Terminally Ill Adults (End of Life) Bill
Meg Hillier Excerpts(3 days ago)
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Rebecca Paul
I will therefore speak to my new clauses 17 and 18, which would provide important protections for hospices, which are currently lacking in the Bill. New clause 18 makes it crystal clear that any regulated care home or hospice can decide whether to provide assisted dying on its premises, and new clause 17 makes it clear that they cannot be subject to any detriment for not providing or permitting assisted deaths, and that their public funding cannot be conditional on their providing this service. Whether one is in favour of assisted dying or not, we must preserve the rights of organisations, companies and charities to choose whether to offer it. They must never be forced into it by public funding being conditional on the provision of assisted dying.
I note that new clause 10, tabled by the hon. Member for Spen Valley (Kim Leadbeater), would expand the protection for individuals not to participate in the assisted dying process if they so wish. It seeks to protect employees from being subjected to any detriment for participating or not participating in the provision of assisted dying. This sensible protection would ensure that if an NHS hospital provides an assisted death service, any member of staff who does not want to participate would not have to do so and would suffer no detriment as a result. However, there needs to be a sensible mechanism balancing that against the employer’s right to set their own policy on assisted dying, and that is what my amendment (a) to new clause 10 seeks to do—we have already talked about that, so I will not go over it again.
I did want to talk about process and family, but it looks like I will not have time to do that. I will end there. I thank you for your patience and generosity, Mr Speaker. I am grateful that I have had the chance to speak in support of the amendments, and I look forward to hearing from other Members.
Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
I rise to speak to new clauses 1 and 2, which stand in my name, and consequential amendment 2, and I will touch on others at the end. These amendments—without being dismissive of those who helped me draft them—are imperfect. Those of us who are not the promoter of the Bill have not had the support of Government drafters in tidying up the Bill. We need to acknowledge that the Bill in front of us today is the Bill—more or less—that will or will not be passed by this House. For any amendments made, by the point of Third Reading, that is it—there will be no further opportunity to redraft them.
Sadly, one of these amendments was rejected in Committee. If those changes had been discussed before the original Bill was published, or even in evidence before Committee, we would have been in a better place to get that tighter drafting that is needed in making good legislation. We are not a debating society; we are now legislating for a law that would enable the state to assist in people taking their lives. I am sad that we are able to discuss these amendments only now. I did not get the opportunity to be on the Bill Committee, but I commend all Members who spend so many hours discussing and debating those issues.
The ramifications of the clauses I want to talk about are important for potential users of a service, for medical professionals, for families and for other health professionals. The Bill currently allows doctors to suggest assisted dying to a patient who has not raised it themselves. This, I believe—as I know many others do—presents a serious risk that terminally ill patients, already highly vulnerable, will feel pressured to end their lives.
Dr Simon Opher (Stroud) (Lab)
I realise that my hon. Friend’s new clause 1 comes from a good place, but can she not see that it is inconsistent with our ethical obligations as doctors? That is why the British Medical Association has suggested that although there should be no duty to raise the issue, neither should there be a ban on doing so. I ask her to consider that the Australian state of Victoria initially had such a measure—a so-called gagging clause—as part of its Bill, but it was removed because it caused confusion and was detrimental to patient care. Should we not learn from that?
Dame Meg Hillier
I thank my hon. Friend for his point, which brings me to something I really want to address. As I said in my opening remarks, these are imperfect amendments. I will get into some of the conversations that I have had with a number of people about this. I am one person; I have not been able to consult the BMA, as a Government or a sponsor could, for example, but I am aware of its concerns. However, we are talking here about very definite and irreversible decisions on life and death. I know that many doctors have had conversations about that, but not to the level required to legislate for it. This is a different set of circumstances, but I very much appreciate his point.
Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)
Does my hon. Friend agree that far too many people do not have confidence in the face of authority, and that if a doctor raises assisted suicide with them—no matter how tactfully or professionally—they will feel that they are being steered in that direction?
Dame Meg Hillier
I thank my right hon. Friend for that intervention. Given her many years as a constituency MP in the same borough as me, we both know many such vulnerable people. Dr Rachel Clarke, a hospital palliative care doctor, said:
‘If, for instance, you say to a vulnerable patient who has just been told they have a diagnosis of terminal cancer, “Have you thought about assisted dying?”, I would suggest that stating it broadly like that is a form of pressure and that you are potentially unintentionally coercing that patient.’––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 75, Q93.]
So we are in a very difficult space, as my hon. Friend the Member for Stroud (Dr Opher) highlighted, with his background as a practising GP. We recognise that. As I have said, this is an imperfect process to deal with that challenge, but it is a very different set of circumstances compared with the other advice that doctors give.
