Assisted Dying

Danny Kruger Excerpts

Monday 29th April 2024 Westminster Hall

[Danny Kruger (Devizes) (Con)]

I greatly respect the campaigners who are proposing a change in the law and the people who signed the petition. Nevertheless, it is not the case that the majority of the public support what is euphemistically called “assisted dying”. When the details of the proposed law change are explained to people, a majority of people oppose a change in the law. Crucially and most importantly, the doctors who work with the dying—people in palliative care and geriatric care, and GPs—overwhelmingly oppose a change in the law, because they know what we are talking about. Nor is it the case that in countries that have legalised assisted dying—

[Paul Blomfield]

When the BMA consulted its members, more doctors supported a change in the law than opposed it.

[Danny Kruger]

The BMA has decided to be neutral on this matter. Most of the doctors who supported a change in the law are do not work with the dying and the elderly. I accept that a majority of doctors have now accepted a change in the overall position. What I am talking about is people who know what they are talking about—I say that with great respect to the hon. Gentleman, who I understand has a lot of knowledge of this topic, as well. My point is that while there might be overall polls that suggest public support, in fact, when professionals, members of the public and MPs get the chance to look at this closely, they end up opposing a change in the law, and for good reason.

Palliative care services do not rise in countries that have legalised assisted dying compared with countries that have not; they flatline. Of course, all palliative care services are going up because the population is ageing, but they decline in countries that have legalised assisted suicide.

[Paul Blomfield]

Has the hon. Gentleman not read the Select Committee report? We looked at every single jurisdiction. There was no evidence that palliative care declined in countries that adopted assisted dying. There was only evidence that it had opened a debate that had led to an increase and improvement in palliative care.

[Danny Kruger]

The point I just made is not that it declines, but that it does not increase compared with countries where assisted dying is not legal. Often, the increase and investment in palliative care is actually because there is more spending on assisted dying, which has now been legalised in those countries. I am very happy to take up this point offline, because it is very important, and I recognise the Select Committee looked closely at it in its report. However, there is an important point about the investment in palliative care in countries that have assisted dying and those that do not.

I am not sure whether this point was in the report, but what does go up in countries that have legalised assisted suicide is suicide itself in the general population. The fact is that suicide is contagious. Suicides among people who would not be eligible for assisted suicide increase in countries that have legalised it. I am afraid that is understandable when we consider that the Government have told society that some people would be better off dead. We have policies in this country to prevent suicide—we want to stop people committing suicide. It is important that we recognise the potential implication of a change in the law for others.

As that suggests, this is a profoundly moral question. I recognise that there are people with deeply held beliefs on both sides. There is a quasi-religious belief in the notion of autonomy and choice as the only moral question in this debate, and I have heard that suggested. It is important to acknowledge that the people with the least agency and autonomy—the vulnerable, the disabled, the mentally ill, the frail, the lonely—are the ones who suffer in every country where the law has been changed. It is not surprising that every country that legalises assisted suicide starts with very tight restrictions, and then the scope and the access expands. I will demonstrate that offline after the debate, because it is true.

[Paul Blomfield]

We looked at this in detail as a Select Committee. Not a single jurisdiction that has defined its law in terms of terminal illness has chosen to broaden it.

[Danny Kruger]

The definition of terminal illness is incredibly difficult, and people can always find a doctor to demonstrate it. That has happened in Oregon, in Canada and other countries. Again, let me take this up offline. [Interruption.] I respect position of the hon. Member for Sheffield Central, but I stand on the point that the scope, access and eligibility expand, and of course it does, because expansion is implicit in the principle.

[Robin Millar (Aberconwy) (Con)]

I note from the Health and Social Care Committee’s “Assisted Dying/Assisted Suicide” report that:

“Wherever the boundaries are set, evidence from other jurisdictions shows that the boundaries are eroded and criteria expanded, with concomitant escalation in numbers, most markedly seen in Canada.”

Does my hon. Friend agree that that is the concern he is trying to express?

[Danny Kruger]

I am very grateful to my hon. Friend. These things are very contentious, and there are issues around definition. But I stand on the principle that there is implicit expansion in the scope of any law. [Interruption.] Am I being given extra time for the interventions I am taking?

