Terminally Ill Adults (End of Life) Bill

Simon Hoare Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

[Kim Leadbeater]

My hon. Friend makes a very important point. I thank him for it, and for his years of service as a nurse. I have spoken to many medical professionals about this issue, and they say that this is part of their job. They are very skilled and they work closely with patients, particularly dying patients, to assess their needs and to have those difficult and delicate conversations. As the KCs said, at the moment we check for coercion in cases where people have taken their own lives—when someone is dead. The Bill would make coercion a criminal offence with a sentence of up to 14 years.

Surely, by putting a legal framework around this difficult situation, we will provide an extra level of safeguarding. One psychotherapist, who is terminally ill herself, said to me recently that coercion happens when things are hidden away. The Bill would bring things out into the open. Surely, that must be safer for everyone. Let us look at what the absence of a robust legal framework looks like.

[Simon Hoare (North Dorset) (Con)]

I thank the hon. Lady for giving the House the time to debate the Bill this morning. She references coercion, and I understand her point about the two medics, but medics will not be able to see or hear everything at all times. People will not be put beyond challenge, because subsequent to the death, if a relative claims coercion of another relative, investigation will remain. I am entirely unclear how, without peradventure, two clinicians can claim that there had been no coercion at any point.

[Kim Leadbeater]

The hon. Gentleman has made the point for me: within a robust system, we will check for coercion, but we do not have any of that now. At the moment, the person will be definitely be dead. We have to look at the status quo. Putting in layers of safeguarding and checking for coercion must be better than the system that we have now.

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[Danny Kruger]

I am grateful for that intervention.

The assessments have to determine whether the patient is terminally ill, whether they have mental capacity to make the decision, and then whether they have been coerced or pressured into the decision. In many ways the whole issue turns on the question of whether someone is terminally ill. I am afraid that it is a term of great elasticity, almost to the point of meaninglessness. It is well known, as the right hon. Member for Belfast East (Gavin Robinson) said earlier, that it is impossible for doctors to predict with any accuracy that somebody will die within six months. It is a purely subjective judgment, made in this case by a doctor whose job will be approving assisted deaths. They simply have to determine not whether it is reasonably certain that death will occur, but that it can be reasonably expected—in other words, that it is possible.

[Simon Hoare]

The thrust of the Bill, as I understand it, is to ease suffering and pain in a patient who has a diagnosis and will die of the condition that has been diagnosed. But that right could only be exercised within a six-month period, and the pain and discomfort could last a lot longer than that. Has my hon. Friend heard—because I have not—what the importance of six months is? Why not eight, 10 or 12? What would stop people challenging it on the grounds that the dam has been breached, the six months is entirely arbitrary and it could, and indeed should, be extended by negative resolution in a statutory instrument?

[Danny Kruger]

My hon. Friend makes the right point, and I am afraid to say that is absolutely the case. The six-month cut-off is completely arbitrary and impossible to determine. It is a line in the sand, and of course it could be challenged, as so much of the Bill could be challenged, on human rights grounds. Every one of the safeguards that has been introduced by the hon. Member for Spen Valley would in fact be a barrier and a discrimination against the new human right that has been awarded to one group but should of course be awarded to all—if the point is conceded in this way.

Terminally Ill Adults (End of Life) Bill

Simon Hoare Excerpts

Report stage
Friday 20th June 2025 Commons Chamber

[Kim Leadbeater (Spen Valley) (Lab)]

I beg to move, That the Bill be now read the Third time.

It is an honour and a privilege to open the debate on Third Reading of the Terminally Ill Adults (End of Life) Bill. It has been a long journey to get here, and I do not underestimate the significance of this day. It is not often that we are asked to wrestle with issues of morality, ethics and humanity, but with great privilege in this job comes great responsibility, and never more so than at a time like this.

Benjamin Franklin told us that

“in this world nothing can be said to be certain, except death and taxes.”

In this House we debate the latter incessantly, but here and in the country as a whole discussing death is something that we tend to shy away from, yet it will come to us all and to all those we love. We all have our own experiences of death, loss and grief. There are good deaths and bad deaths. I, like many, have experienced both.

I appreciate that, for some colleagues, the journey to this point has been a difficult one. I want to pay tribute to the way in which the overwhelming majority of Members have approached the subject. Second Reading back in November was quite rightly seen as an example of Parliament at its best. Contributions from across the Chamber were incredibly powerful, the atmosphere was respectful, and people listened with care. I hope that we will see the same today.

