Assisted Dying (No. 2) Bill

Maria Caulfield Excerpts

Friday 11th September 2015 Commons Chamber

[Maria Caulfield (Lewes) (Con)]

I come to this debate as a nurse with more than 20 years’ experience in the NHS, most of which time was spent working in cancer care. I have looked after many patients with metastatic disease and many who needed end-of-life care. As a result, it has been my humble privilege to share the last few days, hours and minutes of many people’s lives and, on numerous occasions, I have held the hand of someone as they have breathed their last.

Having experienced dying at first hand, I can say that death can be one of the most rewarding parts of life. It does not have to be as painful or distressing as the supporters of the Bill have described. The reason behind my positive experience of death is the availability of good palliative care, which tackles symptoms such as pain and enables people to have a good quality of life right up to the end. In the field of cancer care, we are fortunate to have access to some of the best palliative care in the world. However, many patients living with other illnesses are not so fortunate. Patients with cardiac failure, multiple sclerosis and Parkinson’s—to name but a few—often have little or no access to palliative medicine, but instead of tackling the lack of palliative care, the Bill promotes assisted dying as a solution. Death today has become medicalised, and it is seen as a failure or as something to be feared instead of as a normal part of life. The reality is that a natural death can be a moving and peaceful experience for all involved.

Therefore, not only do I disagree with the rationale behind this Bill, but I have severe concerns about the lack of safeguards it contains. The first relates to its requirement to give someone a diagnosis of less than six months to live. It is almost impossible accurately to predict a person’s prognosis in months. In my experience, that is not something a consultant would readily do, as someone’s prognosis can vary greatly according to their disease, general health and response to treatment. This part of the Bill gives the false impression that having a terminal illness means life is over—nothing could be further from the truth.

If assisted dying becomes law, it will remove the incentive for science and medicine to find treatments for illnesses. Metastatic prostate cancer was a terminal illness 10 years ago but is now a chronic disease, whereby men, although not curable, are treatable and often die of other causes long before their prostate cancer ever becomes a problem. The same is true of metastatic breast cancer, with many women now able to live long and healthy lives even though they cannot be cured. HIV used to be a death sentence, but thanks to advances in medicine it is now a chronic illness that people live with, rather than die of. Would these treatments have been discovered if assisted dying had been legalised 10 or 20 years ago?

My third concern is that with so many doctors against legalising assisted dying—the Royal College of Surgeons, the British Medical Association, the Royal College of Physicians and the Association for Palliative Medicine are almost unanimous in their opposition—who will be left to assess the patients who wish to discuss assisted dying? The Bill requires both the attending doctor and the independent doctor to advise a patient on diagnosis, prognosis and treatment alternatives to assisted dying before giving consent. Most general doctors, however, would struggle to provide such specialist information. Are we certain that if we change the law, this will be carried out properly?

My final concern relates to the experience of places where assisted dying is already law. If the death rate in Oregon, where assisted dying is legal, were transposed to this country, 1,500 deaths a year would occur here from assisted dying. In Oregon, patients with lung cancer and prostate cancer are already being denied treatment on their state health insurance plan and are instead being offered assisted dying, as we have heard today. Is that what we want for patients in this country? Do we want them to be denied cancer treatment but offered assisted dying as an alternative?

Before we change the law to legalise assisted dying, we need to see serious evidence to prove, first, that the current law is not fit for purpose and, secondly, that what is being proposed would be better. On neither account has any convincing evidence been presented. Our current law is not perfect, but it does what it is designed to do: it holds penalties in reserve to deter malicious assistance, while allowing discretion not to prosecute, where appropriate. What is needed is not a change in the law, but better access to palliative care for all.