Terminally Ill Adults (End of Life) Bill

Jim Shannon Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

[Kim Leadbeater]

I agree absolutely. Those conversations, which are not taking place at the moment, are very important. I will make some progress.

There has rightly been a lot of discussion about palliative care in recent weeks, and I am convinced that a significant amount of that discussion would not have taken place without the introduction of the Bill. It is a long overdue conversation, and I am very pleased to see it happening.

I have met with the Association for Palliative Medicine, Hospice UK, Sue Ryder and Marie Curie, and last week I was delighted to attend the inaugural meeting of the all-party parliamentary group for hospices. I also attended the fantastic Kirkwood hospice, which serves my constituency of Spen Valley. I pay tribute to the dedicated staff and volunteers across the country in the palliative care sector, who do some of the most vital work in society. We must do more to support them, and I look forward to working with the Government and colleagues across the House in that important endeavour. That is why I have included in the Bill a requirement for the Secretary of State to report to the House on the availability, quality and distribution of palliative care.

Of course, assisted dying is not a substitute for palliative care—it is not an either/or. We have some of the best palliative care in the world in this country, and, when it can meet the needs of terminally ill people, it is second to none. However, when it cannot, surely the choice of an assisted death should be one component of a holistic approach to end of life care.

The comprehensive report by the Health and Social Care Committee, published earlier this year, found no indications of palliative care deteriorating in quality or provision in places where assisted dying had been introduced.

[Jim Shannon (Strangford) (DUP)]

Ever mindful of what the hon. Lady has said about the criteria, I remind her that Belgium started off with a simple project like the one she refers to but it deteriorated and expanded to include sufferers of dementia and under-18s—children. What guarantees do we have that this legislation will not end up with a situation like that in Belgium, in which case anything goes? Is that what the hon. Lady wants? I do not want that. Does she?

[Kim Leadbeater]

I thank the hon. Member for his intervention, but let us be very, very clear. Huge amounts of research has been done by the Health and Social Care Committee, and indeed by myself and others. The model being proposed here is nothing like what happens in Belgium. It is nothing like what happens in Canada. There are strict, stringent criteria, and if the House chooses to pass the Bill, those criteria cannot be changed.

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

Jim Shannon Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[Dr Kieran Mullan (Bexhill and Battle) (Con)]

I am conscious of the limited time available and so will keep my remarks focused. I appreciate that it is not commonplace for Front Benchers to speak at length on money resolutions, but this is not commonplace legislation. I reiterate that His Majesty’s loyal Opposition have taken a neutral stance on the merits of the Bill, both in principle and in detail. The House has expressed its support for the introduction of assisted dying, and Members are currently considering the Bill in detail before it is presented back to the whole House for further consideration. The money resolution is a necessary part of associated legislation. Proponents of the Bill will welcome the Government bringing this forward, as it is not unheard of for Governments to withhold these resolutions in a manner that delays the progress of legislation.

[Jim Shannon (Strangford) (DUP)]

There are concerns from those of us who voted against the assisted dying Bill. I understand the process, and how it works with the money resolution coming forward, but on the day that this was finalised I asked a question, and the make-up of the Committee was 15 of those who voted for the Bill, and nine who voted against. A secrecy process has now been brought into the Bill, and we do not know what is happening. That is against the rules of this House. The second thing they have done is the issue of withdrawing the opinion of the judges, which is also out of order.

[Dr Mullan]

I hope that the hon. Member will appreciate that the money resolution is narrow in scope—I will perhaps bring the attention of the House to some tangentially related issues when it comes to the role of the Government in these proceedings.

As I said, proponents of the Bill will be glad of the progress that has been made, but this motion brings into sharp focus the fact that at some point the Government will need to fund, organise and provide assisted dying services to reflect any legislation that receives Royal Assent. As the Minister said, the money resolution will provide the legal basis for funding that service. I recognise that we are not yet at the stage when the Government can say with certainty what exactly those services and their associated funding will look like. There is time still for changes to be made, and we should not of course make an absolute assumption that any Bill will pass all its stages, as likely as that is, given the will of Parliament as expressed to date.

