Terminally Ill Adults (End of Life) Bill
Debate between John Hayes and Rachael Maskell(2 weeks, 3 days ago)
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Rachael Maskell (York Central) (Lab/Co-op)
I rise to speak to amendments 26, 45 and 46, which stand in my name and the names of other Members. I am grateful for their support.
On amendment 26, hospice care is not a formulation of care, but a clinical setting where palliative care is delivered, so I trust that the House will accept my amendment in the interests of accuracy.
On amendment 45 and consequential amendment 46, the literature points to complex clinical decision making—which the subject of the Bill is—being safer if it happens in the context of multidisciplinary teams, as was advocated for by the professional bodies at the very start of the process. Such a context screens out unconscious bias and provides for clinical accountability with robust interdependency. It demands a deliberative process and it safeguards clinicians and patients with more secure outcomes. I have talked extensively to the professional bodies and clinicians, and I have read the academic evidence. In drawing on best practice, this amendment would provide such safeguards and ensure that the patient is at the heart of the process.
Members will know from the evidence given to the Bill Committee that the initial assessment is the most important part of the process, and clinicians and professional bodies do not understand why psychiatrists and social workers are being placed in a quasi-judicial role, rather than being used for their clinical and social expertise. The process makes the wrong assumptions. Without the amendments, there is a predication towards an assisted death, rather than the Bill recognising the insecure position that someone with a terminal illness finds themselves in and the safeguards that are required. There are many reasons for suicidality, and they should be explored.
In clinical practice, should someone determine that they want to end their life for whatever reason, a clinician would seek to ensure that the right professionals were involved in the care of the person, with exploration, diagnosis and, where necessary, therapeutic and pharmacological interventions.
Rachael Maskell
I will not. Dr Lade Smith, the president of the Royal College of Psychiatrists, could not have been clearer, and academic research says the same: when someone is in receipt of a terminal diagnosis, there is frequently an episode of depressive disorder. Dr Price said in evidence:
“Those who had a wish to hasten death were 18 times more likely to also feel suicidal”.––[Official Report, Terminally Ill Adults (End of Life) Bill Public Bill Committee, 30 January 2025; c. 275, Q359.]
They say that mental disorders are treatable. The spike in suicidal ideation and action is highest in the first few months following terminal diagnosis and then dissipates with time or intervention. Again, that is evidenced. People change their mind and no longer want to die.
As with other aspects of the Bill, poor care, poor pain management and poor symptom control—or the fear thereof—are reasons why people seek to end their life. That can be palliated. Colleagues must recognise the paucity of mental health provision given to somebody when they receive a terminal diagnosis. Often there is no psychological aftercare. People are failed, but that should not be a reason to die.
I ask for a panel, which would include a social worker, to assess the psychological needs of a patient. They are experts in detecting coercion, whether intrinsic or extrinsic, and understanding people at their most vulnerable with a fusion of complex emotions, anxiety and fear. Solutions can be found by them. There would also be a psychiatrist. Depression, anxiety and fear are natural responses to trauma, but they can be treated with the right interventions, if detected at the point that somebody expresses a wish to die, and a person can have a wish to live. The travesty of getting it wrong is unconscionable.
There would be a palliative care consultant who is registered on the GMC’s specialist register. They would understand the actions that could alleviate someone’s suffering. Evidence to the Bill Committee from Sue Ryder showed how poor provision led to someone considering an assisted death. Likewise, the president of the Association for Palliative Medicine, Dr Sarah Cox, said:
“We know that effective palliative care can change a terminally ill person’s point of view from wanting to die to wanting to live.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 70, Q84.]
That is evidence. It is a point I have heard from all leaders on the Commission on Palliative and End-of-Life Care. These are the specialists who know how to palliate the physical, psychological, social and spiritual problems of a patient, and they have techniques that many people have not had access to, because of poor provision.
The palliative care commission reported on Tuesday and I urge hon. Members to read its evidence-rich report, which draws on best practice. We reported that excellence in end-of-life provision is achievable, but that too many people are not getting access to it. Without that, I fear that the Bill only leads the patient down one route—to die. This is not a choice at all, but a path to an assisted death.
Petitions
Debate between John Hayes and Rachael Maskell
Sir John Hayes (South Holland and The Deepings) (Con)
I rise to present a petition on behalf of my constituents, just shy of 2,000 of whom have signed a petition calling on the House of Commons to protect Market Deeping’s much loved Mill Field. Market Deeping has little over 6,300 people living in it, so almost a third of the town has signed. Mill Field is an area of 11 hectares of green field, bordered by mature hedgerows and trees. On one side there is Milford Road, the last rural lane in Market Deeping. The site has been used by the community for a variety purposes over many years, from the 19th century onwards. It should be a designated green space, but, sadly, it has been earmarked for development. This is despite opposition from the local community and from Market Deeping town council. The development is being imposed on a community that does not want it, and it threatens unspoiled grassland used by families for generations. This petition is due to the tireless work of Pamela Steel and the Friends of Mill Field and I present it on their behalf this evening.
Following is the full text of the petition.
[The petition of residents of South Holland and the Deepings,
Declares that South Kesteven District Council should reconsider its plan to develop Mill Field, one of the few remaining green fields within the parish of Market Deeping, given that Lincolnshire County Council, which owns the field, has put it forward as suitable for large housing development; notes that Mill Field is an intrinsic part of the rural character of the local area, and should be protected given its historical use for community events and so it can continue to provide residents with space for informal recreation; further notes that planning policy is clear that local communities should not have unwanted development forced upon them.
The petitioners therefore request that the House of Commons urges South Kesteven District Council to protect Mill Field from development and removes Mill Field from their draft local plan and designates it as a Local Green Space, so protecting it for future generations in perpetuity.
And the petitioners remain, etc].
[P003004]
Rachael Maskell (York Central) (Lab/Co-op)
It is a pleasure to see you in your place, Madam Deputy Speaker.
I rise to present a petition on dental healthcare on behalf of my constituents in York Central and others. York has a significant NHS dental crisis: less than 40% of adults have accessed NHS dentistry in the past two years, and 1,707 residents have therefore signed the petition to call for a new approach to oral health, with a focus on prevention, supporting children, older people and those with co-morbidities, and addressing the workforce shortages, including with a dental school at the universities of York and Hull combined.
The petition states:
“The petitioners therefore request that the House of Commons urge the Government to discontinue the current unworkable NHS dental contract and instead bring dental services fully back into the NHS through a National Dental Service.”
Following is the full text of the petition:
[The petition of residents of the United Kingdom,
Declares that the current NHS dental contract has failed and that UDAs (Units of Dental Activity) do not match the time required for dentists to provide dental care to their patients; further that in England only £35 is spent per person on dental care, compared to £47 in Wales, £55 in Scotland and £56 in Northern Ireland, making funding and the system unviable for most dentists undertaking NHS work; further that patients must deal with extremely long waiting lists to see a dentist; further that in order to reduce waiting times, more dentists need to be trained up in the UK to meet future shortages through commissioning a number of new dental schools, including the joint universities of York and Hull in other locations, to run alongside their outstanding medical schools; further that there is need to address the workforce challenges within a dental workforce plan; further that preventative dental care through fluoridation should be accelerated, as well as a school check-up service and supervised brushing programme; and further that everyone over the age of 60 should be prioritised since poor dental health can lead to malnutrition and other comorbidities.
The petitioners therefore request that the House of Commons urge the Government to discontinue the current unworkable NHS dental contract and instead bring dental services fully back into the NHS through a National Dental Service.
And the petitioners remain, etc.]
[P003005]