Terminally Ill Adults (End of Life) Bill

Jess Asato Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

[Jess Asato (Lowestoft) (Lab)]

After spending almost a decade working to protect women and children from harm, my focus with any piece of legislation is the potential it creates for abuse and coercion. While I would once have been supportive of the principle of assisted dying, and might wish that option for myself, I have been increasingly unable to reconcile my desire to safeguard the most vulnerable with putting that principle into practice. I am concerned that if the Bill passes we will see people coerced, either by an abuser or by societal expectation, into ending their own lives.

We do not want to think about it, but abuse surrounds us—2.3 million victims of domestic abuse in the last year. One in six older people experience abuse. The definition of coercive and controlling behaviour includes behaviour that repeatedly puts someone down, telling them they are worthless. Victims describe this as a “drip, drip” effect, and it goes unnoticed. Not just because we do not want to think about it, but because it is hard for professionals to identify it without proper training and with the lack of specialist support. There is no mandatory training for judges on coercive and controlling behaviour, nor is there effective training for medical professionals. In a 2019 survey, 50% of healthcare professionals said that they did not feel they had received adequate training to identify a victim of domestic abuse.

It is also hard for victims themselves to realise they are being coerced until they have got free. We know that older people, especially those who are disabled, are particularly susceptible to abuse by a family member and less likely to be able to escape their abusers. Those who are coerced are often isolated from friends and family. If people are not required to tell friends and family they are opting for assisted dying, who will raise the alarm? How would any concerns be reported? Will judges be able to investigate the police records of those around a person who has requested assisted dying—family or carers?

I will always remember a conversation I had with a hospital-based independent domestic violence adviser, who was called to the bed of a lady in her 80s in her last days living with cancer. The lady disclosed to the IDVA that she had been abused by her partner of 50 years, and said “Thank you. I have never told anyone before, but now I am finally free to die, and I am grateful for the release.”

We know from the Monckton-Smith report that a third of female suicides could be linked to domestic abuse, and from the Killed Women campaign that as many as 130 women each year could be murdered by a partner or relative but have their deaths are recorded as suicide or accident. Every week, we hear of family court judges failing to spot coercive and controlling behaviour. In one case, a judge found that a man repeatedly calling his partner worthless and telling her to die was not controlling conduct.

Where is the discretion of gender in the Bill? Out of 60 documented cases around the world of euthanasia and assisted dying for people with anorexia, 100% were women. I have come to the view that no Bill, however drafted, could adequately sift those with a genuine desire to end their own lives from those doing it for all the wrong reasons. For that reason, I will vote against.

Terminally Ill Adults (End of Life) Bill

Jess Asato Excerpts

Report stage
Friday 20th June 2025 Commons Chamber

[Jess Asato (Lowestoft) (Lab)]

I did not start this process opposed to the idea of assisted dying, but having worked in the field of domestic abuse, I found myself increasingly concerned about how this Bill would impact on those who are most vulnerable to coercion and abuse. As a Labour MP, I reflected on why I joined the Labour party. It was because of our commitment to protecting the vulnerable and fighting for equality, suspicious of individualism and narrow notions of choice that turn a blind eye to the impact of that choice on others.

If I could legislate to create a Bill just for me, I would be tempted by these measures, but I believe my role as an MP is to legislate in the best interests of those who have no voice, whose choices are often limited by poverty, the patriarchy, racism, trauma, ill health, and state and societal failure. We must recognise that if we advance this Bill yet further today, there will be unintended and undesirable consequences, and it is the Bill in front of us that we are voting on today—not the principle, or a distant promise that the other place might fix the holes, but what we know is in, and not in, this legislation.

I would like to briefly illustrate the reasons why I believe this Bill will create harm for families across our country. Imagine the scenario of your mother. You were there when Dad used to belittle her. In public, it was jokes putting her down, but in the house, you would hear him say that she was worthless and ugly and would be better off dead. You got out of there as soon as you could, but she would never leave—she loved him, and could not see a life for herself outside of his control. You could see her health deteriorating, but he often stopped her from going to the doctor or reaching out to friends. One day, you get a call from your dad to say, “She’s dead. She got an assisted death.” You worry that she took her life, not because of her illness, but because it was the only way out from the abuse. You fear that your dad made her do it, but there was no chance for you to tell anyone about your concerns, and there is no automatic requirement for an investigation by a coroner. Would you ever be able to prove his malign control now that she is gone?