As the Bill proceeds, it will become increasingly important, and helpful to Members voting on future stages, to begin to have some idea of how the civil service and Ministers are envisioning enacting the legislation, not least in relation to the matter of resources before us today. The hon. Member for Spen Valley (Kim Leadbeater) estimated that up to 3% of adults may eventually choose assisted dying. In 2023 there were 577,620 adult deaths in England and Wales. If 3% of those were assisted dying cases, that would result in about 17,000 cases annually. Those are not insignificant numbers, and Members will recognise the considerable existing challenges with resources and personnel in the relevant areas of spending.

Although this is not a Government Bill, the Lord Chancellor has ultimate responsibility for ensuring the effective functioning of our legal system and judiciary, as does the Secretary of State for Health and Social Care for the delivery of this service, and how that will balance and interact with the other health services provided. I therefore have a small number of questions relating to resources, which I hope the Minister agrees will assist the House in better understanding how the Government are approaching such matters.

If information is not forthcoming today, it is crucial that the Minister sets out, in slightly more detail than he did earlier, at what point the Government will engage more fully with the detail of how they intend to resource the Bill, and start sharing their considerations. First, have the Government produced at the very least internal estimates of a potential range of the costs of delivering an assisted dying service, for both the NHS and the judiciary? If they have, will they share that with the House today? If they have not produced internal estimates, when do they anticipate doing so, and when do they intend to publish such estimates?

Secondly, have the Government identified potential sources of funding for the service? If they have, will that funding come from existing departmental budgets, or will it be allocated from outside currently allocated funding? In the latter case, where will those additional resources be drawn from? If the Government have not yet produced options for Ministers to consider on these questions, when will they do so, and when will they share them with the House?

Questions of resources relate to the impact on existing services of any decisions that the money resolution enables. The closer we come to the closing stages of the Bill, particularly ahead of any final parliamentary vote on a settled set of proposals, the more important it will be that Members get the benefit of answers to those questions, which can only come from the Government. It is important to say that it is perfectly legitimate for Members to decide that a better understanding of these issues is not an absolute necessity, and it will be for Members to decide whether they are happy to support legislation purely on principle. That may well be the position for many Members of the House, but I think most would agree that it would be preferable to be able to vote with, at very least, possible approaches and assessments of these matters, even if not definitive answers.

In conclusion, these are not merely procedural or technical issues. The Government’s tabling of this motion signals an acceptance that, should the Bill become law, the financial costs will need to be met, and that will not be a minor area of expenditure. This House has a duty to scrutinise every aspect of the Bill, and I urge the Government to provide a degree of clarity that only they can provide to assist Members in doing that. At this stage there has been a clearly expressed will of Parliament to introduce this service, and it is right for the Government to make legal provision for funding it in principle. However, the Government should enable Members to make decisions at future stages with as good an understanding as possible of how the legislation they may wish to support will translate into the real world.

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[The Minister for Care (Stephen Kinnock)]

I thank Members for their continued contribution to the debate. The Government are of the view that the Bill is an issue of conscience for individual parliamentarians and it is rightly a matter for Parliament, not the Government, to decide. The money resolution allows the Bill to be debated in Committee, where its detail will continue to be scrutinised. As I have said, the Government will also be assessing the impact of the Bill and we expect to publish an impact assessment before MPs consider the Bill on Report. I therefore commend the money resolution to the House.

Question put and agreed to.

[Jim Shannon (Strangford) (DUP)]

On a point of order, Madam Deputy Speaker. The right hon. Member for North West Hampshire (Kit Malthouse) made a comment that I feel impinged upon my integrity. I have spoken to the right hon. Gentleman and he knows what I am referring to. I underlined and highlighted that the Terminally Ill Adults (End of Life) Bill Committee went into private session; some 15 Members, who support the Bill, voted for the private session and nine Members, who oppose the Bill, voted against the private session. The record must be corrected about what the right hon. Gentleman said about the comments I made about that. Facts are facts; they matter to me, as does my integrity.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Thank you, Mr Shannon, for letting me know you would be making a point of order. The Chair is not responsible for the content of Member’s speeches, but I remind the House of the advice in Erskine May on the importance of good temper and moderation in parliamentary language.

