Assisted Dying

Karin Smyth Excerpts

Monday 4th July 2022 Westminster Hall

[Tonia Antoniazzi]

I thank my right hon. Friend for his contribution, because that is often the case. Clearly, Gareth wanted people to know that he does not think what his dad did was actually suicide, but bringing an end to his suffering.

Susan’s husband, Duncan, was diagnosed with motor neurone disease, which we all know has no cure. Susan described Duncan as a very strong character who, after researching MND, determined straightaway that he was going to be in control of his own death. Until he had a plan in place, he was distressed and unhappy, but once he had a plan, he could start to live again. Three years after his diagnosis, Duncan took his own life at home with help from Susan. He left information for the police about how and why he had done it. Although his intention had been to do it when Susan was not at home, Susan said that, after 42 years of very happy marriage, she could not not be there for him at the end.

Despite the information that Duncan left, it was six months before the Crown Prosecution Service deemed that it was not in the public interest to prosecute Susan. She was interviewed for six hours under caution by the police, which, after the death of her husband, was obviously very distressing. I cannot imagine how it must feel to have something like that hanging over you when you should be grieving the loss of a loved one. Susan had the means to fight these charges and her solicitor eventually got her arrest removed from her record. What happens to someone who does not have the money to stand up to a criminal justice system that demonises people who find themselves in this invidious position?

Susan also believes that because Duncan made his intentions clear, the doctor seemed reluctant to give him drugs to help him sleep, which exacerbated his problems. Ultimately, Susan takes comfort in the fact that Duncan got the death he wanted. However, it is a tragedy that his death was not within the law. We know that people falling foul of the criminal justice system is not uncommon in situations where someone ends their life, but empathy and sensitivity are required in these situations—not the heavy-handed approach we have seen too often.

Tim was a carer to his friend, David, who also had motor neurone disease. Within two days of his diagnosis, David had signed up to Dignitas. It was more than two and a half years before he died, after travelling to Switzerland. There is only one end to a diagnosis of MND, and David was not willing to be trapped in his body while his brain was still functioning. By making the decision to join Dignitas, David had some peace of mind. However, even with his membership, the process was not always easy; information was not forthcoming until certain points in David’s illness, and the full picture was not available until they reached Switzerland.

It would have been so much easier if David could have done it at home. At home, the only option David was given was to be sedated for three weeks while his body shut down—as Tim said, prolonging the suffering. When Tim spoke about the inevitability of David’s death, he said that doctors were willing to prolong his life to the extent where the consequences were not worth it. Pain was not really an issue for David, but the suffering that he went through—not being able to sleep due to choking; having to be fed through a tube in his stomach—was unbearable.

Throughout this process, all participants have spoken of the anxiety that they faced because they or their loved ones did not have the option of assisted dying. As Jan said in her contribution, knowing that there is an option for assisted dying is an insurance policy: it may not be something you decide to do in the end, but having it there is a comfort. We have to consider the impact on the families who are left behind. Having to watch a loved one die is never easy, but prolonging the suffering can lead to trauma and PTSD for families and friends. I have already spoken on the record about my father dying.

[Karin Smyth (Bristol South) (Lab)]

My hon. Friend is representing the Petitions Committee superbly and speaks on behalf of the families we have met outside.

I think we all appreciate how difficult it is for people to come to us to talk about personal experiences. My hon. Friend has spoken about her father before. I know he would be very proud of her. We all know how strong her support is for this cause.

[Tonia Antoniazzi]

I thank my hon. Friend for that intervention to save me from a few more tears. I wanted to say that the PTSD my brother suffers as a result of my father dying is something we will all have to live with as a family. I think that is worth mentioning.

Tim said that palliative care can mitigate some of the pain, but it can never mitigate the suffering. This seems to be so true. Even the best palliative care cannot make it easy, and it never is going to be easy, but we could do a lot more to make it better. Research has shown that where assisted dying is an option, palliative care improves. I truly believe that everyone in this debate can get behind that. We must do better for those at the end of their life.

