Terminally Ill Adults (End of Life) Bill

Josh Fenton-Glynn Excerpts

Report stage
Friday 20th June 2025 Commons Chamber

[Dr Cooper]

I agree with my hon. Friend, and I will come to that point later.

In public health, we focus primarily on prevention care for the population. In other words, we take decisions, using the best available evidence, that have the potential to impact the health of thousands, if not millions, of people. There is almost always a trade-off in these decisions. Quite often, one sees the label of “nanny state” thrown our way. That is because we deal with choice and freedoms on a population level.

When considering this Bill, I asked myself: which population is this legislation for? What are the needs of this population? What freedoms and choices are we being asked to legislate for? As for the people for whom the Bill will be relevant, it is a narrowly defined population who I can clearly see have specific needs. That is to say, it is people coming to the end of their life with a terminal illness. In public health, at this point in our consideration we are often met with—we have already heard about this—the slippery slope argument: “If you legislate for this group of people, it won’t stop there.” However, the criteria for someone to be considered for assisted dying are clear in the Bill. I have heard from constituents who think that the criteria are potentially too narrow, but that is not what is in front of us today, and any change by future Parliaments will have to go through another legislative process.

Looking at the needs of the population for whom the Bill is relevant, numerous concerns have been raised in this area, both from a safeguarding perspective and in the provision of end-of-life care. Constituents and fellow parliamentarians have voiced unease at the thought of coercion in this space—that is, if a person meets the criteria for the Bill but does not wish to access assisted dying, will they be coerced into doing so by a person or persons with malign intent? In public health, we often refer to this balance as the precautionary principle; we are supportive of people having a choice, but we need to be satisfied that the risk of harm is minimised. In the context of assisted dying, this translates into taking extra precaution to ensure that legislation does not lead to unintended consequences and abuse, and there has been much debate on this.

The concerns that have been raised are reasonable and valid, but I think they have been met with reasonable responses in the Bill. Safeguarding measures have been specified, including clinician awareness, support and training; referral mechanisms for any concerns; multidisciplinary board oversight; a specific disability advisory board; independent advocates; and multiple discussions to assure all parties that the person has come to the decision of their own volition.

Turning to the second area—the needs of this population—end-of-life care is a profound professional commitment for the people who provide it. My heartfelt thanks go to the healthcare teams in my constituency who have reached out during this process to tell me extraordinary stories of compassion, joy and hope brought to people in their final days. They have also reinforced the fact that excellent end-of-life care should be a standard offering in our healthcare system, and that this is not currently the case. As with public health, end-of-life care is often seen as a “nice to have”, rather than the essential part of our health system that it actually is.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

I have the pleasure of sitting with my hon. Friend on the Health and Social Care Select Committee. I am well aware, as she is, that palliative care is not where it should be. That is one of the reasons I am voting against this Bill today, because we know—as my hon. Friend knows from her public health lens—that there are social determinants of health. Surely, we cannot vote for measures today that would lead to a social determinant of an early death.

[Dr Cooper]

I thank my hon. Friend for his intervention, but this Bill is not about negating end-of-life care. If anything, it is shining a spotlight on it and saying that care, dignity and choice at the end of our lives should be afforded to us all.

That brings me to my final thoughts on legislating for choice—our freedom from and freedom to. Currently, if a person would like to choose assisted dying, that choice is only open to them if they have sufficient financial resources. This is an equity issue: if a person is financially poor, terminally ill and nearing the end of their life, they do not have the freedom to choose assisted dying. That does not mean, of course, that they would, but this legislation will allow an equitable choice for this defined group of people. Much of public health is determined by legislation, and the underpinning premise is that we are creating a safe environment for a population, within which individuals can make their informed choice. I think that this Bill creates those conditions, and therefore as a public health physician, I am satisfied that I can vote for it.

Ultimately, a good death is something that we all want for ourselves, and for those we love and care for. My vote for this Bill is based on the arguments I have laid out today, but my broader vote and voice will always be for compassion, understanding, and continuing constructive dialogue to ensure we do our best to improve the lives of the people we serve until their dying day.

--- Later in debate ---

[Luke Taylor]

I will make some progress, thank you. I start by making the somewhat unusual case that this issue, for which we are gathered here on a Friday, giving up bake sales and constituency surgeries, is not quite the big deal it has been whipped up to be by both proponents and opponents. I do not believe that we are considering a fundamental change in the relationship between doctor and patient, or seeking to change the relationship between the state and the individual. I do not believe that we are stepping on to a slippery slope or unpicking the very purpose of the NHS, as some have suggested. We are here simply to give those who already face terrible decisions—doctors, patients and their families—a real choice of how to face those decisions, and protection in law for choices that are already being made today.