Terminally Ill Adults (End of Life) Bill

Jim Shannon Excerpts

Report stage
Friday 20th June 2025 Commons Chamber

[Sir James Cleverly (Braintree) (Con)]

I have no doubt that the vast majority in this House—probably every single hon. and right hon. Member—is sympathetic to the underlying motivation of the Bill, which is to ease suffering in others and try to avoid suffering where possible. For the most part, the debate, both in this Chamber and in Committee, has been good natured and conducted in a way that we can be proud of.

There have been wider questions about the motivations of both the proponents and the opponents of the Bill. Although this is not about any individual one of us, I think it is only fair that, because some questions have been asked, I put a few things on the record about my own position. I do not come at this from a religious point of view—I am an atheist; I am a humanist. My position is driven by my concerns about the practicalities of the Bill, rather than any religious viewpoint.

It has been suggested, particularly when people talk about their experience of talking to people who have lost loved ones or who are themselves terminally ill—this has been said to me on a number of occasions—that if we had seen someone suffering, we would agree with the Bill. I have seen someone suffering. Earlier this year, my closest friend died painfully of oesophageal cancer, and I was with him in the final weeks of his life.

I come at this from a position neither of faith, nor of ignorance, and I hope that the House will take those factors into consideration when I say what I am about to say.

[Jim Shannon (Strangford) (DUP)]

On the TV last night, they did a survey of GPs. The relationship between a GP and a patient is incredibly close. When our children and grandchildren come into the world, our GP is involved. When a GP has to deliver a diagnosis of terminal illness, there is fear not just in the eyes of the patient but in the eyes of the GP—the doctor, the friend we all have. Does the right hon. Gentleman recognise the importance of today’s debate and vote? It will change forever that relationship of trust between the GP and the patient; it will do so in a negative way and it will never change ever again.

[Sir James Cleverly]

I will refer to the hon. Gentleman’s point later in my speech. I will try not to take too many interventions, because many people have not had the chance to speak in the debate and I want to give them the chance to do so.

On Second Reading I made the point that we need to think about the detail of the Bill and not just vote in accordance with the broad principles. I made the point that, because it is a private Member’s Bill, the opportunity to change it fundamentally is limited, and so we have an enhanced duty to get it right first time. We were told on Second Reading that a lot of the concerns, worries and detailed questions would be resolved in Committee. We were promised the gold standard: a judicially underpinned set of protections and safeguards. Those protections did not make it through Committee. I have also heard people say, where there are still problems, issues and concerns, that the Lords will do that work. But none of us should think that it is right to subcontract our job to the other place.

We are making an incredibly important and fundamental change, as the hon. Member for Strangford (Jim Shannon) highlighted, in the relationship between medical professionals and those they serve. If we make that change, we will introduce a small but permanent question mark in the minds of every patient, particularly a patient who is discussing a serious illness or terminal diagnosis: “What is this medical professional expecting of me? What are they thinking? Where is their head?” Whereas, with the situation we have at the moment, the patient knows that the medical professional is dutybound to do no harm, and to preserve life and dignity wherever possible.

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[Naz Shah (Bradford West) (Lab)]

I start by thanking my hon. Friend the Member for Spen Valley (Kim Leadbeater), all the Members who served on the Committee and, indeed, the whole House for the approach that everyone has taken to this Bill.

I want to make it clear that I came to this Bill with an open mind. Like many, I supported it in principle at first glance, but this debate is no longer about the principle of assisted death—that is not the decision before us today; it is not the issue on which we will walk through the Lobby when we decide to vote for or against this Bill. Our responsibility in this place is to make sure that the Bill is safe, workable and effective. That is the test that will lead us to vote for or against the Bill today. As the Bill stands, it presents a public safety issue.

[Jim Shannon]

I spoke to the hon. Lady beforehand, and I understand her concerns. They are the same concerns I have, on behalf of those who have anorexia, those with mental health conditions, troubled people—those who would be vulnerable when this idea was presented to them. Does she think, like I do, that this Bill does not in any way address the issue of those who are vulnerable, when it comes to assisted dying?

