Terminally Ill Adults (End of Life) Bill

Simon Opher Excerpts

Friday 16th May 2025 Commons Chamber

[Dame Meg Hillier (Hackney South and Shoreditch) (Lab/Co-op)]

I rise to speak to new clauses 1 and 2, which stand in my name, and consequential amendment 2, and I will touch on others at the end. These amendments—without being dismissive of those who helped me draft them—are imperfect. Those of us who are not the promoter of the Bill have not had the support of Government drafters in tidying up the Bill. We need to acknowledge that the Bill in front of us today is the Bill—more or less—that will or will not be passed by this House. For any amendments made, by the point of Third Reading, that is it—there will be no further opportunity to redraft them.

Sadly, one of these amendments was rejected in Committee. If those changes had been discussed before the original Bill was published, or even in evidence before Committee, we would have been in a better place to get that tighter drafting that is needed in making good legislation. We are not a debating society; we are now legislating for a law that would enable the state to assist in people taking their lives. I am sad that we are able to discuss these amendments only now. I did not get the opportunity to be on the Bill Committee, but I commend all Members who spend so many hours discussing and debating those issues.

The ramifications of the clauses I want to talk about are important for potential users of a service, for medical professionals, for families and for other health professionals. The Bill currently allows doctors to suggest assisted dying to a patient who has not raised it themselves. This, I believe—as I know many others do—presents a serious risk that terminally ill patients, already highly vulnerable, will feel pressured to end their lives.

[Dr Simon Opher (Stroud) (Lab)]

I realise that my hon. Friend’s new clause 1 comes from a good place, but can she not see that it is inconsistent with our ethical obligations as doctors? That is why the British Medical Association has suggested that although there should be no duty to raise the issue, neither should there be a ban on doing so. I ask her to consider that the Australian state of Victoria initially had such a measure—a so-called gagging clause—as part of its Bill, but it was removed because it caused confusion and was detrimental to patient care. Should we not learn from that?

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[Anneliese Dodds]

Yes, I do share my hon. Friend’s concern in that regard. Sadly, we all know how perpetrators of coercion operate. They will often school the subject of their coercion in how to respond to questioning, to try to hide what they are doing from others. That is a concern.

[Dr Opher]

Does my right hon. Friend not see that, in Committee, we were very aware of coercion? That is one of the reasons why we have a social worker on the panel of experts. Additionally, clause 1(2)(b) says it will be necessary to establish that a person

“has made the decision that they wish to end their own life voluntarily and has not been coerced or pressured by any other person”.

It is very clear in the Bill.

[Anneliese Dodds]

I very much appreciate my hon. Friend’s efforts, and those of my hon. Friend the Member for Spen Valley, to ensure that these matters were covered in Committee. Sadly, because of the patterns of behaviour that we see time and again with those who have been subject to coercion, I do not believe that the safeguards go far enough. That is my assessment, and I know that other Members will come to a different view.

--- Later in debate ---

[Madam Deputy Speaker]

I reassure the hon. Lady that I have heard her point. I repeat that I will not make a pre-decision on any closure motion that has not yet been moved.

[Dr Opher]

I will be very quick, Madam Deputy Speaker, because I am aware of the need to fit in as many people as possible.

I will address a few issues on the assessment of capacity under new clause 9. One key point about assessing capacity as a doctor is that in most cases it is very clear cut: someone either has capacity or they do not. That is quite easy and quick to establish. With a very small number of patients, it is more difficult. By amendment to the Bill made in Committee, we must now refer such a person to a consultant psychiatrist for an assessment by a specialist. They are then in the best position to assess those very difficult points of capacity. That very much strengthens the Bill.

I will speak very briefly to new clause 1. As doctors, we must, under our ethical obligations, give options to patients. If we are absolutely forbidden to do that—new clause 1 would make it a crime, so we could be convicted for doing so—that totally wrecks the doctor-patient relationship. It is unprecedented and unworkable.

[Several hon. Members rose—]

[Dr Opher]

I am sorry, I cannot give way. I am just going to go through these points very quickly.

That is why the BMA is against new clause 1. There is no duty for doctors to raise the issue, but there should not be any ban on them doing so. As I have pointed out, the so-called gagging clause was introduced in Victoria as part of the legislation. However, after five years that has now been removed by an independent review, because it caused confusion and it harmed patient care. I urge colleagues to vote against new clause 1. Let us respect the patient’s right to information, not restrict it. Let us ensure that no patient is left suffering simply because they did not know what to ask, and that no doctor is punished for trying to help.

[Sarah Russell]

I thank my hon. Friend for giving way. On that point, I have particular concerns—

[Madam Deputy Speaker (Caroline Nokes)]

Order. May I just clarify whether the hon. Gentleman was giving way?

[Dr Opher]

Yes, I am happy to give way.

[Sarah Russell]

Thank you, Madam Deputy Speaker. On that point, does my hon. Friend agree with my concerns about new clause 2, which, although genuinely meant and intended, is in danger of being read, together with new clause 1, to indicate that it should not be discussed with children at all, even if they raised it first, because of the difference between the wording of the two clauses?

[Dr Opher]

Any restrictions around the doctor-patient relationship will harm patients, so I agree with my hon. Friend.

[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.