[Josh Fenton-Glynn]

Will the hon. Member give way?

[Luke Taylor]

I will make some further progress.

This Bill would simply give the choice to those who will die—and those eligible will die soon—on the manner and timing of their death, and it would protect doctors and families from legal repercussions at such a tragic time. This is not a Bill about the choice between life and death; it is about the choice, should we want it, of how and when we will die. This is the ultimate choice. We speak sometimes of the right to choose, of the right to decide how one might bring life into this world, a debate about which on Tuesday this Chamber showed that there is a huge majority in favour of the right of the individual. We have a chance to neatly bookend the week by establishing the existential right of the individual, when given a terminal diagnosis, to choose how one might exit this earthly realm.

Terminally Ill Adults (End of Life) Bill

Josh Fenton-Glynn Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Calum Miller (Bicester and Woodstock) (LD)]

I rise to speak in support of amendments 21, 103, 104 and 42, tabled by my hon. Friend the Member for Twickenham (Munira Wilson), the hon. Member for Newcastle-under-Lyme (Adam Jogee) and my hon. Friend the Member for Wimbledon (Mr Kohler). As other Members have said, this is a deeply consequential Bill. I want to record my thanks to the hon. Member for Spen Valley (Kim Leadbeater), to all members of the Bill Committee, and to all those who have contributed to its careful scrutiny through the tabling of amendments and debates over them.

The Bill is about the end of life. It is an emotive and sometimes painful topic, and I am grateful to the many constituents who have generously shared with me their experiences and opinions. I have also taken some time to consult palliative care practitioners, including those providing hospice care in my constituency. Those conversations reinforced the awe and admiration I hold for these caring professionals. Their expertise and deep commitment are always impressive. Contrary to the points made by the hon. Member for Gosport (Dame Caroline Dinenage), they are adamant that they can provide sufficient pain relief to the vast majority of those receiving end-of-life care. The issue is about not the efficacy of treatment, but access to it. In this, I echo the powerful points of the hon. Member for East Renfrewshire (Blair McDougall) on the present inequality of access to palliative care.

Amendment 21 would ensure that the availability, quality and distribution of palliative and end-of-life care is published within one year of the Act being passed. When assessing the provision of end-of-life care, it is critical that this House and the public can see how palliative care is being delivered. For the measures in the Bill to provide a genuine choice to those at end of life, palliative care must be much more widely available.

The hon. Member for Spen Valley (Kim Leadbeater) argues that there should be no false choice between palliative care and assisted dying, yet she and health Ministers know that there is a choice as resources are limited. When so many hospices have closed beds due to funding shortages and receive more than 70% of their funding from donations, I am concerned that we may see significant expenditures on a new regime for assisted dying, funded by the state as a health treatment, while the palliative care sector and hospices in particular remain chronically underfunded.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

rose—

[Calum Miller]

I will not give way.

Only by having the assessment of the palliative care system that is proposed in amendment 21 can we be confident of knowing whether access to palliative care is sufficient. If we are to provide a true choice at end of life, that is critical.

I also stand in support of amendments 103, 104 and 42. Amendments 103 and 104 would give this House a say over the key decisions that still remain to be taken on the implementation of the Bill. Given the significance of the Bill and the importance of the many questions still to be resolved, these amendments are critical.

Amendment 42 would ensure that we do not career towards the enactment of this Bill in four years whether or not the system is ready to operate safely and fairly. Taken together with amendments 21, 103 and 104, this would ensure that this House has the chance to consider whether those at end of life can access the full range of support, advice and protections intended by the Bill, and which they deserve from palliative care services across the country.

Like so many in this House, I have direct personal experience of the issues addressed by the Bill. My father was diagnosed with stage 4 cancer in May 2002. Over seven weeks, he and my family benefited from the incredible care of our local hospice. Sharing my dad’s life, care and death has shaped me, so I fully understand why so many of my constituents have asked me to vote on this legislation in the light of their and their loved ones’ experience.

Yet our task is to legislate for a new system that will affect thousands of people and society as a whole. However this House votes on this Bill, our debates must result in a new focus on the provision of palliative care, so that all people at end of life truly have options in the management of their care and death.