Terminally Ill Adults (End of Life) Bill

Jonathan Davies Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

[Andy Slaughter (Hammersmith and Chiswick) (Lab)]

It is a pleasure to follow the excellent speech of the right hon. Member for Sutton Coldfield (Mr Mitchell). In preparation for today I have had a number of discussions with my hon. Friend the Member for Spen Valley (Kim Leadbeater), and I want to put on record that the measured way she has dealt with the proceedings has been excellent. I do not know whether she has ever had moments of doubting whether this was the right thing to pick as a private Member’s Bill, but she has been an absolute credit to this House in the way she has dealt with these matters so far.

In 2015, in the last Chamber debate on this subject, I wound up for the Opposition Front Bench, but my interest in it goes back much further. Like all Members of this House, I have had hundreds of emails from constituents on both sides of the argument. Many ask me to oppose the Bill; those emails come from people of faith, and I wholly and entirely respect what they say, but they are the first people also to say that this is an individual decision for every individual Member of the House to make.

As I have been at the bottom of the list of speakers to be called for so many years, I have great sympathy for those who find themselves there today, so I will try to keep my remarks to one narrow point: the legal context of the Bill. There is a false dichotomy that the law as it stands is fit for purpose, that we go into the unknown with the Bill before us and that we should somehow keep the safety of the status quo. I think that could not be more wrong. There are no safeguards in the current law. The only sanction against coercion is ex post facto; we are leaving it to individual directors of public prosecutions to make decisions in individual cases after the event.

DPPs take that job extremely seriously, as anyone knows who has heard Sir Max Hill, the last DPP to speak on the subject. They have, at the instigation of the courts, set out guidelines—I think we know that it was an excellent Director of Public Prosecutions who set out the guidelines on this case. They have done everything they can, but it is not their responsibility; it is our responsibility, and the courts, up to and including the Supreme Court, have made that clear.

We assign in this Bill a role to the High Court as part of the process, but we are the final decision takers. That has been made clear not only by domestic, but by international courts; the European Court of Human Rights has said in every case in which such matters have come before it that the margin of appreciation should be put into effect and therefore it should not interfere with the law as we decide it. We cannot dodge our responsibilities and I know that we do not want to do that. We have a duty to put in place the best law we can, and that is not the law as it stands.

There are three choices for people who want to end their own lives. They can go to Dignitas alone, if they can afford to do that. They can attempt, and perhaps succeed in, suicide. They risk failing. If they succeed, they will have a lonely death. They may, as others have pointed out, simply have to resort to refusing treatment or food. The third option is that they can embroil their relatives or friends, at the risk of their being investigated or prosecuted. They also risk ending their lives too soon.

On safeguards, I do not follow the view of opponents of the Bill. At some times they seem to say that they are too complex, too expensive and that there are not enough resources. If we want to resource the Bill, we can. I do not think that those are the strongest arguments.

[Jonathan Davies (Mid Derbyshire) (Lab)]

Will my hon. Friend give way?

[Andy Slaughter]

I really do not want to, because of the time. I am sorry. [Interruption.] Should I? I will give way once.

[Jonathan Davies]

My hon. Friend talks a little about safeguards. I invite him and the House to reflect on the covid pandemic, when a lot of safeguards around a lot of things were relaxed. I worry that if we were to see another pandemic on the scale that we saw in 2020, people might feel that they were doing something patriotic by getting out of the way and freeing up a bed for a younger person. I invite him to reflect on that.

[Andy Slaughter]

In practice, a terminally ill person will need to formally consider their decision at least eight times under the provisions in the Bill. This is a starting point—a number of Members have made that point. I believe the Bill has already had more scrutiny than most public Bills we consider, but we have up to nine months before us to consider it further.

All the practical and legal considerations point towards the Bill. It may well be amended to change the safeguards or the way it operates, but we have the opportunity to do that. In the end, for me, that is not the decision. The decision is about two things: it is about human dignity and it is about agency. I would like to think that even at the end of life—no, especially at the end of life—when someone has their faculties but may be at their weakest ebb, they can still exercise that agency and still make decisions for themselves. They can have the longest life they can and they can end that life in the way that is most beneficial to them, their loved ones and their family. That is simply not happening, and by voting against the Bill today Members ignore those facts.

Terminally Ill Adults (End of Life) Bill

Jonathan Davies 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

Jonathan Davies Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Dame Caroline Dinenage]

Thank you, Madam Deputy Speaker. I am addressing new clause 13, which provides the strict regulation of life-ending substances and self-administering devices. That means there will be transparency about what substances are used and how they are stored, prescribed and delivered. We owe it to patients, clinicians and the public to ensure that every part of the process is governed by clinical standards and ethical safeguards. For those physically unable to swallow or self-ingest, the new clause ensures that devices to support self-administration can be safely used. Without that, we risk creating a system that excludes some of the very people it is meant to support.

While we must regulate the system properly, we must also reject amendments that would undermine or stall the Bill’s delivery. Amendment 19 proposes adding suicide prevention, the Mental Health Act and deprivation of liberty safeguards to the code of practice. As the Minister who put much of that legislation through, those are really important topics for me, but this is not the legislation to address them. Let us keep the code focused on the Bill’s core function of ensuring a safe, consistent and compassionate assisted dying process.