[Naz Shah]

I thank the hon. Member for his intervention. I think he might have read some of my speech, which I will carry on with.

I will set out why the Bill is not safe, and speak about the two amendments that I tabled: amendment 14, which we have nodded through today, and amendment 38, which we will not get the chance to vote on. Amendment 14 dealt with the issue of voluntarily stopping eating and drinking, or VSED, which has been used as a “bridge” to assisted death in other jurisdictions. I am pleased that my hon. Friend the Member for Spen Valley accepted that amendment, but let me be very clear: this does not close the anorexia loophole—that was the subject of another amendment. Voluntarily stopping eating and drinking is not what happens to people with anorexia. People with anorexia stop eating and drinking because they have a psychiatric illness. Those are two categorically different issues. I must make it absolutely clear that even though amendment 14 has passed today, it does not address concerns about anorexia or close that loophole.

Members in the other place are already raising the concern that, because this is a private Member’s Bill, they do not believe that they can provide all the necessary safeguards if we give a Third Reading today to a Bill that is not safe to be delivered to the public. At least 60 women with anorexia in multiple countries have died by assisted death when they needed treatment, not help to die. Every one of them was assessed to have capacity by two doctors.

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[Josh Babarinde]

The hon. Member will be aware that the Bill creates a criminal offence that would punish those who would coerce a relative in such a way. [Hon. Members: “Self-coerce.”] There are folks who talk about the concept of self-coercion, but others would frame such a decision as a choice. Self-coercion is a choice.

My constituent said,

“This could have been avoided with an assisted dying law. My partner was from a jurisdiction where such a law exists. A relative used that law. They were able to gather their family, say a proper goodbye and die in peace and with dignity before losing all physical and mental capacity.”

[Jim Shannon]

Will the hon. Member give way on that point?

[Josh Babarinde]

I will not, to give others the chance to speak after me.

My constituent went on to say,

“The procedure to enable this was protracted and had several safeguards which would prevent much of the concerns we hear about by those opposed. I urge you to support this bill”—

the Bill, and not just the principle. I will do so because the status quo is completely unacceptable and must be reformed.

Terminally Ill Adults (End of Life) Bill

Jim Shannon Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Kim Leadbeater]

I have taken legal advice from Government officials to ensure that devolution is respected at every stage in proceedings. Where legislation that affects other jurisdictions needs to be amended, those conversations have already started and will continue.

[Jim Shannon (Strangford) (DUP)]

Will the hon. Lady give way?

[Kim Leadbeater]

No, I am going to make some progress, if that is okay.

The substances that would be used would not be new substances. As we know, assisted dying is available in many other jurisdictions, and there are substances that have been used safely and, in some cases, for many years. Their safety and efficacy has been proven around the world, but they do need to be treated differently, which is the purpose of new clause 13.

[Simon Hoare (North Dorset) (Con)]

Will the hon. Lady give way?

[Jim Shannon]

Will the hon. Lady give way?

[Kim Leadbeater]

I am going to make some progress.

However, it is most likely that these products are already licensed for other purposes. They could well be regulated through the Medicines and Healthcare products Regulatory Agency and within the Human Medicines Regulations 2012 for the purposes of the Bill, but it is important that time is given—

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[Kim Leadbeater]

Given what you have said, Mr Speaker, I will make some progress. [Interruption.] A lot of Members wish to speak today.

I now turn to new clause 14 and amendment 73. The new clause imposes a duty to make regulations prohibiting advertising of services related to voluntary assisted dying. This issue was discussed in Committee, following an amendment tabled by the hon. Member for West Worcestershire (Dame Harriett Baldwin). It was proposed that there should be no advertising of assisted dying services. I agree, and there was a consensus on that in the Committee. There were some issues with the previous amendment’s workability, so I gave a commitment to return to the matter on Report—hence the inclusion of this new clause. Amendment 73 provides that regulations under new clause 14 would be subject to the affirmative procedure, providing parliamentary oversight.