Imagine that you have a brother who has struggled with an eating disorder ever since he entered secondary school. He was sexually abused by a family friend and never received any real support for what he went through, and court backlogs mean that the criminal case is still ongoing. He spends longer and longer watching social media influencers paid by assisted dying companies to advocate for what they call a peaceful end to life. He begins to starve, and doctors withdraw treatment because they claim nothing more can be done. You get a call only a few months after his 18th birthday to tell you that your brother has opted for an assisted death.

[Catherine Atkinson (Derby North) (Lab)]

Will my hon. Friend give way?

[Jess Asato]

No, thank you. I am sorry, but we have to make time for others.

We know from other jurisdictions that it is disproportionately older and disabled people who would access assisted dying. These are two of the groups most vulnerable to abuse or coercion, particularly by strangers through financial abuse and cuckooing. Coercion is not just a risk with this legislation, but a certainty. There are 2.3 million victims of domestic abuse in the UK. Even if this Bill implemented gold-standard training—we do not know that it will—professionals will not be able to identify everyone. It is sadly inevitable that if the Bill passes, it is the most vulnerable people in our society who will experience wrongful deaths. A prominent campaigner in favour of this Bill said:

“Even if a few grannies get bullied into it, isn’t that a price worth paying for all the people who could die with dignity?”

Please, we must not settle for this. In a system designed to end life, there can be no room for doubt or human error. Coercion and abuse are real—they happen all around us all the time, whether or not we want to see them, as does feeling like a burden. Perceiving yourself as a burden is a common phenomenon associated with having a terminal illness, one that often leads to a desire to die. This Bill allows that feeling of being a burden—to those closest to you, and to society more broadly—to be acted on, rather than treated.

Research has found that doctors wrongly predict how long terminally ill people have to live in over half of cases. There is so much life left to live after a terminal diagnosis. We should not relinquish our bonds, duties and responsibilities towards each other as fellow human beings. I urge colleagues to reject this Bill.

Terminally Ill Adults (End of Life) Bill

Jess Asato Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Kim Leadbeater]

I am afraid not.

Coroners investigate suspicious or violent deaths, or situations in which the cause of death is unknown. Assisted deaths would not fall into these categories, and there would therefore be no need for a default coronial investigation. This will ensure that any unnecessary delays and distress for bereaved families are avoided. These are not unexpected deaths; sadly, they were inevitable.

[Jess Asato (Lowestoft) (Lab)]

Will my hon. Friend give way?

[Kim Leadbeater]

I will not, I am afraid.

It is the manner and timing of their death about which the patient will make a legal, informed choice, having been thoroughly assessed. As Professor Aneez Esmail has said, “I cannot think of any death that would be the subject of greater scrutiny in advance of the person dying than an assisted death. The process far exceeds the level of safeguarding that is in place for many of the deaths that are, at present, routinely reviewed by medical examiners and not referred to a coroner.” Of course, anyone can report a death—including an assisted death—to the coroner, or indeed to the police, if they have any concerns that it was not carried out in accordance with the Act, and if any offences have been committed, they will be investigated.

--- Later in debate ---

[Alison Hume (Scarborough and Whitby) (Lab)]

I rise to speak in favour of new clause 15, which clarifies that an assisted death would not be classified as an unnatural death and that a full coroner’s inquest would not normally be required.

My constituent Antony Shackleton lived with motor neurone disease for six long years. As his condition worsened, his options narrowed until there was only one choice that preserved his dignity, autonomy and peace: to travel to Dignitas in Switzerland and end his suffering on his own terms. Louise, as his wife of 25 years, and someone who had known him since the age of 18, did what any loving partner would do: she stood by him. She helped him on to that plane and held his hand through the most difficult decision of their lives, and now, for that act of love, she is under police investigation.

That is precisely why we need new clause 15. If the Bill is passed, assisted dying would be a legal, strictly regulated and monitored choice made by the individual concerned.

[Jess Asato]

I recognise that the situation facing my hon. Friend’s constituent is awful, but we are here today to balance such situations with the choices of people who may not be loved as dearly as him. Our concerns would be about the fact that many of these killings could be mercy killings, and if there is no recourse to the coroner, some people may be taking their own lives under coercion and pressure that may never be discovered, because the full law will not be applied.