[Mrs Pauline Latham (in the Chair)]

No.

[Danny Kruger]

Then I will not take one now.

Baroness Campbell, herself a wheelchair user, said that:

“The existing law…rests on a natural frontier”,

namely that we do not kill people. She asked:

“What the proponents of 'assisted dying' want is to replace that clear and bright line with an arbitrary and permeable one…If terminal illness, why not chronic and progressive conditions? And, if chronic and progressive conditions, why not seriously disabled people?”

It is impossible to make distinctions between those terms. That is why the law always has the scope for its own expansion within it. That is why we should oppose the change.

--- Later in debate ---

[Nick Fletcher]

Will the hon. Member give way?

[Danny Kruger]

rose—

[Ruth Cadbury]

I want to crack on so that both the Government and the mover of the debate can have their chance.

We have heard concerns about vulnerable adults nearing the end of their life who could be at risk of pressure from either family members who feel incapable, for whatever reason, of providing care and support for a terminally ill person, or, as eloquently touched on by my right hon. Friend the Member for Knowsley (Sir George Howarth), those with even worse motives. If reform is offered, it is essential that there is a plan for robust and effective safeguards against those issues.

Matthew Parris’s article has been referenced by the hon. Member for South West Bedfordshire (Andrew Selous) and my right hon. Friend the Member for East Ham (Sir Stephen Timms). Unlike the hon. Member for North Antrim (Ian Paisley) and the right hon. Member for New Forest West (Sir Desmond Swayne), I believe that the article is not a reason for doing nothing—I hope I have got my negatives right. Change must be backed by evidence. Safeguards must be backed by evidence that they work, so we must learn from international experiences and look at how reform has played out in other jurisdictions that have implemented such a law change.

I want to address palliative care and hospices, which is an issue I had hoped to speak about in the Chamber last week as I recently visited the Shooting Star hospice used by my constituents. We know that we need to improve palliative care in this country. The Chair of the Select Committee, the hon. Member for Winchester (Steve Brine), said that a law change in other jurisdictions has led to significant improvements in palliative care in those countries. My hon. Friend the Member for York Central (Rachael Maskell) addressed the issues of loneliness and poor social care. It is so essential that everyone, whatever their choices, has a good end of life experience. Irrespective of what happens with the law on assisted dying and what choices we take, we must improve end of life care in this country.

I was moved by the hon. Member for South West Bedfordshire, who described the difficulty in getting adequate morphine for his mother-in-law as she was nearing her end. As the former Secretary of State for Health, the right hon. Member for West Suffolk (Matt Hancock), said, even the best palliative care cannot remove the trauma and terrible pain of some health conditions. The issue of choice has been mentioned many times by Members. I will paraphrase the right hon. Member for North West Hampshire (Kit Malthouse), who said, “Please don’t impose the choices of others upon me.” The hon. Member for Brighton, Pavilion (Caroline Lucas) and others have addressed the fact that going to Dignitas is expensive and out of reach for many, and those who do go are not able to have close family with them because that would risk police investigation, as Esther Rantzen mentioned this morning on the radio.

My hon. Friend the Member for Kingswood (Damien Egan) said that, in Oregon, a third of those who initially choose the option of assisted dying do not actually take that route. Again, they have the choice at the end. The issue about choice was described most profoundly when the hon. Member for Great Grimsby (Lia Nici) read out her friend’s letter and described what her friend had said to her in her last painful weeks. That really came home to me in a very moving way. We have had other considered and thoughtful contributions from a number of Members, which I do not have time to list, but I thank them, and I listened carefully.

To conclude, only by reforming the law, and introducing safeguards to address the concerns that hon. Members have raised today, can we move the law forward—a law that is about personal freedom and morality. As the Supreme Court has decided, only Parliament can make the change. I want to restate our clear commitment that a future Labour Government would make time for a private Member’s Bill so that Parliament can have the final say through a free vote following a full debate and a process of amendments. This place is at its best when it rises to the occasion and takes a cross-party, consensual and evidence-based approach to issues, and that is the approach that we need on this vital issue.