Assisted Dying Law

Karin Smyth Excerpts

Thursday 23rd January 2020 Westminster Hall

[Fiona Bruce (Congleton) (Con)]

I will turn to the part of my speech that deals with some concerning developments from other jurisdictions that have legalised assisted suicide, as I prefer to call it. In Oregon physician-assisted suicide for the terminally ill was legalised 10 years ago. The annual Government report of 2018 stated that more than half of those applying now cite

“fear of being a burden”

as their major end-of-life concern. Far fewer cite pain concerns. Disability groups are extremely concerned about what has happened, for example, in Canada since 2016. In just four years, under the law that has allowed terminally ill people to request assisted suicide and euthanasia, safeguards have been ignored, removed and extended to non-terminally ill people such as those with depression. In July a depressed but otherwise healthy man was killed by lethal injection, despite not being terminally ill. Another man who suffers from a neurological disease actually recorded hospital staff offering him a medically assisted death, despite repeated statements that he did not want to die. Only this week, on Tuesday, there was an article in The Times about three Belgian doctors on trial in relation to the euthanasia of someone reported to have a personality disorder and autism. The family believes that she was depressed but that she did not, as required by Belgian law, have a serious and incurable disorder.

The point to note is that, regardless of the wording of eligibility criteria in legislation, in practice safeguards are often discarded, and vulnerable and depressed people are assisted to end their lives. That applies in all jurisdictions that have legalised assisted suicide or euthanasia. In Canada, where medical aid in dying was legalised in 2016, the superior court of Quebec ruled last September that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life. That is particularly concerning because, while the ruling applies only to Quebec, the Canadian Government have now committed to changing the MAID law for the whole country, so it will no longer be, as was originally intended, limited to those nearing the end of life.

[Karin Smyth (Bristol South) (Lab)]

I am grateful to the hon. Lady for giving way; I realise that time is short. I do not have time to rebut all those arguments, and I will not do so in my speech, but will she address why more and more jurisdictions across the United States, Canada and Australia are changing the law and extending provision, if they think it is not safe?

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[Karin Smyth (Bristol South) (Lab)]

I am grateful for the chance to speak in this debate. I do so not only as the Member for Bristol South, but as chair of the all-party parliamentary group for choice at the end of life.

I want to pick up the discussion where we left it at the end of the last Parliament. We were hoping for a call for evidence and to have some discussion with the Government on that. The Government said that they would continue the debate but were not currently persuaded. We can indeed debate, but ultimately only the Government can make a call for evidence; only the Government have the power to gather evidence. Only this Government can show their own compassion and demonstrate to the people of this country that compassion is not a crime.

I was privileged last year to welcome Geoffrey and Ann Whaley to the House to talk about their experiences. I do not have time today to repeat their stories, but people like Ann Whaley and Adam and Kate Wellesley are still being investigated by the police. They dreaded that knock on the door, which did come. Police officers are required to intrude on a family in the last days and weeks before the loss of their loved ones. I therefore welcome the debate that is now happening within policing. It was surfaced by Ron Hogg, a police and crime commissioner, and many police and crime commissioners are now also asking for a review of the evidence. Ron sadly died in December, but that was a powerful call about how the law is currently impacting on policing.

The current law does not offer protection. Assisted deaths are very rarely investigated. Illegal and unregulated voluntary euthanasia happens now. Current end-of-life practice is, if anything, less safeguarded than assisted dying and it is just as ethically challenging. Who decides whether someone should be sedated until death? How do doctors check that someone is not being coerced into refusing treatment? Is it right to support someone to starve and dehydrate themselves to death? I do not think so. If assisted dying laws are not proven to work, why are more and more being introduced rather than the existing ones being overturned?

My own interest in this area came from my time working in the NHS with clinicians talking to people about how to live and die. I found that it is often no one’s job to talk to people about dying, and it is very lonely for those people. Despite the care from the NHS and our brilliant hospices, 17 people a day—

[Dr Luke Evans (Bosworth) (Con)]

I thank the hon. Lady for giving way; I appreciate that time is short. It is interesting that we are in a place that deals with finalities—death and taxes—yet we never have a wider debate about what death is. As a GP, I speak to people all the time, and it is very difficult to raise the subject of death. Fundamentally, as a society, we need to be talking about what death actually is, because it is inevitable. That inevitability means that we have to answer some of these questions. Does the hon. Lady agree with me that that may well be the best place to start to move the discussion on?

[Karin Smyth]

I wholeheartedly agree and am grateful for that intervention from a clinical perspective, because what the hon. Gentleman describes is also my experience. Around the world, the current law does not protect the doctor-patient relationship and people are not having those honest conversations. The law does not allow the doctor to really talk to people about end-of-life choices, because people are frightened that their intention to perhaps go to Switzerland will result in someone being fearful of breaking the law.

I am not sure what the Government’s response will be today. I hope that the Minister can respond with compassion for people who are desperate for some recognition of the way the current law is not working. We cannot keep ignoring that. Asking families to retell their stories only perpetuates the trauma that they are going through. Families will keep coming forward, and their experiences are shocking—heartbreaking. For me, representing the constituency of Bristol South, the fact that only people who have between £10,000 and £15,000 spare can access safe care—in Switzerland—is equally shocking.

Is the law working now? No, it is not. Are people safer now? No, they are not. I am disappointed not to have more time to go into why that is the case. That is why, beyond the debate today, we need a review of the current law and how it is working. People need to have time to review the law. It is not working for families at the moment, and I hope that the Government will meet me and others who would like to discuss how a review might work in practice.