[Jim Shannon]

On the evidential basis, on page 15 of today’s edition of The Times there is a story about a gentleman who was born in South Africa and lives in Australia. He has come to London this week for this particular Bill in order to give his story. He was diagnosed with pancreatic cancer and told he had only two weeks to live: he lived for three years and one month, and he is still living. There is a growing evidential basis. He said that he was never afraid to die, but he says that he is afraid of the process of dying, and the hon. Lady is the initiator of that. Will she acknowledge the evidential basis and the importance of this subject? Does she realise that the evidential basis against this Bill is growing?

[Kim Leadbeater]

I thank the hon. Gentleman for the intervention, although I am not sure that it is relevant to the banning of advertising for assisted dying services, which I will try to stay focused on.

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[Sarah Olney]

I will not, if that is okay.

We were told that it was not practical to produce such an assessment until after Committee stage, as it would be necessary to assess the impact of amendments made in Committee.

The equality impact assessment was finally published five weeks ago. I have to say that I was pretty astounded. It does not recognise that certain groups in this country may have their lives prematurely shortened as a result of this legislation; instead, it concerns itself with the barriers that vulnerable people may face when trying to access assisted dying. I find that astonishing. Did the people who drafted the assessment not hear the speech of the hon. Member for Vauxhall and Camberwell Green (Florence Eshalomi) on Second Reading? She spoke with passion about how the underlying inequalities in access to healthcare experienced by those from black and minority ethnic backgrounds would be exacerbated if the Bill passed unamended. Did they not listen to the oral evidence that Dr Jamilla Hussain gave to the Bill Committee? She talked about her experience of working with racialised communities in Bradford and their fears of being pushed disproportionately towards an assisted dying pathway. Did they not listen to the testimony of Dr Miro Griffiths on the experience and concerns of disabled people—testimony that has been echoed by Baroness Tanni Grey-Thompson and the actress Liz Carr?

I find it inexplicable that the framing of the impact on vulnerable people should be the removal of barriers to accessing assisted dying and not, as it should be, the increased risk to their health and wellbeing that the Bill presents. I am concerned that we are thinking about the impact on vulnerable people solely with reference to those who are suffering a terminal illness with less than six months to live. We are not thinking about the impact on wider society of introducing a concept of lives not being worth living and how that might disproportionately affect our more vulnerable communities.

My new clause 19 and consequential new schedule 2 and amendment 88 seek to ensure that a comprehensive range of statistics are collected about those who seek and receive an assisted death, so that proper and complete monitoring of requests can be carried out. It is imperative that we get the most detailed possible picture of who is requesting an assisted death so that any patterns of disproportionality can be properly detected and addressed.

[Jim Shannon]

What assurances does the Bill give to the families of people with a disability, or those with mental health issues and those who are anorexic? I do not see any. Does the hon. Lady see any assurances for those who want to end their lives but suffer from those ailments?

[Sarah Olney]

I welcome that intervention. I spoke extensively about the Bill’s impact on anorexic people, and I am not satisfied that those concerns have been addressed.

I am pleased to support amendment 21 tabled by my good friend, colleague and constituency neighbour, my hon. Friend the Member for Twickenham (Munira Wilson), which has attracted support from across the House. It would require the Secretary of State to report on the impact that the Act has had on the healthcare available to those with palliative and end-of-life care needs. I am really pleased that the hon. Member for Spen Valley (Kim Leadbeater) has agreed to accept the amendment.

I am also pleased to support amendments 103 and 104 in the name of my other constituency neighbour, my hon. Friend the Member for Wimbledon (Mr Kohler). They seek to make all statutory instruments made under the Act subject to the affirmative procedure rather than the negative procedure. As it stands, the Act will come into force in four years’ time with no further scrutiny by MPs, yet a whole host of issues that have been delegated to the Secretary of State or have not even been considered will need to be legislated for after Royal Assent. As the Bill stands, the only way for Parliament to scrutinise those powers will be to call for a 90-minute debate on a motion that cannot be amended and will be voted on only if the Leader of the Opposition calls for a vote. Making statutory instruments subject to the affirmative procedure rather than the negative procedure would mean that the Secretary of State, whoever that is, can exercise the powers delegated to them only with the approval of Parliament. For an issue as sensitive and profound as assisted dying, I believe that to be an appropriate level of scrutiny.

