Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Rebecca Paul Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[The Chair]

That was a specific question to Mr Amin, but it is an important issue. Does anyone else wish to come in, briefly please?

Chelsea Roff: One thing I would like to highlight in our study is that all 60 people who died—young women, mostly—were found to have mental capacity to make the decision to end their life, so I worry that mental capacity will not be an effective safeguard to prevent people with eating disorders from qualifying under the Bill.

I also note that Oregon and California, where I am from and where we have found cases, have an additional safeguard to mental capacity. That is, if there are any indications that the person might have a mental disorder, that person must be referred for a mental health assessment. It is important not to make a false equivalence between mental capacity and mental health.

We could, for instance, have a person who has a prognosis of six months or less, but their wish to die is emerging from severe depression, from suicidality. We saw very high rates of suicidality and depression: 89% were depressed and nearly half chronically suicidal when they died. Physicians emphasised, still, that the wish to die was not emerging from a mental illness, despite them having diagnosed mental illness.

[Rebecca Paul (Reigate) (Con)]

Q My question is to Chelsea Roff. First, thank you for your written evidence, which I found extremely helpful. It indicates that in Oregon, California and Colorado, patients with anorexia have qualified as having a terminal illness. There have been instances of patients suffering with anorexia being described as terminal, and of treatment being withdrawn, in the UK itself. Is it accurate to regard these young women as suffering with a terminal illness? What changes to the Bill would you suggest to protect them better?

Chelsea Roff: Thank you for that question. No, I do not think it is accurate, but I have to emphasise that laws in other countries have expanded through clinical interpretation, not just legislative amendment. There are clinicians—a very small minority—who disagree and who have characterised anorexia by name as a terminal illness, but they have also said that eating disorders qualify because of the physical manifestation of the disorder. You cannot disentangle a mental disorder from its physical effects. They cite terminal malnutrition; we have identified 25 cases between California and Colorado where malnutrition was listed as the terminal condition. I cannot rule out whether that was anorexia or something like voluntary stopping of eating and drinking, but I worry that it is the physical manifestations that will be cited and, without a mental health safeguard in the Bill, that puts a whole lot of people at risk.

[The Chair]

Dr Griffiths or Professor Shakespeare, do either of you wish to comment, because you have not spoken yet?

Professor Shakespeare: If you look at clause 2, the definition of terminal illness is very clear:

“a person is not to be considered to be terminally ill by reason…of…having one or both of…a mental disorder”

or “a disability”. I think that would cover that case.

Chelsea Roff: May I add one sentence? I think you have left out an operative word in that sentence, which is “only”. It reads,

“a person is not considered terminally ill by reason only of”—

New Hospital Programme Review

Rebecca Paul Excerpts

Monday 20th January 2025 Commons Chamber

[Wes Streeting]

I am grateful to my hon. Friend for his question. I am not surprised that Conservative Members tried to shout him down. They want to silence criticism of their record because they are ashamed of it. That is a simple fact. He is absolutely right about his parliamentary neighbour, who sat around the Cabinet table of the notorious Liz Truss, even as she crashed the economy, and then has the temerity to turn up and lecture other people about the sound management of public money. These people have no shame whatsoever, and they will have no credibility until they sincerely and honestly apologise to the country for the mess they made.

I am very happy to talk through with my hon. Friend and his constituents why his project has been phased as it has. There are a number of constraining factors—not just resources, but other factors such as allocation of land, planning and so on—but I reassure his constituents that we will deliver. I also reassure his constituents that, since his arrival in this place, he has been absolutely dogged and determined in speaking up for them and lobbying on their behalf.

[Rebecca Paul (Reigate) (Con)]

I welcome the Secretary of State’s clarification on the timing of the new Sutton specialist hospital, which will serve my constituency. I am really pleased that the project is going ahead, although the delay is disappointing. The current situation at Epsom and St Helier university hospitals NHS trust is not sustainable. The trust currently runs duplicate services across two sites, which makes staffing incredibly difficult. The physical estate is deteriorating faster than it can be fixed, and some of the buildings are older than the NHS itself. Could the Secretary of State set out how he intends to reduce waiting lists in Reigate, Redhill, Banstead and our villages in the short term in the light of the delay to this project?

Puberty-suppressing Hormones

Rebecca Paul Excerpts

Wednesday 11th December 2024 Commons Chamber

[Wes Streeting]

The order relates to the use of puberty blockers by that particular group of patients for that particular purpose, where the evidence base is not sound and for which the Commission on Human Medicines has described the current prescribing environment as representing an “unacceptable safety risk.” Puberty blockers are safe and proven for use among children and young people for other conditions, including precocious puberty. Where we lack a sound evidence base and a safe prescribing environment, and where that medicine represents an unacceptable safety risk, is in relation to its use for that particular purpose for that particular group of patients.

[Rebecca Paul (Reigate) (Con)]

I welcome the statement and commend the Secretary of State for putting the safety and wellbeing of children first. The use of puberty blockers to treat gender dysphoria is—I will not mince my words—nothing short of a medical scandal, in my view, so I very much welcome his approach. He said that it is important that young people receive the right care from paediatricians and mental health professionals. Does he agree that no child should ever be told by a health professional that they were born in the wrong body?

[Wes Streeting]

It is important, particularly with this group of children and young people, that clinicians ask a range of questions to identify the nature of a child’s needs, and respond appropriately by providing holistic and evidence-based healthcare. That is the best way of turning around the horrendous statistics on the effects of gender dysphoria on children and young people, and it is how we will achieve better, healthier and happier outcomes for that cohort of patients.