Dr Johnson
I rise to support the hon. Lady’s new clause 1. As a doctor, I am very aware of the trust that the public place in doctors and the seriousness with which they take what we say. If a doctor gives somebody information about assisted dying, it is quite reasonable for that person to think that the doctor is suggesting that they should take part in that process, or is hinting that their death will be dreadful and trying to be kind. If doctors are allowed to say, “This is a good process,” more people will take it up than would otherwise have wanted to.
Dame Meg Hillier
I need to get into the arguments for my two new clauses, so I will not take any more interventions for the time being.
I believe that there is a serious risk that terminally ill patients, who are already vulnerable, could feel pressured into ending their lives sooner than they would wish to. We know of examples of patients who felt suicidal and low at the point of diagnosis, and at that point they are vulnerable—this is not the debate in which to make points about that—but often, with good care and pain relief, they can move away from that decision. There is also the issue about the burden on family.
Dame Meg Hillier
I must make progress.
I also want to talk about how the teenage brain works. The Bill would apply to a young person at the age of 18. A month or so after they reach that age, they could undertake an assisted death. Let me highlight some of the good conversations that I have had with people who have generously given their time to speak with me about these important issues, which I am worried have not been addressed at any point in the Bill’s passage, except for a short and important discussion in Committee.
Dame Meg Hillier
Let me finish my point about doctors’ advice before I move on to the issue of 18-year-olds. Dr Alexandra Mullock, who is a senior lecturer in medical law and co-director of the centre for social ethics and policy at the University of Manchester, said in written evidence to the Bill Committee:
“The freedom for a registered medical practitioner (RMP) to raise/discuss the option of seeking help to die in clause 4(2) is ethically problematic.”
She also highlighted:
“Professional advice regarding treatment will be received by the patient as a recommendation”,
as the hon. Member for Sleaford and North Hykeham (Dr Johnson) said. That is a really big concern. The UK coalition for deaf and disabled people is very concerned, and would like this provision removed as well.
Tim Farron (Westmorland and Lonsdale) (LD)
The hon. Lady makes an excellent point. Does she also acknowledge that, given what we are beginning to know about coercive control, the suggestion by a doctor—innocently; maybe neutrally—that this is an option could be latched on to by someone who is coercively controlling the person who may choose assisted dying, and we would never find out that that had been the case until after the person’s death, if at all?
Dame Meg Hillier
The hon. Gentleman highlights an important point in relation to my amendment and others: in this House, we made coercive control illegal in legislation only in recent years. This is such a big issue, and what is different about the Bill—this is why some positions are particularly challenging—is that we are talking about irreversible decisions.
I want to talk a bit about how the teenage brain works. Children and young people are particularly susceptible to being influenced, including into dangerous and risky behaviour. In a number of countries, assisted dying laws have been expanded to allow children and young people to end their lives. We need to be alert to that very real risk. I am impressed by the work of the Children’s Commissioner, who recently published a report into children’s views on assisted dying. It was heart wrenching to read. Those with illnesses and disabilities were particularly concerned about what the Bill means for them. These children have not really had a voice in the debate so far, and there is talk about whether the Bill may apply to children with life limiting or severe progressive diseases.
Sorcha Eastwood (Lagan Valley) (Alliance)
I, too, am greatly concerned about our young people. I was at an event in my constituency of Lagan Valley the other night, at which it was said that almost all our young people across the UK are having their mental health impacted by social media. If we throw this into the mix, it has the potential to do untold damage. I do not support the Bill, but I applaud everybody who has taken the time today, regardless of their view, to try to make it better. However, I have grave concerns about its ramifications.
Dame Meg Hillier
I thank the hon. Lady for her comments. If I have time, I will touch on social media, but I want to put on the record my thanks to some of the professionals who gave of their time to speak to me in preparation for my amendment.
Dame Meg Hillier
Not at the moment.
I had some very interesting conversations with Sophie Scott, professor of cognitive neuroscience at University College London; Sallie Baxendale, professor of clinical neuropsychology at UCL; Sarah-Jayne Blakemore, professor of psychology and cognitive neuroscience at the University of Cambridge; Dr Richard Hain, consultant and clinical lead, all-Wales managed clinical network in paediatric palliative medicine at Cardiff and Vale university health board; and Dr Anna-Karenia Anderson, consultant in paediatric palliative medicine and medical director for Shooting Star children’s hospice. I am only sad that there has not been a bigger debate, because the process has not allowed for one. I apologise to them in advance that I will not be able to do justice in the time that I have to the very many careful and thoughtful points that they raised.
Dame Meg Hillier
I have said no—I need to explain the issues, and give due credit to the people who have assisted me in raising them.
