Terminally Ill Adults (End of Life) Bill
Neil O'Brien Excerpts(2 weeks, 3 days ago)
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Dr Ben Spencer (Runnymede and Weybridge) (Con)
I rise to speak to amendments 18, 30, 31, 17 and 32, which stand in my name.
I will start with amendment 18. Many moral arguments on the need for the Bill have been proposed both inside and outside this place. Some of those arguments have addressed the desire for greater control at the end of life, but the vast majority have focused on the prevention of irreversible suffering. The principle of bodily autonomy—which I strongly support in the context of full decision-making capacity, with certain important caveats—is used to justify the rights that the Bill will grant. However, let us put aside the debate surrounding the Bill and focus on the text of the clauses, which is the task that we face on Report.
The provisions are silent on suffering, silent on control and silent on all but a terminal illness with a prognosis of fewer than six months. If the principle is that we must prevent irreversible suffering, all those suffering irreversibly should be able to seek physician-assisted suicide. If the principle is that we should give people control—another level of expression of bodily autonomy—all adults who truly and freely consent with full decision-making capacity should be able to seek physician-assisted suicide. If those principles are circumscribed to an arbitrary definition of “terminal illness”, the inexorable conclusion must be that those patients’ suffering or autonomy are more important than those of others, or that their lives have less value. We have seen that position subtly imported into this debate. When requesting an assisted death is not framed as suicide because some perceive it as understandable, the underlying argument is, “If you’re terminally ill, of course you want to die—that’s understandable.”
We must ensure that we do not, by accident or otherwise, enshrine in our statute book value judgments on the worth of the lives of the terminally ill or on the protections that they should enjoy like everyone else. I tabled amendment 18 to expand the scope of the Bill as much as I can to reduce the discrimination inherent within it. The maximum I could do was to remove the six-month restriction, but I wish the amendment could go further. I know that some Members will wince at this provision, but I ask them to ask themselves what the principles and values in the Bill are, how they are being applied and whether they are being applied equally. I believe that the Bill as drafted is incoherent and discriminatory. My amendment would introduce some moral clarity to the Bill. If we do not do so, the courts will.
I turn to amendments 30 and 31. If we are to rely on the principle of autonomy to authorise physician-assisted suicide for terminal illness, the expressed choice must be true and free. Autonomy needs help, though. A true and free choice needs to be informed; a true and free choice cannot be made under coercion; a true and free choice requires decision-making capacity. I believe that, if we are to rely on the principle of autonomy for the most grave of decisions, there needs to actually be a choice. In the absence of relevant and available palliative care options, where is the choice? How can we rely on autonomy in the absence of choice? The prospect of people choosing physician-assisted suicide not because it meets their needs, but because their needs are unmet owing to a failure in the provision of palliative care, is a moral outrage. My amendments 30 and 31 would ensure that that does not happen.
Dr Spencer
I am sorry but I really cannot, given the time restrictions.
Amendment 17 pertains to the test of decision-making capacity. In English and Welsh law, we use the Mental Capacity Act 2005 to define capacity, and I believe it is right that the functional test of capacity is used in this Bill. We have common law tests of capacity in some circumstances, which arose before we had the Mental Capacity Act. However, the decision to end one’s own life was not permitted in the early case law leading up to that Act. There is no jurisprudence background or guidance. These capacity tests have not been done before. This test needs a bit more of a framework of support.
Amendment 17 lays out the minimum information that needs to be understood as part of the functional test of capacity. Critically, that would include information about the current treatment options, about doing nothing and about proceeding under this legislation. It would make clear that physician-assisted suicide is not a medical treatment, but a personal choice about life and death. Without amendment 17, this Bill will fundamentally undermine the doctor-patient relationship. Doctors do not prescribe death, and this Bill must make that clear.
I turn finally to my amendment 32. There has been some discussion about the inadequacies of the decision-making capacity test as gatekeeper. In effect, there may be circumstances in which, despite having capacity, the person is otherwise recognised as vulnerable. That is how our courts operate. The impact of depression or personality disorder on decision-making capacity can be subtle and elusive. I know, as I used to be a consultant liaison psychiatrist and did research in the area of decision-making capacity. This is tricky stuff to do, especially in the context of a request for an intervention, rather than a refusal.
