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

Simon Opher Excerpts

Committee stage
Wednesday 12th February 2025 Public Bill Committees

[Danny Kruger]

The hon. Gentleman makes an important point. However, as we discussed earlier, the terms of the Suicide Act 1961—which explicitly include the term “encouragement”—include pressure. The understanding and interpretation of “encouragement” include the effect of the encouragement, which is that someone has been persuaded by a third party to take this step, whereas the principle of the Bill is that people are acting entirely autonomously.

[Dr Simon Opher (Stroud) (Lab)]

This is a really interesting discussion, but it misses the point of how clinical people assess coercion. What we really do not want is a tick-list saying, “Confirm that you have not been encouraged” and so on, on a piece of paper. It is a much more open discussion. To get to real coercion, we have to leave it completely open. We follow the flow of the patient’s conversation. I do not think that any particular words will help in that context.

[Danny Kruger]

I am grateful to the hon. Gentleman for stating so clearly the ultra-libertarian position: “Leave it all open; trust the doctors—allow them to conclude if there has been any problem.” The implication of the Bill is that some questions will be asked, appropriately, but I do not think the questions are quite tight enough. I am afraid to say that I disagree with the hon. Gentleman’s suggestion that leaving it “completely open”, as he puts it, to doctors would be safe.

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[Naz Shah]

My hon. Friend makes a very important point—because if we visit this issue afterwards, that person is dead.

[Dr Opher]

I do believe that what was actually said in evidence was that one of the reasons was that the person felt a burden, but there were other reasons. From the Californian doctors, we heard that feeling a burden is not in itself a reason to approve an assisted dying request.

[Naz Shah]

My hon. Friend is right, but the point I am trying to come back to is to do with those people who feel a burden; wherever they feel a burden, somebody is benefiting from that, because we are taking the burden away—there is ultimately a benefit to somebody.

We have talked a lot about people feeling a burden in terms of potential coercion, potential financial issues and all those things, but we have not discussed this in detail. It is important that we do so if we are to make this Bill, as my hon. Friend the Member for Spen Valley intends, the safest Bill in the world. It is incumbent on us to look at both sides. Just like in the earlier debate about whether we choose assisted dying or choose to take out the plug, ultimately the end is the same—it is death—but they are two different things. The amendment tabled by the right hon. Member for Braintree is very much about the question of who is benefiting from the person taking that decision.

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[Danny Kruger]

I remember the hon. Lady’s very powerful speech on Second Reading and I fully recognise that, which is why I said that I recognise that including suffering would be problematic. I understand her point about pain as well. I think we need belt and braces. If we are going to do this, we should have strict restrictions on prognosis, because I want to restrict the time limit. I could go further than six months; we keep hearing about people in the very last stages of their life, and I think it should be restricted to them, but I also think the purpose of seeking an assisted death should be consistent with all the arguments that we keep hearing about people suffering terribly at the end from an agonising death, and we need to restrict it to those cases as well. It should be for people at the very end of their life, for the avoidance of suffering terrible pain. Those are the reasons that the public, in so far as they do support the Bill, support it—they support it for those reasons only.

[Dr Opher]

In my experience, often the reason people talk to me about assisted death—obviously, it is not legal at the moment—is fear of uncertainty at the end of life. That is one of the major things. For example, if someone has a bronchial tumour, it might suddenly haemorrhage, causing them to die by drowning in their own blood. That is something that people will do a lot to avoid. That is not pain; it is something else. As the right hon. Member for North West Hampshire mentioned, a tumour on the carotid artery can suddenly bleed catastrophically. That is not pain, but it is another reason for doing it. I believe it is that fear of what might happen at the end of life that drives most of this. Sometimes it cannot, but usually pain can be palliated —there are many ways to do that—but that fear of what will happen cannot be. We must not do this just for pain.

[Danny Kruger]

The amendment would require people to request an assisted death for the purpose of avoiding pain. If the purpose is to avoid the pain of the death that the hon. Gentleman described, they would qualify under the amendment. I want to push back slightly. I recognise that he is a doctor and I am not, but the case that was cited on Second Reading has been refenced a number of times. I want to look more closely at it, because I have heard from a number of professionals that the account given was not reflective of the usual course of events for that illness. I am sure that, as a doctor, when people say that they fear that sort of death, he does not confirm that it is likely to happen to them.

I want to come to the reality, as I understand it from the evidence, of the genuine opportunities that medicine gives to afford people a good death, which is what medicine should be about.