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It is beginning to feel as if this were a deliberate tactic. “Keep things vague, do not make anything too real or tangible, and do not confront what this will mean day-to-day. Let’s just keep it light. Let’s keep it airy-fairy. Let’s keep it in the cloud of principle and, somehow or another, through benign intervention, good will accrue.” This is too serious an issue in which to place that faith, because it could be misplaced. That relies on us as Members of Parliament not to care—to switch off when we hear the words “secondary legislation”, something that we know can often be dealt with in five or 10 minutes in a Committee room, with 14 or 20 people selected by the Whips and no debate on the Floor of the House. This is not a niche issue for the Hansard Society or the Delegated Powers and Regulatory Reform Committee, and it would be a shame and a stain on this House and this Parliament if we were to nod through a Bill that gives us the idea that Henry VIII is the way to go.

[Jim Shannon]

Will the hon. Gentleman give way?

[Simon Hoare]

I will not; I am very conscious of time.

Madam Deputy Speaker, given that so many right hon. and hon. Members have been constrained in the length of their contributions because of your persistent cough—I say that not as a criticism—and that next week we have a lot of one-line Whips and the following week we have exactly the same, more time really should be given to the Bill. I do wish the Government had taken it on, not as a Government Bill but by finding Government time for Report on the Floor of the House. This is too serious an issue to have as many gaps and lacunae as this Bill has.

The founding fathers of the United States worked on the basis that the vague generalities of the constitution would always be adhered to, and that men and women of goodwill would adhere to it. I am pretty certain that they are now beginning posthumously, with the current incarnation, to wonder whether that is true. We should not be legislating to leave it up to Ministers to define regulations and decide how they come forward. We have Bills that have page after page after page which, when people ask themselves, “What is this all about?”, actually amount to very little. The amendments that have been tabled, and which I support, have been tabled in good faith, but I am afraid to say that, in trying to improve the Bill, they are trying to make a silk purse out of a sow’s ear.

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[Carla Lockhart (Upper Bann) (DUP)]

I rise to support and speak briefly to amendment (a) to amendment 77, tabled by the hon. Member for South Antrim (Robin Swann), and I will speak to new clause 13, amendment 96 and other amendments if time permits.

I was rather confused when I looked at the amendment paper a few days ago and noticed that amendments that would directly impact on Northern Ireland had been tabled. When last I checked, the Bill as a whole extended only to England and Wales, so I find amendments 76 and 77 perplexing. To be clear, health and criminal justice are devolved matters. The people of Northern Ireland elect their own Assembly to make precisely these sensitive decisions, including whether to legislate for assisted suicide, which is an issue of profound moral weight and cultural consequence.

[Jim Shannon]

My hon. Friend is right to pursue this matter. The hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) said it earlier on: the NHS was formed by the Labour party and is of the Labour party. These amendments would ensure that the Secretary of State could overrule Assembly Members. In other words, 90 Members of the Assembly could make a decision, but the Secretary of State could overrule it—surely that is incredibly wrong. It flies in the face of the democratic process that we are here to uphold.

[Carla Lockhart]

My hon. Friend is absolutely right. On a constitutional basis alone, amendment (a) to amendment 77 is necessary, and I hope that hon. Members will feel they can support it.

Moving on to factors beyond the constitution, I am concerned that there is a dangerous absence of an adequate regulatory framework for lethal drugs under the Bill. At present, clause 25 gives the Secretary of State powers to approve lethal drugs, while clause 34 mandates the Secretary of State to make provision for prescribing, dispensing, transportation, storage, handling, disposal and record keeping, as well as enforcement and civil penalties. However, the fundamental issue of how these approved substances are actually approved remains alarmingly weak. The Bill defines “approved substances” simply as

“a drug or other substance specified”

by the Secretary of State in regulations. There is no explicit requirement for those substances to undergo specific, rigorous testing for their use in assisted dying.

When this issue was debated in Committee, I was disappointed to see good-faith amendments to engage, such as amendment 443, being dismissed.