I am also grateful to Liz Carr for taking the time to speak to me on Friday evening. The worries that Liz and other campaigners have need to be heard, and I believe we have a duty as Members of Parliament to open up this debate and listen to all sides. There are so many debates where people are very polarised in their arguments, particularly in this House, and I feel very strongly that both sides should be heard and that we should listen to everyone.

--- Later in debate ---

[Karin Smyth (Bristol South) (Lab)]

It is a pleasure to serve under your chairmanship, Sir Roger, and to follow my fellow chair of the all-party parliamentary group on choice at the end of life, the right hon. Member for Sutton Coldfield (Mr Mitchell).

I am not a convert. I have wanted to change the law on assisted dying since I became a Member of Parliament, following my experience 14 years ago working with clinicians on how to communicate with patients about how to live and die with respiratory disease. That is not terminal, but the work opened my eyes to how we talk about death—how we do not prepare for the inevitable and, although we seek to have choice, agency and freedom throughout our lives, we have no power at the end. There will be many people listening to the debate who are facing death or the death of their loved ones. As we debate this issue, we must be mindful of the personal circumstances and experiences of those people, and of all of us in the Chamber.

End-of-life care has improved since my work in the health service 14 years ago, but there is still a contrast between how we talk about dying and how we attempt to talk about other care, which is indicative of the problem. In all my years working in the planning and commissioning of services in the NHS, it was all about co-production—the importance of patient voice and choice—but the co-production partnership disappears at the time we can least fight: the time we die. However, the reality is that a person can have choice—if they have an average of £12,000 spare. We can debate all we like, we can pretend this is not an issue, and the Government can turn an eye, but if a person has the money, they have the choice.

For campaigners, that is a really frustrating position. As we have heard, poll after poll suggests that we as MPs are far from our constituents on this issue. I have been humbled today by meeting families and friends who have travelled to speak to us and share their stories. It is absolutely right that, if Members of Parliament have not previously engaged with this subject, they should engage with it, they should be properly informed, and they should have the opportunity to scrutinise all the proposals and to be convinced that change is better and safer than what we have now. We seek parliamentary time to do just that.

First, we must understand that the current situation is not safe or sustainable. Secondly, we want to learn from those who have safely operated an assisted dying law for over 20 years. Thirdly, we want to ensure that we address all the concerns expressed, especially about safeguarding.

We have heard some shocking examples of people taking their own lives. My hon. Friend the Member for Sheffield Central (Paul Blomfield) spoke movingly about that three years ago, and we see it in the ONS data. Currently, there are no up-front safeguards to stop people taking their own life or refusing food, water or ventilation. There is no regulation on people choosing not to have treatment. People live in fear of accompanying their loved one and getting that knock on the door from the police—that happens. Additionally, as I said, there is choice for those who can afford it.

We need to scrutinise the proposals and learn from Oregon and from recent debates in Australia and New Zealand. Since we last debated the subject, as the right hon. Member for Sutton Coldfield said, six states in Australia have legalised assisted dying, as have several states in the United States, New Zealand, Canada and many other countries. I have had the pleasure of talking with parliamentarians from across those countries about the debates they have had. We can learn from them. The concerns raised by opponents have not come to pass. Medical opinion has shifted dramatically, and new evidence has been published that demonstrates how unsafe our current law is. That is why I am confident in these proposals.

We need time to go through the arguments and the safeguarding concerns. I have spoken to several MP colleagues and I understand those concerns, but they have not come to pass elsewhere. The rights of people in different parts of the United Kingdom are dominating our politics. In fact, in the main Chamber, Members are currently talking about Northern Ireland as part of the United Kingdom. With proposals coming through in Jersey and Scotland, the United Kingdom Parliament and the United Kingdom Government will have to engage with assisted dying here in the United Kingdom. It is useful to have debates like this one, but what we need is Government time. I hope the Minister will take the Government’s head out of the sand and respond positively to the request for just that.