[Dr Opher]

In carcinoma of the bronchus, it is a real risk—and it is a risk that oncologists will tell me and tell the patient. That is the sort of thing that people adopt assisted dying to avoid.

[Danny Kruger]

I am grateful to the hon. Gentleman.

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What about people who do not respond to opioids or cannot tolerate them, which we hear about? There are many non-opioid pain medications that can be used: neuropathic agents, non-steroidal anti-inflammatories and so on.

[Dr Opher]

I think we are going slightly off topic. The hon. Gentleman is talking about pain control, not whether pain can be used as the sole criterion to qualify for assisted dying. I do not know, Mrs Harris, whether—

[The Chair]

The Clerks are quite happy with it, but thank you for your assistance.

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[Danny Kruger]

Well, perhaps my hon. Friend wants to come up with a further amendment, to strengthen it even more and say that we should restrict it only to agony or extreme pain. No, I am trying to be reasonable and say that the case made for the Bill, in public and I think in the public mind, is that its beneficiaries will be those who face terrible pain at the very end of their life, and if that is our intention, let us specify that. That is what the Bill does.

[Dr Opher]

I do not believe that the intention of the Bill is simply about being able to have an assisted death because of pain. Nothing in the Bill says that. We heard evidence from Dr Hussain, who was against assisted dying, but she admitted that there are people for whom we cannot control the pain, so that is another point. The whole interpretation of the Bill is incorrect. It is not about pain at the end of life; it is about controlling one’s own death.

[Danny Kruger]

That is exactly my point. There are those who think that it should be just for people facing terrible pain at the end of life, but that is not what the Bill does, and it is not what the hon. Gentleman says it should do. He would like there to be a Bill that says simply, “If you want to take your own life with the help of the state, you should be allowed to do so.” That is the logic of his position. I do not see why there are any other safeguards—if we believe in absolute autonomy, that is where we are. It is either/or. Either this is a Bill for full autonomy, or there are safeguards to restrict it to the people whom the public are rightly concerned about: those who suffer terribly at the end of life.

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[Danny Kruger]

That is absolutely right. It is a very depressing fact that it seems to be the sentiment of the Committee that we should allow people to request and receive an assisted death for the purpose of saving their relatives money. That does seem to be what people are saying.

[Dr Opher]

There is something called continuing healthcare, which would fund end-of-life care, if someone has a terminal prognosis of six months or less, so care costs would be covered by the state.

[Danny Kruger]

That is a fair point. I do not propose to push the amendment to a vote, but I hope that the point has landed sufficiently. There is a genuine concern that people will, as they do in other countries, with increasing regularity and in concerning numbers, seek to have an assisted death not with their own personal interests in mind but for the sake of others. That may be generous-spirited of them, but it is not the purpose of this Bill as far as I understand it.

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[Kim Leadbeater]

I am certainly not being dishonest, which is the hon. Lady’s implication. I refer back to the complexity of those conversations, and the fact that safeguards will need to be in place to check for coercion, dishonesty and pressure. Ultimately, it comes down to a question of autonomy, dignity and choice for patients, but they are not simple conversations. I think it would be very unusual if the conversation looked how she is describing.

[Dr Opher]

As a doctor, if I, under this legislation, came across someone who gave their main reason for ending their life as being that they wanted to save money for their family, that would come under pressure or coercion, even if it was from themselves.

[Kim Leadbeater]

It is really important to remember that, at the moment, there is no legal framework that checks terminally ill people’s reasons for ending their lives or shortening their deaths. That is why having this legal framework is so important. During the oral evidence sessions, Sir Max Hill told us that in his experience of working as Director of Public Prosecutions, he oversaw a number of cases to do with people travelling to Dignitas. He said:

“In each of the 27 cases I considered, the deceased individual was already dead, and that is when the scrutiny started. The major advantage of the Bill…is that that will be reversed, and scrutiny will be before death.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 86, Q111.]

The same applies to terminally ill people who have taken their own lives in this country. The only time that anyone checks for coercion, either internal or external, is when the person is dead. The Bill provides a robust legal framework, which is a significant improvement on things as they stand.

Dr Aneez Esmail, who changed his position on assisted dying as a result of his work as a professor of general practice, said in his oral evidence,

“How is the law protecting anyone at the moment?…we don’t have a legal framework…it is actually very unsafe…a law…which produces safeguards, is a huge improvement on where we are at the moment.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 166, Q211.]

I also worry about the subjectivity of this amendment. We know that the law likes certainty, rather than abstract concepts, such as doing something for one’s “own sake”, which seems somewhat abstract.