, I was honoured six weeks ago to meet David Minns, who has terminal myeloma. He told me a heart-rending story about how he saw in recent years his daughter die of a very painful cancer without successful pain mitigation, and he does not want to go through that. Nor does he want to go to Switzerland; he is a proud, patriotic man. He could potentially live longer if he knew that he could be assisted in his death, as we have heard from so many others.

Nine countries now allow assisted dying in a highly specific form. There are reasonable arguments on both sides, so there are constraints in place. We can learn from the experience overseas. There are countries with our common law tradition and parts of this United Kingdom that are considering assisted dying.

[Danny Kruger]

Does my right hon. Friend not acknowledge that in every single country where measures such as assisted dying, assisted suicide or euthanasia have been introduced, there is only one direction of change, which is towards more progressive liberalisation of the law? It always goes towards more liberalisation, including in Canada, where euthanasia is now being proposed.

[Matt Hancock]

I heard that argument, so I looked into it. In Oregon, for instance, which is the originator of the proposals that many people support, that is simply not the case. There was one change made many years ago and the law has now rested. There is essentially agreement about it.

I cannot see how the Minister can argue for anything other than an informed, compassionate debate on the Floor of the House. For 50 years we have had a legal choice over who to love. For a decade we have had a legal choice over who we can marry. Let us have an informed debate about, when the end is inevitable and the pain insufferable, how we die.

--- Later in debate ---

[Sir Stephen Timms]

I have not seen the polls that the right hon. Member refers to, but I think it is the case that all the major organisations representing disabled people in the UK oppose this change in the interests of their members.

There are good and compassionate arguments—we have heard a number of them—in favour of the change that the petition calls for. I do not agree with those arguments, but let us be clear that they are not the only arguments for the change. In some minds, they are clearly not the decisive arguments either. As we have been told, in some countries where the change has been made, it is explicitly about saving the health service money.

My party introduced the national health service, which is our proudest achievement. It needs to be adequately funded. The fact that it is not being adequately funded at the moment must not become an excuse for giving up and accepting that painful deaths are unavoidable. Instead, as all right hon. and hon. Members have agreed so far in the debate, we need to invest in palliative care, where there have been big advances and where there could be many more, and to ensure that adequate care is provided to everybody who needs it.

I agree with the organisation Care Not Killing that we want

“a funded policy for comprehensive hospice, community and hospital specialist palliative care services across the country with a duty placed on NHS trusts to ensure these services are made available to all who need them.”

I visited my local children’s hospice on Saturday—we have heard from a number of Members who have made such visits—and it had a fête to raise funds, because it is struggling for cash. In my view, it should not have to do that.

“In Place of Fear” was how Nye Bevan summed up what had been achieved in founding the NHS. Let us not give up now and decide that we can no longer afford the relief from fear that he rightly promised.

[Danny Kruger]

Will the right hon. Gentleman give way?

[Sir Stephen Timms]

I cannot give way again.

We should renew our determination not to impose fear and an awful moral dilemma on frail and conscientious elderly people approaching the end of their lives, and insist on modern palliative care for those who need it and a properly funded health service that supports living.

--- Later in debate ---

[Andy Slaughter]

I not only do not accept that; I find it the most appalling scaremongering. I have never met a GP who I do not think has a duty to their patients. They may vary in their competence and skills, but in their duty to their patients there is a very honourable tradition among general practitioners, and indeed the whole of the medical profession in this country. To throw such comments into this debate is not helpful to the right hon. Gentleman’s own side, let alone anyone else’s.

It is right that recently, under the former Health Secretary, the right hon. Member for West Suffolk (Matt Hancock), who spoke earlier, the Government undertook research, but they have so far not found the time or resource for a proper investigation and debate, potentially leading to legislation. I am a supporter of good local palliative care, and for several years I have been fighting to retain it for my constituents against attempts to restrict it. We should strive to provide the very best palliative care to all those who are nearing the end of their lives. For many families, palliative care and respite care for family members is essential, but in order to offer the very best palliative care, we need the tools, the people and the money to sustain it.

My hon. Friend the Member for Ilford North (Wes Streeting) has recently spoken about Labour’s plan for a national care service. To offer people real dignity in dying, we need a focused approach to care and end-of-life care, which a national care service could provide. Pembridge Hospice and Palliative Care in North Kensington served my constituents for many years until, several years ago, the in-patient unit was closed because it could not recruit a consultant. That is where we should look for problems. Assisted dying is not an alternative to palliative care; the two complement each other.

[Danny Kruger]

Does the hon. Gentleman acknowledge that the Health and Care Act 2022 included the amendment proposed by my noble Friend Baroness Finlay of Llandaff to ensure that palliative care becomes a commissioned service in the NHS for the first time in its history? Does he welcome that?

[Andy Slaughter]

I heard that from one of the hon. Gentleman’s colleagues earlier and I absolutely welcome it. However, as I said, we need not only a policy commitment but funding—and that includes workforce planning, because palliative care consultants are in short supply.

This should not be a debate only between different attitudes, religious practices or medical treatments; it should be a debate about ensuring that the needs of the terminally ill are met in the most appropriate and compassionate way. I understand the strongly held views of those who oppose assisted dying, but I am a firm believer in freedom of choice and bodily autonomy—issues that have come to the fore in the wake of the reversal of Roe v. Wade, and not just in the US. This is a matter of conscience. It is one of the most sensitive that we have to deal with, but we must not shirk our responsibility on those grounds.

I agree with the petitioners’ request for the Government to grant the means to debate and, if there is the will in Parliament, to reform the law in the interests of those who find themselves at the end of their life and in a perilous position. Whatever our difference of opinion here, we all agree that those nearing the end of their life deserve our compassion. There is more that we can do, not just in the debate on assisted dying, but in how we care for those who are terminally ill.

As the world changes around us, we cannot stand still. We have a duty to bring this matter before Parliament again and allow it to decide. How we begin that process is down to the Government. I hope the Minister agrees that, if the necessary time is made available in Parliament, we should be able to debate, vote and, if there is the will, legislate on this issue. It would be perverse if Scotland, Jersey and the Isle of Man had legislated on this matter before we have even had a chance to discuss it in a meaningful way. This has been a very good and measured debate, but the next stage must be to allow the voices of our constituents, which are very strong on this matter, to be heard—not just this in Chamber, but the main Chamber, and therefore through legislation.