We should have trained psychiatrists at an early stage assessing capacity. They are expert at picking up these subtle cues and all the other stuff that is going on. A request for physician-assisted suicide should not be taken in isolation, and that needs to be understood and supported. We need someone who knows how to use the Mental Health Act, because if a doctor is doing the assessment, and they have a patient in front of them with a mental disorder, expressing a desire to end their life, they need to make sure that that patient gets the right and appropriate treatment. That may well be using the Mental Health Act. We need to make sure that this happens; I hope it would happen as part of the process as usual, but there is no safeguard in the Bill to make sure that it does. Psychiatrists turning up on the panel at the end is not good enough; they need to be there from the start.
Finally, there are broader issues about the interaction with protections to save life, article 2, and a doctor’s duties. I will cover those in the debate on the second grouping, along with the incredible importance of the Bill’s interaction with the suicide prevention strategy.
Sarah Olney (Richmond Park) (LD)
I rise to speak in support of amendment 87, which stands in my name, and in support of various amendments tabled by other Members and also signed by me.
Prior to this legislation being laid before the House, I had not held strong feelings about the issue of assisted dying. I listened carefully to the arguments on both sides, including those of the many constituents who wrote to me on the issue, before deciding to vote against the Bill on Second Reading. I made my mind up very late in the day. I continue to be appreciative and respectful of the reasons why people are in favour, but, for me, the fundamental question was whether we were putting vulnerable people at risk by passing this legislation. I resolved that, on balance, we were.
The lead Member, the hon. Member for Spen Valley (Kim Leadbeater), was keen to reflect the balance of opinion across the House, as well as within parties, in the make-up of the Bill Committee, and I was happy to volunteer as the sole Liberal Democrat “no” voter, as a service to my party and to the House. It was a privilege to serve on the Committee, and I wish to put on the record my admiration and respect to all Members, Ministers, Chairs and House staff who served alongside me, and my thanks to the many witnesses who gave oral and written evidence on which we came to rely.
I regret to say, however, that my experience in Committee has only hardened my opposition to the Bill. My opposition is not rooted in a fundamental objection to the principle of assisted dying, but in the approach taken to framing the legislation.
Amendment 87 seeks to tighten up the arrangement around the first declaration, to rule out the possibility of “doctor shopping”. In oral evidence we heard from the chief medical officer, Professor Sir Chris Whitty, that a diagnosis of terminal illness and a prognosis of life expectancy cannot always be made with a high degree of accuracy and that a degree of professional judgment is required on behalf of the co-ordinating doctor, which can result in differences of diagnosis and prognosis.
That was backed up by the Royal College of Physicians this week, whose spokesperson was quoted in The Times saying that it is “extremely hard to tell” if somebody has only six months left to live. My amendment seeks to establish whether the patient has already sought and been refused permission to seek an assisted death so that the co-ordinating doctor can consider the reasons for the first refusal and whether the patient’s circumstances have materially changed since that time.
Sarah Olney
I will not; I am sorry.
The amendment would help to inform the clinical judgment that will need to be made in each individual case and discourage patients from applying to multiple doctors for an assessment.
I am proud to support amendment 24, tabled by the hon. Member for Bexleyheath and Crayford (Daniel Francis), which would disapply the presumption in the Mental Capacity Act 2005 that a person has capacity unless the opposite is established. There was a great deal of debate in Committee about the efficacy of the Mental Capacity Act and whether its provisions were sufficient to establish an individual’s capacity to make an informed decision about whether to seek an assisted death. The hon. Member for Bexleyheath and Crayford spoke compellingly in Committee about his experiences of how the Act is not always applied effectively. I am glad that the whole House has had an opportunity to hear him today.