--- Later in debate ---

[Paul Blomfield (Sheffield Central) (Lab)]

I pay tribute to the 155,000 people who signed the petition prompting today’s debate and to my hon. Friend the Member for Gower (Tonia Antoniazzi) for the way she introduced it.

It is an extraordinary coincidence, but today is the 11th anniversary of my father’s death—more extraordinary, because the last time the Commons debated assisted dying on the Floor of the House was the eighth anniversary of his death. Like an estimated 300 people in the UK every year, he took his life after a terminal diagnosis. Although I still find it difficult to talk about, I want to share his story today, because he would have wanted me to, and because his experience echoes that of so many others and informs a central issue in our discussion. Inevitably, the debate on providing choice at the end of life often focuses on the impact of the change that is being proposed, but I think we should start from a different place: by looking at the existing law and recognising the pain it causes, and the way it forces so many into desperate and premature deaths.

Eleven years ago today—also a Monday—I got a phone call here: he had been found dead in his garage. I had spoken to him the previous night on the phone as I walked through St James’s Park. An ordinary conversation that gave me no inkling of his plan. But later he obviously tidied up his belongings, left some small piles of money to settle bills with—with the newsagent and one or two others—and wrote some final notes. He then walked to the garage, connected a hosepipe from his car exhaust into the car, took an overdose and switched on the engine.

I was shocked and clearly still struggle with it, but I should not have been surprised, because he had always believed that the law should be changed to allow assisted dying. And let us be clear—we should be very clear about the terms we use—my dad was not suicidal. He loved life; he was 87. But at that age he had inevitably watched many of his friends go, often miserably—horrific deaths. He talked with me about their last days and he had always been clear that he would rather end things than face a lingering and degrading death, but I still was not expecting it.

He was somebody who had made the most of life. He had a tough east-end upbringing, became an RAF pilot during the war and built a successful business career. He had had his share of health problems, but he faced them all positively, until a terminal diagnosis of inoperable lung cancer clearly led to his decision to take his life. He could not talk to me or his partner about it, because he would have made us complicit. The current law forced my father into a lonely decision and a lonely death. And he died prematurely, because I am sure that what drove him to end his life at that point was the fear that if he did not act when he was still able to do so, he would lose the opportunity to act at all.

[Karin Smyth]

My hon. Friend is making a very powerful speech. I am grateful to him for sharing his story with us again. What he exemplifies is the wider impact on the family. Families are loving places to be for most people, and the impact goes on for a number of years. The inability to have those conversations with family is one of the things that my hon. Friend is highlighting for us today. The current law inhibits honest conversations in families to help a more supportive situation to go forward. I think that is something we should all take with us this afternoon.

[Paul Blomfield]

I thank my hon. Friend for that intervention. She is absolutely right, and I appreciate the breathing space that she has given me.

Some people have already said in this debate that we simply need to improve end-of-life care. We should, and I say to the hon. Member for Devizes (Danny Kruger), contrary to his comments, that many of those states, for example in Australia, that have introduced assisted dying have, at exactly the same time, substantially increased the amount of money spent on palliative care. We should do that, but it would not have changed my dad’s decision. He supported our local hospice. I have raised funds for it. It does a great job. But no hospice can enable everybody to die with the dignity that they would want.

Indeed, for my father, it was soon after his appointment with the palliative care nurse, where together they talked about his last months and how that would pan out, that he took the decision to end his life. My hon. Friend the Member for Bristol South (Karin Smyth) alluded to the fact that, if the law had made it possible, he could have shared his plans with us. And knowing that he could, with support, go at the time of his choosing would have enabled him to stay longer. If the law had made it possible, he would have been able to say goodbye and go with his family around him, not in a carbon monoxide-filled garage. He deserved better and many others like him deserve better. And we, here, can make that possible. We simply need to change the law, as the overwhelming majority of the British people want.

I appreciate that there are those whose personal belief makes my father’s choice unacceptable. I respect those beliefs. Live your life by them. But do not impose them on others. Let people have the choice at the end of their lives. Allow them the dignity in dying that we would want to give them during their life.