Adolescents’ brains develop differently. From the age of puberty, there is a rapid change in how young people make decisions. As adults, we have the experience to imagine what the future might look like, but younger people, up to about the age of 25, often cannot plan or predict their future because that part of the brain has not developed well, and they are not good at understanding regret. The comparisons are different for adults. Role models and social groups matter a great deal.
Christine Jardine
I appreciate the hon. Lady giving way, given the time constraints. Does she acknowledge the concern that many of us have about not telling patients all the options, particularly young people who are now so social-media literate? Their automatic reaction is to Google everything; in fact, we all do it. The danger is that, if they are not told all the options and given the guidance that is available, they will go to Google and see yet more of the dangerous suicide attempts that we see at the moment.
Dame Meg Hillier
I do not have time to completely unpick the hon. Lady’s points, but to have something positively suggested is a big issue for young people, so the social media aspect is important.
The social network matters. At the point of puberty, teenagers will look to their social group, which will massively influence their behaviour in a way that their families will not. Adolescents are more likely to take risks: their neurodevelopmental underpinnings are different, and pathways between the rational and the emotional parts of the brain are not fully developed. In “a hot situation”, where there is a lot of emotion, they take more risks, particularly because they do not have the ability to think about the counterfactual. In this case, the counterfactual is not being here anymore; that is a very difficult thing for a lot people to understand, particularly young people.
The ability of young people to think flexibly and change their minds is in the front of the brain, which does not always react to the—
Dame Meg Hillier
I need to make some progress. Madam Deputy Speaker, I am trying to speak at great pace.
Teenagers are passionate about their beliefs and peers can change their minds in a way that their parents often cannot. There is not always a logical decision-making path. A doctor would carry weight. In response to the point made by the hon. Member for Edinburgh West (Christine Jardine), a child may be thinking about dying but somebody—that doctor or professional—could make their decision a legitimate option.
There are many issues in palliative care. We talked about Gillick competency, but to be clear, young people under the age of 18 can make their own decisions about healthcare. Even young people under the age of 16 can have such conversations because of Gillick competency, which is a good principle, but the issues around mental capacity and Gillick competency are often not well put in place—
Dame Meg Hillier
I have said no to my hon. Friend—I have moved on from the points that she wanted to talk about.
The law is ambiguous about Gillick competency. The Mental Capacity Act 2005 and Gillick competency triangulates through the person but also the condition, so it relates to the complexity of the condition as well as to the individual. Peer pressure is a big part of what has an impact on people, as well as the view of the professional or doctor.
Dame Meg Hillier
I need to make progress.
On the issue of children making a decision at the age of 18, they could have a conversation with someone about dying and then on their 18th birthday sign on the dotted line; the conversation would not even have to be at that point. We need to understand that even at the age of 18 or 19, young people’s brains are in a different place on this. If we pass the Bill, we are saying that at the age of 18, 19 or 20, people could have an assisted death. We need to understand the ramification of that for those people.
I want to ensure that I cover some of the other points that hon. Members have made. I do not have time to go through all the amendments that play into this, but strengthening the panel and the safeguards, as well as the issues that hon. Members have raised around coercion and capacity, are very important. There has not, however, been time to work through how those issues have an impact on younger people. If only I had time to go into some of the evidence I have received—I have only been able to give a hasty run-through because of the pressure on time today, which is a sign of the challenges of the process. We have not got time to go into the detail that we need to consider.
Socialisation is important. Social media has a very big impact and we need to understand that that will have an impact on young people making their decisions.
Several hon. Members rose—
Dame Meg Hillier
I am trying to do the maths on my timing. I fear I have run out of time. I would like to speak for longer, but I sense from the mood of the House, and from you, Madam Deputy Speaker, that hon. Members do not wish me to do that. I am very concerned that the issues have not been properly discussed. I again remind hon. Members that if we vote on the Bill, these matters have not been fully tested with the professions concerned, as we have heard from the Royal College of Psychiatrists this week and from many of the other professions who would have to grapple with the legislation in practical terms. What we are doing now is legislating for the real practice of delivering those measures, and we have not had time to fully explore that.
Several hon. Members rose—
Carla Lockhart
No, I will not give way because of time.
The new clause would not affect any duty relating to a requirement to provide information. That concern over conscience was raised earlier this week by the Royal College of Psychiatrists in its press release, which announced its opposition to the Bill and set out its concerns that clinicians are still required to signpost patients to information on assisted suicide. It noted:
“For some psychiatrists who wish to conscientiously object, this would constitute being involved”
in the assisted suicide process. New clause 10 will not allay such concerns. When those representing clinicians express such concerns, we ought to listen to them—listen to the professionals. I encourage Members to listen to the royal college and the 250 GPs opposed to the Bill.