I want to thank you, Mr Speaker, and your team along with the fantastic Clerks and procedural experts who have ensured that parliamentary protocols have been followed and have guided us through the intricacies of what can be a complex parliamentary process—one that is steeped in tradition, but not always easy to follow. Of course, process is important, but it is also important to remember that we are not voting on the merits of parliamentary procedure; we are voting on an issue that matters deeply to our constituents. Indeed, the issue before us is very personal for many people—so many of our constituents, but many of us as well. It is an issue that transcends party politics. I thank colleagues from across the House who have shared their very personal stories with me.

I am grateful to all colleagues who have studied the detail of the Bill. It is essential that we come to a decision based on the content of what it actually says. I have been pleased to work with Members on all sides of the debate to ensure that the legislation is something that Parliament can be proud of—a cogent, workable Bill that has one simple thread running through it: the need to correct the profound injustices of the status quo and to offer a compassionate and safe choice to terminally ill people who want to make it.

I will not go into the amendments in detail, as I know that is not the purpose of this debate, but whether by adding further safeguards and protections for patients through additional training around coercive control, the addition of specialist expertise through the inclusion of multidisciplinary panels, widening the provision for professionals to opt out of the assisted dying process, providing additional employment protections, or prohibiting the advertising of assisted dying, cross-party working has strengthened the Bill.

[Simon Hoare (North Dorset) (Con)]

I am grateful to the hon. Lady for giving way. What level of concern does it give her that, between Second Reading and today, a growing canon of professionals and their independent professional bodies have urged great caution about this Bill, not on the principle, but because they are opposed to the details of this Bill and believe it should be defeated?

[Kim Leadbeater]

I thank the hon. Gentleman for his intervention. I think what he is saying is that people have got different views, and they do have different views; we have different views in this House, and different people in different professions have different views. Every royal college has a neutral position on assisted dying because of that.

I have been pleased to work with Members on all sides of the debate to ensure that this legislation is something that Parliament can be proud of, and the many safeguards in this Bill ensure that only terminally ill patients who are eligible under the strict criteria and want to access assisted dying can do so.

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[Ms Diane Abbott (Hackney North and Stoke Newington) (Lab)]

This may be the most fateful Bill that we discuss this Parliament. It is literally a matter of life and death. I have heard talk today of the injustices of the current situation. What could be more unjust than someone losing their life because of poorly drafted legislation?

We hear about panels. The people talking about panels presumably have not had much to do with them. I would not put my life, or the life of anyone dear to me, in the hands of a panel of officials. I stress, right from the beginning, that it is perfectly possible to support assisted dying, as I do, but not be prepared to vote for this Bill. There is so much that is problematic about it.

First, as I believe is widely understood, there has not been enough time to debate the Bill. Secondly, a Bill of this seriousness should be given more time.

[Simon Hoare]

Does the right hon. Lady find it rather peculiar that the previous Parliament spent 746 hours discussing the death of a fox and about 98 hours discussing the death of fellow humans?

[Ms Abbott]

There has been a lot of talk about there being no evidence of coercion, but within the family, the most powerful coercion is silence: it is the failure to answer when a question is put. If police cannot spot coercion in domestic violence, how can they be expected to spot coercion in assisted dying?

The Royal College of Pathologists and the former chief coroner have pointed out that without a role for a coroner, the Bill raises the possibility of foul play. When an amendment was tabled in Committee to deal with that, however, it was opposed. The Bill would allow private for-profit contractors to run an assisted dying service with no profit cap and no transparency, but when an amendment was tabled in Committee to deal with that point, it was opposed.

We have heard—and we will hear over and over again in this debate—about choice. This Bill may produce choice for those of us, like almost everybody in this House, who have for the entirety of their adult life been confident in dealing with authority and institutions, but even then, the Bill would need amendments. But what choice does the Bill hold for someone who, all their life, has lacked agency, particularly in a family context, which may be particularly the case in certain cultures and communities? And what choice does the Bill offer to those who lack access to good palliative care?

As the former Prime Minister Gordon Brown has put it, our law should not

“focus on the few who wish for assisted dying and do too little to support the majority of those facing their final days who want—and deserve—access to the best of palliative care.”

What choice is it for those who think that, because their doctor raises it with them at all, they are being guided in that direction? An amendment that might have addressed that issue was rejected in Committee. It is a possibility that proponents of the Bill do not take seriously at all, but anyone who knows how institutions work should be watchful of it.

I came to this House to be a voice for the voiceless—that has not always been favoured by my own leadership, but that is why I came to the House. Who could be more voiceless than somebody who is in their sick bed and believes that they are dying? I ask Members in this debate to speak up for the voiceless one more time. There is no doubt that if the Bill is passed in its current form, there will be people among the most vulnerable and marginalised in our society who lose their lives unnecessarily. I therefore implore the House to reject this Bill—not because I am opposed to assisted dying in principle, but because my concern is for vulnerable and marginalised persons and communities.

