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

Sarah Olney Excerpts

Committee stage
Wednesday 29th January 2025 Public Bill Committees

[Danny Kruger]

Q Mr Robinson, I want to come back to the question of coercion. We heard from advocates of assisted dying laws elsewhere that there is hardly any evidence of cases of coercion in this service overseas, and yet you are reporting—and we absolutely believe you, because we see evidence of it—that there is a chronic problem of elder abuse in our country. Presumably there is in every country. How do we square this? Is it that elder abuse does not apply in the context of assisted suicide in other jurisdictions, or is it just not being picked up?

Richard Robinson: I think there is a fundamental misunderstanding around what the abuse of older people is, and that has been borne out by a number of research papers that we have written, some working with YouGov, for example. Likewise, as I said, it is also a question of understanding what coercion is and getting the older person to open up, to help them to understand and to trust the person they are talking to.

We fully believe that there is nowhere near enough training and understanding across the medical profession and the judiciary around understanding the signs of abuse or coercion. Even though we completely welcome the new law on coercive control in the Domestic Abuse Act 2021, we have not seen a significant change. If anything, we as a charity believe that there is an epidemic of abuse against older people at the moment. Some of it is due to the economic climate that we are in, with people just wanting to have their inheritance now, and some of it is due to the fact that older people feel like a burden. You mentioned Oregon: of course, there is also the statistic that 48% of people who went down the assisted dying route in Oregon cited being a burden as part of their decision-making process.

I think that the abuse of older people in this country is vastly underplayed. I have mentioned the 75,000 impacts that we see and the 2.6 million people affected by it, but we have to fight for headlines and for understanding in every sector of society. It is seen as a minority issue, and it is really not. It is not a niche issue, and it is growing.

That does not mean that we as a charity are against the assisted dying Bill. If anything, we are pushing towards a safer ageing society. We would like to see a safer ageing society by 2050, and we believe that older people as a demographic should have an independent choice of what they want to do. That fits within our safer ageing society viewpoint. However, safeguarding is at the very heart of this. Until society can take the safeguarding of older people more seriously and look at training around abuse in the same way as with other forms of abuse and neglect, there is a much broader question to be asked.

[Sarah Olney (Richmond Park) (LD)]

Q Professor House, concerns have been expressed in written evidence that an assisted dying Bill of this sort is incompatible with wider policy around reducing suicide or suicide prevention measures. Do you think that it is possible to implement effective policies to reduce suicide rates, while having an assisted dying Bill at the same time?

Professor House: It is a challenging question, isn’t it? A lot of it is based on interpretation of far-from-definitive evidence. A starter would be to observe that we would have to change our national suicide prevention strategy, because at the moment it includes identifying suicidal thoughts in people with severe physical illness as something that merits intervention, and the intervention is not an intervention to help people proceed to suicide. So the answer to your question, to some extent, is “Yes, it is going to change our approach to suicide prevention.”

The wider question is whether it will change both the medical approach and society’s approach to suicide prevention in general if we start saying, “We don’t like suicide and we want to do something about it, except in some groups of people.” You may know that Professor Louis Appleby in Manchester, who leads the national confidential inquiry into suicide, is concerned about that. The best I can say on the international evidence is that there is no evidence that introducing this sort of legislation reduces what we might call unassisted suicides.

[Sarah Olney]

Q There is no evidence that it reduces it, so it continues at the same rate: it does not increase, and it does not reduce. Is that what you are saying?

Professor House: Well, it increases, but there are so many factors. I will give you one example. Oregon has been widely cited as a model for this sort of thing, although people have been a bit more uncertain in recent times. At the time that Lord Falconer introduced his Bill in the Lords in 2014, Oregon was cited as a place where levels had stayed much the same—not of suicide, but of people receiving assisted dying. In the decade since then, the number of people going through the assisted dying programme has gone up 500%, and the number of suicides has gone up 20%.

[Naz Shah (Bradford West) (Lab)]

Q Professor House, you have said that people applying for assisted dying may be in a state of vulnerability. What is vulnerability and how can the Bill be amended to make sure that vulnerable people do not inappropriately choose assisted dying?

Professor House: Vulnerability is not just an inherent characteristic of individuals. It is the presence of these external factors, circumstances, and internal factors, state of mind, that influence and bias somebody’s thinking about whether their life is worth continuing with and whether they want to end their life. Its importance is that exploring those factors and considering what can be done to ameliorate them can lead to a change of mind. If we do not explore those factors and we do not attempt to ameliorate them, we are losing an opportunity to change the mind of people who may rethink their desire to end their life.

Why I think of it as a vulnerability, rather than just as factors that influence a rational decision, which feels rather like how it is considered in the Bill, is that the emotional tone of the discussion that you have with people about all those factors is negative. They are not people asserting autonomy and pleasure in their ability to make a choice; they are people describing to you things that are negative influences on their life. The worry is that because there is nothing in the current medical assessment that requires a careful exploration of these factors, there is really no opportunity to change them.