The Royal College of Psychiatrists cited the insufficiency of the Mental Capacity Act as one of its nine reasons for opposing the Bill earlier in the week. It said:
“The Mental Capacity Act was created to safeguard and support people who do not have the capacity to make decisions about their care or treatment or matters like finances. Should the Bill become law in England and Wales, implications for both the Mental Capacity Act and Mental Health Act need to be considered.”
I also support new clauses 1 and 2, tabled by the hon. Member for Hackney South and Shoreditch (Dame Meg Hillier), which would prohibit health professionals from raising the subject of assisted dying with a patient. It is my personal belief that people’s rights to pain relief and palliative care towards a natural end should be prioritised above an assisted dying pathway, and that that should be made available only as the result of a specific request. It is particularly important that young people under the age of 18 should not be thinking about assisted dying as an alternative to continued treatment or palliative care.
I was disappointed that during Committee my proposed amendments to safeguard people suffering from eating disorders were rejected. Eating disorders are primarily a mental health condition but have an obvious physical impact, and there is a severe risk that the physical impact of an eating disorder can be diagnosed as a terminal illness, when in fact eating disorders are always treatable. We cannot allow vulnerable sufferers from eating disorders to elect for an assisted death when there remains the possibility of a full recovery and the chance of a happy and fulfilling future. That is why I support amendment 14, in the name of the hon. Member for Bradford West (Naz Shah), who was such an articulate member of the Bill Committee. I was glad to hear that the lead Member, the hon. Member for Spen Valley, will adopt that amendment; I look forward to seeing the further drafting.
I also support amendment 16, tabled by the hon. Member for Vauxhall and Camberwell Green (Florence Eshalomi). I welcome the lead Member’s new clause 10, which extends the right to refuse to participate in assisted dying to any person, but it is important also to extend that right to organisations such as hospices and care homes. Assisted dying undermines those institutions’ mission and purpose, and they should have the right to refuse to provide it on their premises if they do not wish to participate in it.
Finally, I will speak in favour of amendment 22, tabled by the name of the hon. Member for Shipley (Anna Dixon). There is insufficient provision in the legislation to identify and seek to ameliorate mental health conditions or other factors that may lead people to seek a premature end to their life, which they would not seek if those factors were addressed. Every time a person seeks to end their life prematurely is deeply regrettable, and we have a duty to explore whether preventable factors could be addressed before a request for assisted dying is granted.
Dr Mullan
Not on that point.
We may wish to reflect on how we might change our approach to Bills like this one in the future, given the significant dissatisfaction that has been expressed with the manner in which it has been considered, even though it has been done in the ordinary way. But we are where we are.
As on Second Reading, this debate has been a balancing exercise. The promoter of the Bill and others have appropriately reminded us all of the very difficult and tragic experiences faced by the terminally ill and their families, but I respectfully say to the hon. Member for Spen Valley that we should be cautious in saying that opponents of the Bill are happy with the status quo, and I know that she would not have meant to suggest that.
Neil O'Brien
I am one of those people who is against the Bill, not in principle but for the reasons set out brilliantly by many articulate Labour Members. When my constituents ask what I think about this, I have no way of telling them; there is no way for me to get into the nuance of my position on it, because there has been no time to have a proper debate, and so many Members will now be unable to say a single thing about this totally transformative Bill.
Dr Mullan
My hon. Friend has added his concerns to those of others about the manner in which the debate has been conducted, but I reiterate that this has been done in the ordinary manner in terms of the Speaker’s discretion and the Standing Orders of the House.
Opponents of the Bill are concerned that it will lead to a different set of unacceptable circumstances for different people; it is not that they are happy with how things are at the moment. All MPs have talked about people they care deeply about and how to help them. Whether they referred to disabled people, young people or the terminally ill, MPs have been speaking out in support of or against amendments, out of concern and compassion.
I may be tempting fate in saying that we might find consensus on advertising restrictions, but outside of that, Members have undoubtedly expressed a variety of strong views on others’ amendments. It may be that Members vote consistently in line with whether they were originally for or against assisted dying, but other Members who are supportive of the Bill in principle are voting for restrictive amendments because they think that they are necessary. That is because this is a complex moral, legal and societal matter. I understand that Members are considering their votes with a degree of uncertainty.
