Terminally Ill Adults (End of Life) Bill (Money)

David Smith Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[David Smith (North Northumberland) (Lab)]

I would like to raise a couple of practical and principled concerns about the finances around assisted dying. First, on the practical, I welcome the comment from my hon. Friend the Minister that there will be an impact assessment in due course. However, until we see it, we have no idea what the measure will cost. We are being asked to approve a blank cheque for assisted dying. We have heard that the NHS is a blank cheque, but the NHS has a clearly defined budget. At this point, we do not have any sense of what the Bill will cost. If that were the case for any other legislation, we would be shouting about it.

The Bill represents a profound change to the very nature of our healthcare system, and we are simply guessing at the cost. That is not good for the Bill Committee’s ability to scrutinise, and not good for this place, or for the democratic and legislative process. In order to legislate well, we need a firm commitment. I am glad to have heard that the impact assessment will be published before Report. We have heard from my hon. Friend the Member for Spen Valley (Kim Leadbeater) that the motion is routine, and I accept that. However, the consequences are extraordinary, and that is why this is an important moment.

On the principle, whatever the cost, once it is assessed, and despite the Government’s recent financial boost for the hospice sector, palliative care is massively underfunded. The postcode lottery in the provision of end of life care has led to some of the horror stories that we heard on Second Reading. The hospice sector has only 30% of its funding provided by central Government, so this technical stage represents a commitment to taking potentially scarce funding from end of life care and allocating it to ending lives.

[Dr Opher]

Will my hon. Friend give way?

[David Smith]

I do not have time. That opens up the dark possibility of a race to the bottom—to looking for savings in the health and social care budget. Any Government would be tempted, where cost saving is a possibility, to push assisted dying as a cost-saving measure; we have seen that in jurisdictions such as Canada.

Finally, let me say this with humility and respect to my hon. Friends on my left. I fear that the Bill will lead to the marketisation of death and dying. We have learned from other jurisdictions that many medical services and clinicians do not want to be part of the delivery of assisted dying, for reasons of principle or because they fear that they will be sued. Independent private health organisations will have to take over to fill the space. Those businesses will have shareholders and annual reports. They will be driven by the desire to maximise profit, with death for the bottom line. They will advertise and seek to expand their market share.

[Dr Opher]

Will my hon. Friend give way?

[David Smith]

I am sorry; I am almost finished. This could seem like a tangential point to make on a money resolution, but, to summarise this and my other points, I fear the consequences of the relationship between money—this resolution in particular—and assisted dying. Although I will not be voting against this resolution, because I believe in the democratic process, I think we seriously need to consider the relationship between money and this Bill.

Terminally Ill Adults (End of Life) Bill

David Smith Excerpts

Report stage
Friday 20th June 2025 Commons Chamber

[David Smith (North Northumberland) (Lab)]

On Second Reading in late November, I wanted to express the concerns that I had with the Bill around coercion, commercialisation and the pressure on people who feel that they are a burden. Unfortunately, there was not enough time in that debate, and there is not much time today either.

During that debate, the House was repeatedly reassured by some Members that the Bill was about to undergo a rigorous scrutiny process in Committee. The question on Second Reading that we were most implored to consider was whether we wanted to keep talking about the Bill. Indeed, the right hon. Member for Goole and Pocklington (David Davis), who is not in his place, said it best:

“I say to both the Bill’s sponsors that it has a number of areas that they know I think they have to put right—about a dozen, in truth.”—[Official Report, 29 November 2024; Vol. 757, c. 1053.]

While the time for talking is quickly running out, this Bill remains far from ready. Too many concerns remain partially or wholly unaddressed—these things have not been put right.

Let me highlight three of the issues that I was originally concerned about. First, on the issue of coercion, seven months on from Second Reading, the Bill still does not even define “dishonesty”, “coercion” or “pressure”. Let me say that clearly again—it does not define “coercion”. If we, as legislators, cannot do that, then who will? Further, with the exclusion in the Bill of assisted deaths from the coronial system, a vital opportunity has been missed to include the investigative oversight that would be most likely to spot coercion, even if it was after the fact of assisted dying.

Secondly, the marketisation of assisted dying worries me greatly and I do not believe that it has been properly addressed in the Bill. We already know, from last week’s debate, that there is a loophole in the advertising ban, where future Secretaries of State for Health and Social Care could decide to launch public health information campaigns on television, online or in GP surgeries outlining the options of assisted dying.

Even worse, in my view, is the certain involvement of private commercial interests in assisted dying. When we combine the known costs to the state from the impact assessment and the unknown costs, the limited resources currently available within the NHS and the conscientious objections of large swathes of doctors, which is surely inevitable, we can foresee that assisted dying will be largely privatised. Commercial operators with shareholders and a desire to maximise profit will inevitably be delivering assisted death. In such circumstances, they will find ways to grow their revenue, including through marketing it, however subtly.

Thirdly, on the issue of feeling a burden, on Second Reading my hon. Friend the Member for Cowdenbeath and Kirkcaldy (Melanie Ward) raised the issue of Washington state, where 59% of those going through with an assisted death, in a similar process to the one proposed in the Bill, did so because they feared being a

“Burden on family, friends/caregivers.”

There has been no meaningful response to that argument, in my opinion, from those in favour of the Bill.

I ask colleagues in favour of passing the Bill to consider the following scenario. An older relative knows that assisted death is now possible and that their family is struggling to get by, in difficult economic circumstances. They have a health condition, with a prognosis of five months to live, even though studies show that most such prognoses are wrong about 50% of the time. What will stop our parents or grandparents from deciding to seek assisted dying purely to “do the right thing” by their loved ones?

[Jonathan Davies (Mid Derbyshire) (Lab)]

On that point, will my hon. Friend give way?

[David Smith]

I have nearly finished. For that matter, what will stop relatives anxious to receive their inheritance from subtly pushing the option of assisted death?

To conclude, as legislators the responsibility falls on us, in this place, to create outstanding legislation that provides clarity, certainty and benefits to our constituents and to the country at large, yet all my concerns from the start of the process still remain; indeed, they have only grown. We have repeatedly heard today that there is no alternative to this Bill and that the status quo is the alternative. Well, we have agency in this place—the choice that we are making today is a big change to the status quo, so why can we not do other things? It is not simply a choice between this Bill and nothing else. Therefore, I will be voting against the Bill and encourage colleagues to do the same.

Terminally Ill Adults (End of Life) Bill

David Smith Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Tony Vaughan]

I will press on.

Secondly, the amendment attempts to limit the scope of future regulation by barring any changes to the Suicide Act 1961, but that is already covered by new clause 14, which prevents other changes to this Bill, should it become an Act. The amendment is not only duplicative, but closes off avenues for future clarity that might be needed in the Suicide Act, such as to ensure that offences around coercion or fraudulent practice are properly dealt with.

In short, the amendment does not add clarity; it risks confusion. It does not strengthen the advertising ban; it introduces constraints that could make it harder to enforce with evolving practice.

[David Smith (North Northumberland) (Lab)]

I thank my hon. and learned Friend for giving way, given the time constraints. I have a simple but key question: does an advertisement include a leaflet on a GP’s surgery table or on a door going into the GP? It seems unclear to me what is information and what it advertisement.

[Tony Vaughan]

That will have to be worked out; I do not have the answer at my fingertips, but others might.

I was pleased to hear my hon. Friend the Member for Spen Valley say earlier that she is open to working with my hon. Friend the Member for Rochdale and others in the Lords to find a workable way forward on all these issues. I hope that he will take her up on that offer. This is obviously an area where constructive cross-party work could ensure that strong safeguards are achieved without unintended consequences.