Turning to amendment 101, I have a word for our Down’s syndrome community. In a statement published on 9 May, the Down’s Syndrome Research Foundation said:
“We are deeply concerned about the risks of coercion and undue influence. In particular, people with Down’s syndrome and intellectual disabilities are at significant risk of coercion and undue influence, in part because of their need to trust and rely upon caregivers and medical professionals.”
I cannot comprehend why the hon. Member for Spen Valley declined to accept an amendment in Committee that would have provided explicit protections for people with Down’s syndrome. Again, that highlights the flaws and the risk of coercion. The reality is that vulnerable people who are more prone to coercion—for example, people with learning difficulties or a history of depression—have not been explicitly protected in the Bill.
This Bill is not safe and cannot be fixed. It is weaker than it was before the Committee began, and I encourage all concerned Members to recognise that it is flawed and that no amendments or tightening up will ever make it right to legislate to end one’s life with a legal drug.
Dame Meg Hillier
On a point of order, Madam Deputy Speaker. Many people have put in to speak today, and we appreciate the huge challenge to you, chairing this debate, and for the Speaker’s Office. It is normal for private Members’ Bills that the debate continues in an orderly and proper fashion so that everyone can have their say. We appreciate that that is much more challenging in these circumstances, but we have heard many times that we are running out of time, Members are not taking interventions because of concerns about time, and the informal time limit has dropped to five minutes. I am aware that the Front Benchers still need to speak. It is in the power of the Chair, of course, to refuse any suggestion of a closure motion. I would like to ask you whether there is any thinking going on about whether this debate can continue. Many of those who have tabled amendments have not yet been called to speak, and I, for one, would like to hear their points of view.
Madam Deputy Speaker (Caroline Nokes)
I thank the hon. Lady for her point of order. She would not wish me to anticipate any decision on a closure motion at the current time, I hope. She makes a valid point that many Members who wish to speak this afternoon will be disappointed, but she will also know that there will be further debate on the second group of amendments.
Dame Meg Hillier
Further to that point of order, Madam Deputy Speaker. My concern is that this is the last debate on these amendments. It is in the control of the Chair whether to grant a vote on a closure motion. I simply make that point, as I am sure you heard, Madam Deputy Speaker.
Madam Deputy Speaker
I reassure the hon. Lady that I have heard her point. I repeat that I will not make a pre-decision on any closure motion that has not yet been moved.
St Helena: UK Immigration
Meg Hillier Excerpts(6 months, 4 weeks ago)
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Stephen Doughty
I am sorry that the hon. Gentleman has taken that tone. I set out very clearly in my statement the answer to a number of points that he raised. Matters have also been set out very clearly by the St Helena Government. They have indicated their full agreement. In fact, they were fully part of the process and there was full consultation with them. This is a mutually beneficial win-win for the UK Government and St Helena. As I said, the Chief Minister of St Helena has said that it is in a unique position to help the UK Government, and this will strengthen its reputation and enhance its partnership with the British family.
The hon. Gentleman asked a lot of questions about the arrangements with Mauritius. The Foreign Secretary spoke at great length about the arrangements with BIOT recently. The agreement will go through this House in the proper way, as has been set out, and will face proper parliamentary scrutiny. I am sure that it will attract scrutiny, and that is only right. As I explained, this is a contingency agreement for the period before any agreement with Mauritius comes into place; after that, it will take any migrants. The situation on BIOT is not suitable, long term, for migrants. We have explained that at great length.
I have to say that the Government inherited a mess, and we are taking pragmatic, sensible and proactive measures to address the situation. I am hugely grateful to St Helena for the role it is playing. This is a mutually beneficial win-win. The hon. Gentleman asked where the funds will come from. They will come from the FCDO. We already have a long-term established partnership with St Helena, and it has hugely welcomed this plan. It will help it to deal with a number of ongoing issues. I have set out the details fully. The full details of the agreement are also available from the St Helena Government.
Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)
It is welcome to hear St Helena mentioned in the House. The money going there amounts to an increase of about 20% in financial aid from the UK this year, which is sorely needed in a community that is so challenged; but will the Minister explain how he will convey people from BIOT to St Helena, given the travel difficulties, and tell us what conversations he has had with the Chief Minister and her Ministers about where these people will be accommodated, if they do arrive?
Stephen Doughty
I thank my hon. Friend for her interest in St Helena, which has been long-standing. I understand that she visited the island recently, and I welcome her ongoing engagement with the people and the Government there. We have made it clear that we would support the transfer of anyone who did arrive, but let me reiterate that no one has actually arrived on BIOT since 2022. This is a contingency measure only, and, of course, it is not a safe place for people to attempt to go to. This is about closing that route and ensuring that if anyone did make that attempt, they could go to a safe place and be properly supported. The St Helena Government have made clear how they would accommodate and integrate people in that community.