There should be no shame at all in Members’ admitting that they will be daunted by the sheer number of potential changes to the Bill, not to mention the decisions from the Speaker on those we are going to vote on or the challenge of deciding how to vote on each of them, either today or on a future day.
China: Human Rights and Sanctions
Neil O'Brien Excerpts(7 months ago)
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Mr Lammy
Of course I will commit to meeting Sebastien and his family. When I raised the issue of Jimmy Lai, I pointed to his age and the fact that it would be an abomination if he died in prison. I assure my hon. Friend that that issue was raised.
Neil O'Brien (Harborough, Oadby and Wigston) (Con)
Mr Speaker, as one of the parliamentarians who has been sanctioned by the Chinese regime, I thank you for your ongoing advocacy on our behalf. Let us never forget that the Chinese regime were literally spying on us as Members of this House. In Opposition, the Labour party said there was “clear and compelling evidence” of a genocide in Xinjiang. Now that the right hon. Gentleman is the Foreign Secretary, is he prepared to repeat that statement? Does he still believe there is “clear and compelling evidence” of a genocide in Xinjiang or has he changed his mind?
Mr Lammy
I remain hugely concerned about the human rights abuses in Xinjiang, but the hon. Gentleman knows that it must always rightfully be a matter for the International Criminal Court and others to make a determination of “genocide”, not for national government.
Oral Answers to Questions
Neil O'Brien Excerpts(7 months, 1 week ago)
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Dr Zubir Ahmed (Glasgow South West) (Lab)
Neil O’Brien (Harborough, Oadby and Wigston) (Con)
Catherine Fookes (Monmouthshire) (Lab)
Anneliese Dodds
I wish to be very clear as I think there is some confusion on this important point. Following the 2 September suspension, there are currently no extant UK export licences—I repeat, no extant export licences—for items to Israel that we assess might be used to commit or facilitate a serious violation of international humanitarian law. There is only one exception, which is for F-35 components, and the Foreign Secretary has explained that to the House. My hon. Friend is right to say that most licences for exports to Israel are not for the IDF, and I am pleased to be able to put that on the record for the House.
Neil O’Brien
The footage of children caught up in the fighting in Gaza is horrendous, and so is the footage of those who are still held hostage. First, what is the Minister doing to ensure the protection of aid workers in Gaza and Lebanon and, secondly, given that she has just told us that our efforts to get more aid in are not working, what are her next ideas? Where will we go from here, because clearly it is not working?
Israel and Gaza
Neil O'Brien Excerpts(1 year, 2 months ago)
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Mr Mitchell
The point that I hope the hon. and learned Lady will make to her Edinburgh constituents is that she and I, the Government and the whole House are intent on ensuring that more food and more support get into Gaza as rapidly as possible. That is what the Government are doing every day.
Neil O’Brien (Harborough) (Con)
I welcome the hard work that the Minister is doing to get more aid in, to bring an end to the fighting and to get the hostages released, but it is appalling to think that large numbers of innocent people, including children, are about to starve when there is aid just over the border. He is right that aid must flow across the border and that it is better to transport it in trucks, but if that is not possible, we must think of this like the Berlin airlift. We have to get aid in by sea and by airdrops. I welcome what the Americans are doing to drop aid on the shore, and we have to do whatever it takes to get the aid to the kids who are going to starve unless we get it to them.
Mr Mitchell
I completely agree with the sentiments that my hon. Friend expresses so profoundly. He is right that every single mechanism must be explored, but he will know that the amount of aid we can drop from the air, the danger to those underneath and the danger of the aid being misappropriated and stolen by Hamas are very real difficulties. He will also be fully aware of the difficulties of maritime entry. That is why we are doing everything we can to argue for more points of entry into Gaza, more trucks and more land routes to get the aid in that is desperately needed.
Ceasefire in Gaza
Neil O'Brien Excerpts(1 year, 3 months ago)
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Madam Deputy Speaker
I thank the right hon. Gentleman for his point of order. He speaks with his usual passion. He is absolutely right to say that what we now need to do is to move on. I want to put the Question and then we will move on to a further debate.