Terminally Ill Adults (End of Life) Bill

Simon Hoare Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Kim Leadbeater]

No, I am going to make some progress, if that is okay.

The substances that would be used would not be new substances. As we know, assisted dying is available in many other jurisdictions, and there are substances that have been used safely and, in some cases, for many years. Their safety and efficacy has been proven around the world, but they do need to be treated differently, which is the purpose of new clause 13.

[Simon Hoare (North Dorset) (Con)]

Will the hon. Lady give way?

[Jim Shannon]

Will the hon. Lady give way?

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[Dr Sandher]

I have spent a lot of time around data, but I am not sure that I understand the question.

[Simon Hoare]

Will the hon. Member give way?

[Dr Sandher]

I will make a bit more progress.

This has been a heated debate, and hon. Members on both sides of the House feel strongly about it. I am grateful to Members who came before me, who made my place here possible and who have spoken so powerfully and movingly in this debate, but I believe—and the evidence shows—that the colour of my skin does not belong in discussion of the Bill.

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[Rebecca Smith]

I thank the hon. Member for his intervention and I completely agree with him. These are the sorts of safeguards that even the promoter of the Bill is saying should be there. I do not think that they are in the Bill and my amendment to new clause 15 would make them much stronger.

[Simon Hoare]

My hon. Friend is right in what she says. Those of us who are opposed to the death penalty, for example, are against it because we do not believe in the infallibility of the state. The state can get things wrong; professionals can get things wrong—and when they do, there should be a proven, clear path as to how that wrongdoing can be identified, to try to ensure that it does not occur again.

[Rebecca Smith]

I thank my hon. Friend. The statistics I quoted earlier are pretty clear on the point he makes. Let me make some progress.

The work undertaken by the coroner is not a box-ticking exercise or a bureaucratic hurdle. In the context of assisted dying, it is an extremely powerful deterrent against abuse and malpractice. Again, to quote Judge Thomas Teague KC, in a letter to The Times on 7 May this year, he said that the removal of

“any realistic prospect of an effective inquest...would magnify, rather than diminish, the obvious risks of deception and undue influence”.

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[Blair McDougall]

I do not wish to exacerbate your bronchitis, Madam Deputy Speaker, so I will continue.

Amendment 15 touches on a fundamental point at the heart of the debate. Disabled people and the sick, in every aspect of their lives, have to fight every day for resources from a state, a market and a society that view them as a drain on finances. Do we honestly believe that at the moment when the most vulnerable are least able to argue for themselves, under the most intense societal and cultural pressure, and at their most expensive, those same public and private sector institutions will succeed in making choice real for them when they have failed to do so throughout the rest of their lives? Even if we stretch credulity and convince ourselves that that will be true in the state sector, can we say that it will be true in the market? I do not believe that the Bill should be passed, but if it is, let us not make it worse by allowing unscrutinised profit from the loss of human beings.

[Simon Hoare]

I rise to speak in support of amendments (a) and (b) to new clause 14, new clauses 1, 2 and 16, and amendment (a) to new clause 15.

I will make two observations at the outset. I do so as a Welshman representing an English constituency, as a former Chair of the Northern Ireland Affairs Committee, and as the current Chair of the Public Administration and Constitutional Affairs Committee. I remain to be convinced, despite the confidence expressed by the Bill’s promoter, that the Bill honours, in spirit and letter, the devolution settlement. Based on the expression on the face of the Chair of the Scottish Affairs Committee, the hon. Member for Glasgow West (Patricia Ferguson), I do not think she believes that it honours the devolution settlement as far as Scotland is concerned either.

I also make the point that we are here to make law that has to stand the test of time. She was not the only one to do so, but the hon. Member for North Herefordshire (Ellie Chowns) shared a heartfelt anecdote about a conversation with her mother as a result of her mother’s professional work. I know how easy it is to do, because it is a trap that I have fallen into, but, particularly on an issue as emotive and literally life-changing as this, we should not base our decision just on anecdote. We must base it on cold analysis of what is before us.

It is almost six months to the day since the Bill was introduced and still I think it is best described as skeletal. We have been told time and again by the hon. Member for Spen Valley (Kim Leadbeater) and the Minister how busy officials have been looking at the practicalities of the Bill and how to operationalise it and make it workable. Yet this House is kept in the dark on what Ministers intend. Indeed, the hon. and learned Member for Folkestone and Hythe (Tony Vaughan) said in his earlier contribution that his understanding was that the hon. Lady was still prepared to work with colleagues to perfect the Bill. But, Madam Deputy Speaker, we are on the second day of Report stage and we could easily fall to Third Reading today. The time for that evolutionary conversation is long past. The time for detailed clarification is now. The Bill remains skeletal.