[Alison Hume]

New clause 15 particularly addresses the role of coroners. Coroners investigate deaths in which there is a reasonable suspicion that the deceased has died a violent or unnatural death, where the cause of death is unknown, or if the deceased died while in custody or state detention. This is not the case with an assisted death, and there would already be strong safeguards in place, including multiple layers of oversight and assessment. The process is cautious, thorough, and heavily safeguarded. There is no need to investigate an assisted death, as it is not unnatural. In this country, it is still a crime to help someone die peacefully and with dignity, even when they are suffering unbearably from a terminal illness.

--- Later in debate ---

[Rachel Taylor]

No, I will make some progress. Requiring a judicial oath would be inappropriate because the panel is not performing a judicial function. It is a specialist, administrative panel whose first priority must be focused on safeguarding and the review of evidence.

[Jess Asato]

Will my hon. Friend give way on that point?

[Rachel Taylor]

No, I will make some progress and expand on my point. Disqualifying retired and deputy judges would only shrink the pool of experienced candidates, and I do not believe that those changes would make the process safer, more effective or better. Instead, they would make it more difficult to appoint experts to allow the panel to function as the necessary safeguard that it needs to be.

Finally, I turn to the most important aspect of the Bill, which is those who are affected directly. Opponents present hypotheticals, but I have heard real stories from my constituents who support the Bill. One constituent told me about her husband who died of metastatic prostate cancer. He wanted to die at home, and despite the efforts of a dedicated palliative care team, his final month was marked by excruciating pain. Our constituents deserve better. They deserve the choice to say goodbye in peace, surrounded by loved ones, without unbearable pain. For me, this debate is about whether the status quo is acceptable. After hearing these stories and listening to lawyers and doctors, I know that it is not. If we vote in favour of the Bill, our constituents must be able to expect that it will be brought into law quickly. I therefore oppose amendment 42.

The British public overwhelmingly support the Bill. They are looking to this House for courage and leadership. That is why I will vote for the Bill, with the amendments that strengthen it. Let us bring dignity, peace and choice to those facing the end of their lives in difficulty and pain.

--- Later in debate ---

[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

[Jess Asato]

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

[Dr Huq]

Will I get more time? [Laughter.]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

indicated assent.

[Jess Asato]

I thank my hon. Friend and I recognise the time constraints. On the issue of vulnerable groups, she may know that a letter has been sent about eating disorders but the spokesperson for the Bill’s sponsor dismissed it, saying that the concerns raised were old news. Does she agree that there is a problem with the way the Bill is being run, as so often the concerns and evidence presented by groups have been dismissed out of hand?

--- Later in debate ---

[John Grady]

I am obliged to my hon. Friend—that is precisely why I joined the Labour party as a 16-year-old. Faced with terrible circumstances, some people will seek an assisted death. I find it hard to accept that those will be truly autonomous choices. We must be clear that the very same circumstances that have denied people dignity and robbed them of autonomy throughout their lives will drive them to an assisted death. I find that deeply troubling, and I worry that we are placing too much confidence in concepts of capacity, autonomy and self-determination.

Everyone accepts that coercive control is common—indeed, it is incredibly common, as is domestic abuse and elder abuse. There are very clear risks of coercion. I recognise that the supporters of the Bill have sought to improve protections, and to protect people in those types of circumstance. I have anxiously scrutinised those protections, and I do not believe that they will achieve their aim. That is why the amendments are so important.

[Jess Asato]

Last weekend my hon. Friend the Member for Spen Valley (Kim Leadbeater) posted on X a story of two older people who wanted to die together, and who had found doctors to sign off their assisted death. Is my hon. Friend concerned that this debate might be romanticising suicide pacts given that, as we know, there are mercy killings, which are, unfortunately, actual deaths? Does he share the fears of the Government’s suicide adviser that the Bill will undermine suicide prevention efforts?

[John Grady]

I think everyone in the House debates this issue in good faith, and in the courts there is a general view that one should be reluctant to attack otherwise. I am sure that question was meant on that basis. However, one must not lose sight of the fundamental point that the protections in the Bill will not address the profound societal pressures that people will face. One must not lose sight of the fact that, whatever protections are included in the Bill, it will not protect people against coercion.