Madam Deputy Speaker
I do hope that Mr O’Brien is following in that spirit.
Neil O’Brien
Further to that point of order, Madam Deputy Speaker. I believe that today the SNP has been treated unfairly. But it is not just the SNP that has been treated unfairly. Those of us who would like to vote for the SNP motion must now, if we want to do so, vote against the Labour party’s amended motion—a motion that the hon. Member for Rhondda (Sir Chris Bryant) has just said would, if we voted for it, lead to an immediate general election, so we are being placed in an unfair position if we wish to support the SNP motion. We have now seen the exit of SNP Members and many Conservative Members from the Chamber. We are clearly in an intolerable situation. It is a sad situation, Madam Deputy Speaker.
I believe that the current Speaker is a man of honour who has done a great deal over recent years to restore the reputation of the Chair after a dark period for this House. However, even if he believes that the constitutional innovation that he has introduced today is a good one, this was not the time to change the rules. We have heard from the Chair of the Procedure Committee that there is a serious question about the order here and the constitutional propriety of the order in which these questions are being taken—a question being put by the SNP too. May I suggest, Madam Deputy Speaker, that if you are not prepared to suspend the House, we at least defer the Divisions that are supposed to be happening this evening until we can resolve these issues?
Finally, because in this House it is courteous and traditional that the person about whom one is talking is always in the Chamber when they are discussed, we should defer those Divisions so that we can hear from Mr Speaker himself before we come to vote on these issues, because otherwise a great injustice is being done to the SNP and to other Members of the House.
Madam Deputy Speaker
I thank the hon. Gentleman for his point of order. I just want to be clear again that there was the ability to have a vote on all three motions that were before the House. The situation has changed, but that does not mean that I would then withdraw the questions and not put them, because they are still before the House, and I intend to proceed with them in the way that I have suggested.
Oral Answers to Questions
Neil O'Brien Excerpts(1 year, 5 months ago)
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Jeff Smith (Manchester, Withington) (Lab)
Neil O’Brien (Harborough) (Con)
Layla Moran (Oxford West and Abingdon) (LD)
Mr Mitchell
Of course, the position of the American Defence Secretary is exactly the position of the British Government, and that is why we say at all points that everyone must adhere international humanitarian law.
Neil O’Brien
The whole House is appalled by the atrocities committed by Hamas, but also by the civilian suffering in Gaza. Will my right hon. Friend set out the steps he is taking to relieve civilian suffering, and also the steps he is taking against illegal settlements and the actions of violent settlers, because they are an obstacle to the two-state solution and to a lasting and just peace?
Mr Mitchell
On the first part of my hon. Friend’s question, I can tell him that we have delivered 74 tonnes of aid to el-Arish, which we are trying to make sure gets in. On specific relief, I can inform the House that 100 trucks and 120,600 litres of fuel did get across the border into Rafah yesterday. It is nothing like enough, but there was some progress yesterday.
Gaza: Humanitarian Situation
Neil O'Brien Excerpts(1 year, 5 months ago)
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Leo Docherty
Our strategy is to exert all efforts to bring about peace.
Neil O’Brien (Harborough) (Con)
I welcome the Minister’s growing success in getting aid into Gaza and the tripling of UK aid, but even as he works urgently to get aid to the neediest civilians of Gaza in the shortest possible time, will the Government redouble their efforts to bring about a diplomatic solution, perhaps using a contact group, in order that we can grow the humanitarian pauses into a just and lasting peace and a two-state solution?
Leo Docherty
That is exactly our strategy. It is to use diplomatic efforts in concert with humanitarian efforts to bring about a situation whereby diplomacy can take effect and the foundations can be laid of a long-term peace. We are clearly not there yet, and it will require a huge amount of diplomatic effort right across the region and a close relationship with many parties. That is something to which we can bring a great deal of expertise and utility.