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[Jim Shannon]

Will the hon. Gentleman give way?

[Simon Hoare]

I will not; I am very conscious of time.

Madam Deputy Speaker, given that so many right hon. and hon. Members have been constrained in the length of their contributions because of your persistent cough—I say that not as a criticism—and that next week we have a lot of one-line Whips and the following week we have exactly the same, more time really should be given to the Bill. I do wish the Government had taken it on, not as a Government Bill but by finding Government time for Report on the Floor of the House. This is too serious an issue to have as many gaps and lacunae as this Bill has.

The founding fathers of the United States worked on the basis that the vague generalities of the constitution would always be adhered to, and that men and women of goodwill would adhere to it. I am pretty certain that they are now beginning posthumously, with the current incarnation, to wonder whether that is true. We should not be legislating to leave it up to Ministers to define regulations and decide how they come forward. We have Bills that have page after page after page which, when people ask themselves, “What is this all about?”, actually amount to very little. The amendments that have been tabled, and which I support, have been tabled in good faith, but I am afraid to say that, in trying to improve the Bill, they are trying to make a silk purse out of a sow’s ear.

[Catherine Fookes (Monmouthshire) (Lab)]

I rise to support new clauses 20 and 21, and amendments 70, 71 and 92 to 95. They are all about the right people having the right powers at the right time, and they respect the devolution settlement for Wales. I am mindful of time, and therefore I am sorry but I will not take interventions. I am extremely grateful to my hon. Friend the Member for Spen Valley (Kim Leadbeater) for engaging so meaningfully and strongly with the Welsh Government, including going to Cardiff to speak with Welsh Health Ministers and officials, to ensure that they are continually consulted during this process.

New clause 20 ensures that the Secretary of State, not the chief medical officer, is responsible for issuing guidance on the operation of the Bill. It enhances oversight and accountability by placing that responsibility with the Secretary of State, so that scrutiny and accountability regarding how the Bill will be implemented in practice is put in the right place. It is normal practice that officials whose roles and responsibilities may alter over time are not named in primary legislation. It is, however, important to note that the chief medical officer is not being cut out of the process, because the chief medical officers for England and Wales must be consulted. The new clause also allows persons with learning disabilities and other protected characteristics, as well as providers of palliative care services, to contribute to the process of provisioning guidance. It is a simple but important measure that ensures the right level of ministerial oversight, and I urge colleagues to support it.

As my hon. Friend the Member for Cardiff West (Mr Barros-Curtis) has explained, it is important to urge Members to support new clause 21, because it ensures that people in Wales are able to access the assisted dying process in the Welsh language if that is their preference. Almost 30% of the population in Wales speak Welsh, and it is so important that they can access this service in their language should they wish to do so. It is a small change, but it will make a huge difference to patients, families and clinicians in Wales.

Amendments 70 and 71 simply refine provisions around the use of interpreters, requiring the Secretary of State to publish a code of practice on the matter. Interpreters are essential to ensure fair and equal access to the assisted dying process for those whose first language is not English or Welsh.

Amendments 92 and 93 provide greater detail on the Welsh Government’s responsibilities in delivering assisted dying services in Wales. Some hon. Members seem confused about what is and is not devolved, but as a Welsh MP, I wholeheartedly support the amendments, which 100% respect devolution. They ensure that Welsh Ministers have all the powers they need regarding the devolved aspects of the Bill and the health provisions, while retaining the powers of UK Ministers over those aspects that are not devolved, such as criminal justice provisions and, crucially, changes to the Suicide Act 1961.

Amendments 94 and 95 clarify how and when provisions relating to voluntary assisted dying will come into force in Wales. They do not impinge on the devolution settlement, but simply provide clarity and legal certainty. All the amendments would help my constituent, Noah, a 19-year-old with a terminal brain tumour who knows what he wants if his pain becomes unbearable. The Bill is about giving people like Noah the choice, control and compassion that they deserve at the end of life. Who are we to deny that choice?

I pay tribute once again to my hon. Friend the Member for Spen Valley for working closely with officials in both Wales and this place to craft what could be the strongest and most safeguarded assisted dying legislation anywhere in the world. It is a Bill designed to protect everyone, including my constituents in Monmouthshire and people across Wales. Thanks to the careful, considered amendments, including the ones that I have spoken about today, the Bill not only respects the devolution settlement but ensures that the right people hold the right powers at the right time to deliver this law safely. I urge Members to join me in the Aye Lobby to legislate to protect the rights of the terminally ill in their final months—to legislate for compassion, for choice and for dignity.