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[Imran Hussain (Bradford East) (Lab)]

It is, of course, a pleasure to serve under your chairmanship, Sir Graham. I thank the hon. Member for Edinburgh West (Christine Jardine) for securing this very important debate. Although I may not personally agree with her conclusion, as many of us across the House do not, I must credit her with having set out a passionate and robust case, both this afternoon and in her recent article.

I thank other hon. Members for attending—certainly, for a Thursday afternoon, this is probably one of the largest attendances I have seen in this Chamber—and for their own moving and thought-provoking contributions. We have heard many moving and personal accounts. Many of our thoughts and beliefs, and much of what drives our opinions, on this important topic come from our own personal experiences and stories. In this debate and the debate last year, hon. Members spoke powerfully of friends and family members at the end of their lives, or of constituents at the end of theirs. Bound together with our mortality and the fact that some day each of us here will pass on, hoping to do so as peacefully as possible, those experiences are what make this such a personal and hard-hitting issue.

Across the Opposition, across the Chamber and indeed across the country, as we have heard, we are split on the issue of assisted dying, with clear arguments advocated on either side of the divide. For those advocating a change in the law on assisted dying, important and pertinent points have been made by hon. Members on both sides of the House.

Time does not permit me to go through contributions from each hon. Member, but one of the first arguments put forward is that of personal liberty—that relaxing the law would grant an individual control over their own death when it would otherwise be cruelly taken away from them by a terminal illness; and that it would allow them to end what is often incredible suffering, which leaves them with little to no quality of life and forces others to watch helplessly, witnessing the decline of their friend or relative right in front of them. We have heard some very personal experiences of that here today.

The argument that to legalise assisted dying would also spare loved ones the fear of conviction for their compassion, as we have seen with a number of cases such as those of Zoë Marley and Mavis Eccleston, has also been put forward. It will continue to be, for I doubt whether anyone here, regardless of what our views may be, really wants to see an elderly grandmother or others prosecuted for honest acts of compassion. That is joined by an argument that adequate safeguards could be applied to prevent abuses of the process and protect vulnerable people, with several examples of countries and states that have legalised assisted dying put forward as a model for the UK to copy.

However, for every argument made in favour of relaxing the law on assisted dying, a counter-argument is advanced, as it has been by hon. Members in this and previous debates. Those who oppose change point out that legalising assisted dying could lead to an abuse of the system and to pressure being applied, even unintentionally, to those suffering from terminal illness. They may feel that they are, or will become, a burden on their friends, family and carers, leaving them, in their eyes, with no real choice but to end their own life in a selfless act to spare others. That point was made by a number of hon. Members.

Hon. Members also raised the point that to relax the law on assisted dying now would slowly allow an escalation in what is allowed, creating a slippery slope whereby the eventual outcomes are far beyond the reality originally imagined by those who advocate for change. They argued that assisted dying would put immense pressure and stress on doctors and families, and even on individuals themselves.

[Karin Smyth]

Some of the phrases that my hon. Friend has used are used across the world, although there is no evidence for many of those things—for example, that there is a “slippery slope”. Does that not reinforce the idea that, whatever people think, if we can persuade the Government to look at the call for evidence, we can air these issues publicly and get the real evidence in a process that the public, and all who participate in such care, can recognise as rigorous? That call for evidence is the real thing we should be focusing on.

[Imran Hussain]

I thank my hon. Friend for being a strong and passionate advocate in this area. I think the whole House will acknowledge her work on this subject. A call for further evidence or an independent inquiry can only be of assistance to the broader debate. We cannot forget that the ethical and practical issues, and the threat of a slippery slope, have left even medical professionals reluctant to back any changes to the existing legislation on assisted dying.

Despite the clearly differing views in the House and in society, we are united on the principle that everyone should be able to pass on in peace, surrounded by family, friends and fond memories. That brings me to palliative and end-of-life care for those with terminal conditions, for at the heart of this debate is the matter of dignity. Indeed, much of the argument in favour of assisted dying is about the real fear faced by those approaching the end of their lives that they will lose control, that they will have their dignity taken away from them and that they will suffer in pain in their final days, weeks and months.

Sadly, for too many, that fear becomes a reality as insufficient palliative and end-of-life care, too much variation in practice and poor management of symptoms leave those who are at the end of their lives, and their friends and families, suffering unnecessarily. As I pointed out last year, the Institute for Public Policy Research found that there was considerable scope to improve the way that care is designed and delivered for those reaching the end of their lives, and that the experience faced by such people can still be poor, with medical and care staff sometimes failing to recognise that people are dying and failing to respond to their needs appropriately.

The IPPR also found that too few people were offered the opportunity to end their lives in the comfort of their own home, surrounded by their friends and family, and not in a hospital, surrounded by strangers fighting for every last breath. While talking about the pros and cons of relaxing the law on assisted dying—the arguments for and against—we must talk more about how palliative and end-of-life care is not nearly as good as it should be, and how that drives so many people to consider taking their own lives.

Time not permitting, I will sum up. I firmly agree—this is probably not a statement I will make often—with the Minister for Health, the hon. Member for Charnwood (Edward Argar), who stated in response to questions in a previous debate on this issue that this is a matter of conscience and must be decided by Parliament. Of course, as my hon. Friend the Member for Bristol South (Karin Smyth) indicated, for a matter to be considered properly, we must be properly informed and have as much information as possible.

I outlined my personal view at the beginning of this speech, and I believe that this is a matter of conscience that must be decided by the whole of Parliament. However, I hope that we can address some of the real issues at the heart of the debate—insufficient palliative and end-of-life care, and allowing those who are reaching the end of their lives to die peacefully and painlessly.