Cyber-attack: Microsoft
Neil O'Brien Excerpts(3 years, 10 months ago)
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James Cleverly
The hon. Lady raises a point that my right hon. Friend the Member for Chingford and Woodford Green (Sir Iain Duncan Smith) has already raised, and I have already touched on it. As I have said, we will continue to work with our international partners to persuade China to come into accordance with the international standards and norms that we see other countries around the world subscribing to. We want China to be a better-behaved international player. We cannot pretend China away; we cannot prevent China trading and investing around the world, and neither should we, but we should ensure that its behaviour comes into line with the international values, norms and standards that the rest of us subscribe to.
Neil O'Brien (Harborough) (Con) [V]
The exchange attacks mark a further dramatic escalation in China’s state-backed espionage, which is stripping our intellectual property and undermining our democracies. My right hon. Friend the Minister is surely right that we must all work together with our international partners to defeat this escalating and aggressive pattern of behaviour, but will he say a little more about the key themes within that international co-operation to try to stop this increasingly aggressive behaviour?
James Cleverly
My hon. Friend makes an important point: working with our international partners is an incredibly important part of this. The joint statement that we made attributing responsibility to Chinese state-backed actors is important because it is the precursor that legitimates further actions that we might take. It seeks to make it clear to the Chinese Government that we can see what is happening—we are not blind to what is happening—and there is no veil of anonymity behind which they can hide. That then gives us, as part of the international community, the opportunity to go further if required. As I said in my statement, we have made it clear, and are making it clear, to China that such future actions will not go unresponded to.
China
Neil O'Brien Excerpts(4 years, 10 months ago)
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Dominic Raab
The hon. Gentleman is right to join others in expressing concerns. I made it clear that we regard what is happening in Xinjiang as a gross violation of human rights. I have already referred to the reports from Amnesty International, Human Rights Watch and the UN Committee on the Elimination of Racial Discrimination. A report by 11 UN special rapporteurs in November 2019 also raised the issues of not only arbitrary detention, but enforced disappearance and torture. We will look very carefully at all that evidence.
Neil O’Brien (Harborough) (Con)
I strongly welcome this statement. Whether it is the pictures of Uyghur Muslim children who have been separated from their parents, the horrifying footage of Uyghurs in chains being herded off the trains and into the camps, or the news that the Chinese Government are selling the hair of Uyghurs on the internet, I am sure that the Foreign Secretary will feel deeply that many of these things are reminiscent of the darkest moments of 20th century history. Does he agree that as we work across Whitehall to think about all our different points of leverage on the Government in Beijing, we must recognise, first, that they are on a path of increasing aggression externally and increasing repression internally? Does he agree that we must also recognise that some things we do to have the most leverage over them may also be in our economic interest, be that restricting takeovers of companies in this country or restricting their ability to extract technology from our universities? Does he agree that the only way to stand up to a regime that is becoming more and more bullying is to confront it now?
Dominic Raab
My hon. Friend makes a range of good points, and we will, of course, continue to look at all of them in the round. I share his concern about what we are hearing in some of those reports and the harrowing echoes of what we have seen in the past. He is right to say that we need to use every potential lever we have to try to positively moderate or change the behaviour of China. We also need to be realistic about the size and scale of China, and, whatever the debate in this House, about the likely appetite and disposition of not just Europeans and north Americans, but the non-aligned countries in the UN. We will be at our strongest when we unite people together.
Recent Violence in India
Neil O'Brien Excerpts(5 years, 2 months ago)
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Nigel Adams
All minorities in India deserve that protection, and I can assure the hon. Lady that we constantly remind our counterparts at official and ministerial levels of their responsibilities in that regard.
Neil O'Brien (Harborough) (Con)
In my constituency, families of Indian origin have wonderful relations with each other, whether they are Hindu, Sikh or Muslim, so it is heartbreaking to see the violence in India. Is the Minister thinking about how we can use all our policies, including our aid policies, to encourage equally good relationships between communities in India itself?
Nigel Adams
My hon. Friend will be aware that the UK Government have several projects in India, though we do not provide funding directly to the Government of India. I know that this can be helpful and that our intervention is appreciated in many areas.