Amendment 20 would allow non-adherence to the code to be used in civil or criminal proceedings. That is not appropriate. Guidance is meant to help professionals navigate difficult decisions, not become a legal trap. If clinicians act negligently, existing law already applies. We should not be creating new liabilities for those acting in good faith in very difficult conditions.

I also oppose amendments 97 and 27, which would require the MHRA to license drugs specifically for assisted dying and the National Institute for Health and Care Excellence to recommend them. That would make the Bill unworkable.

[Jonathan Davies (Mid Derbyshire) (Lab)]

Does the hon. Member share my concern that the impact assessment associated with the Bill says:

“The safety and efficacy of those substances used for assisted dying is currently difficult to assess”?

[Dame Caroline Dinenage]

I am not entirely sure that I agree with that.

However, I want to talk about the MHRA, which is just not set up to license drugs for ending life. Clinical trials to support such a licence and MHRA requirement would be impossible. However, the substances likely to be used are already tried and tested in other jurisdictions and are MHRA approved for other purposes. New clause 13 already provides us with the strict regulation that we need, without putting prohibitive hurdles along the path to a compassionate and painless death.

Amendment 42 would remove the backstop date for implementation, giving the Government indefinite discretion over when or whether to put this law into effect. That cannot be right. If Parliament passes the Bill, there must be a clear and reasonable timeframe for implementation. The four-year backstop already gives Government more than enough time to get this right. Removing it simply invites delay.

This is a moment to show that we can be both compassionate and competent, and that we can bring an end to the quiet suffering caused by an unjust status quo and replace it with a system that is safe, fair and accountable. Let us support new clause 13, let us reject amendments that would add red tape or stall the Bill’s progress, and let us show dying people that we are ready to treat them with the dignity and trust that they deserve.

--- Later in debate ---

[Ellie Chowns]

I thank the hon. Member for raising that issue and giving me the opportunity to speak about the detailed evidence given by my constituent Emeritus Professor Sam Ahmedzai, with whom I spoke at length yesterday about precisely this detail. I have reviewed a number of tables of data about this. Any substance has side effects but, as the comments made today have indicated, in reality those substances are being held to a far higher standard than substances routinely used in palliative care.

We have to recognise that there is a huge amount of evidence about the efficacy of the substances that are talked about in relation to assisted dying. There is a huge amount of published, peer-reviewed evidence about the effectiveness of those substances, and people like Professor Ahmedzai, who has 40 years of experience and is a global expert in this area, point out that we know how to assist people to have a peaceful, compassionate death effectively, and that is what the Bill is about: helping people who are terminally ill to die with dignity and to face those final moments with the support, love and care of their family around them; not in agony, but in whatever degree of peace is possible when facing death.

As the hon. Member for West Worcestershire (Dame Harriett Baldwin) said, new clause 14, which relates to advertising, has been developed in consultation, as a result of concerns raised by opponents to the Bill, to try to ensure the crucial fact that assisted dying is not an advertised service. There is a crucial distinction between advertising and information, and this new clause will ensure that assisted dying remains a careful, clinical process and not something that would be promoted commercially. It is a balanced, cross-party safeguard supported by people on all sides of this debate.

[Jonathan Davies]

Will the hon. Lady give way?

[Ellie Chowns]

I am very short of time, so I think I had better continue.

Turning to new clause 15, which relates to the role of coroners, if the Bill is passed, assisted dying would be a very strictly regulated process—the choice of an individual; not a death caused by others, but by the individual themselves. As Aneez Esmail has pointed out, this would be the most scrutinised type of death in the country, and it therefore makes no sense to require another legal process at the end when there have already been multiple layers of scrutiny before the death.

--- Later in debate ---

[Patricia Ferguson]

I rise to speak to my amendment 13, which concerns the appointment of the voluntary assisted dying commissioner. In Committee, it was decided that the Prime Minister would appoint the voluntary assisted dying commissioner, and that the appointee would serve for five years and be responsible for appointing the assisted dying review panels. The commissioner would also oversee the training of panel members, give them guidance on the procedures to be used and, crucially, decide when a case that a panel has refused should be referred to another panel for reconsideration. According to the Bill, the commissioner will not be acting as a judge, but they must be a current or former senior judge of the Supreme Court, Court of Appeal or High Court. However, they are not required to have any expertise in medicine or healthcare.

Importantly, following our considerations in Committee, the Bill no longer requires that the chief medical officer be responsible for monitoring whether or not the assisted dying regime complies with the law. That responsibility has now been transferred to the voluntary assisted dying commissioner, so the person in charge of overseeing the process and setting up the panels will also be the person deciding whether the Act is being administered correctly.

[Jonathan Davies]

Given the scandals we have seen in healthcare over many years, from infected blood and medicines that should not have been prescribed to what happened at Mid Staffs hospital, it is clear that having that independent, robust oversight from the chief medical officer is a good way forward if people are going to be able to trust this legislation, if it comes into law.