--- Later in debate ---

[Tom Gordon]

Q My questions are to Dr Graham and Lord Sumption. The Bill, in its current form, has several opportunities for confirming capacity and whether the people who want to take up assisted dying have the capacity to do so; there are a number of safeguards and steps within it. That is more than is typically required for any other end-of-life decisions. I wondered whether you would comment on that. Is the Bill safe enough in its current form? If not, what other steps could be added?

Dr Graham: The only thing I would feel comfortable saying is that, yes, I agree with you that the Bill does contain further safeguards, more safeguards, than some of the other legislation in European countries. The legislation in those countries has been held to be compatible with the right to life and with other rights under the European convention. From a pure human rights perspective, which is all I feel qualified to comment on, I think you are on very safe ground.

Lord Sumption: I take exactly the same view. We must all be conscious of the fact that coercion, even when it is overtly applied, is extraordinarily difficult to detect: the kind that Baroness Falkner described a few moments ago as the subtle pressures that old and disabled people—in fact, people who are very sick generally—will feel without the need for any pressure. That spontaneous feeling of pressure is, I would have thought, practically impossible to detect. We have to live with the limitations of what human beings can do. In the end, I have come down in favour of the principle behind the Bill, but I regard it as an extremely difficult balance to draw—notably, for that reason.

[Sarah Olney]

Q Baroness Falkner, do you consider that in its current form the Bill upholds the rights of all the different groups whose rights are protected under the Equality Act 2010?

Baroness Falkner: Several human rights are engaged in the Bill: article 2 has been discussed; article 3 relates to inhumane and degrading treatment; article 8 is the right to privacy; article 9 is about freedom of thought, conscience and religion; and of course there is article 14, which has been discussed. They are all engaged at different levels of the Bill, and they are important and serious considerations. We are not clear, at this point in time, that the reservations we have about them can be resolved without further changes to the Bill.

[Sarah Olney]

Q Can you give me an example of one of your reservations?

Baroness Falkner: Yes. For example, you have just been discussing capacity, and capacity is a very serious consideration in our concern. You have been discussing coercion as well. There is evidence—coming back to the UN report I mentioned a few minutes ago—that the special rapporteurs on persons with disability and on human rights were very concerned. As Lord Sumption has said, when we have unclear law, it is very hard to understand the extent to which—when it comes to the definition of terminally ill, of coercion, of capacity—judges should have exemptions on, for example, conscientious grounds.

There is a whole host of other areas: regulations, for example. I think the Bill calls for regulations to be laid within five years—an assessment of the measures of the Act to be laid within five years. We wonder why the Government cannot even now, as the Bill is going through, do an impact assessment and a human rights conformity assessment to draw out all those concerns in a more effective manner. It is not too late for the Government to do that. We would suggest that consideration be given by the whole of Government to doing an assessment of those human rights implications, working to cover this Bill as they would cover a Bill that they had proposed themselves.

We are not entirely clear that a private Member’s Bill is a suitable vehicle for this issue, to be entirely honest. I may not be well informed enough, but I cannot remember a private Member’s Bill of such import going through since, perhaps, David Steel’s Abortion Act 1967. There may be other instances of a Bill of that import, but they do not come to mind right now. We look at the import of the Bill and at the fact that it has not been, sui generis, designed for England and Wales; it borrows quite a lot from other jurisdictions, although the number of jurisdictions that have passed similar laws is still relatively limited.

Were this a Government Bill or a Government-sponsored bill, even at this late stage, it could have a whole of Government approach to looking at the different aspects that are engaged: disability rights; older people’s rights; the fact that ethnic minorities have very differential attitudes to some of these things; cultural rights. That would be a better place for Parliament to engage with this profoundly important issue—on which, I should add, we are neutral, in the sense that we can point to the practical problems with the Bill, but we do not take a position on whether the Bill is right or wrong in what it is advocating. We are coming to it more from a process and improvement point of view.

Fazilet Hadi: Could I just add to that?

[The Chair]

I am sorry—just bear with me. Seven people wish to ask questions, and we have just half an hour. If you do answer, can it be very succinct if possible?

Fazilet Hadi: Thank you. I just wanted to support the Baroness, and also say that we believe the Bill will pose a challenge to protected characteristics, particularly of disabled people—and indeed other groups, because disabled people are LGBTQ+ and are black and minority ethnic. The equality journey for disabled people is relatively recent in this country. The Disability Discrimination Act was only passed in 1995, and the Equality Act was only 15 years ago. We are a country that is unequal—that has internalised ableism against disabled people—so I do think the Bill will have a serious and profound negative impact against the valuing of disabled people’s lives.