Assisted Dying

Steve McCabe Excerpts

Monday 4th July 2022 Westminster Hall

[Several hon. Members rose—]

[Steve McCabe (in the Chair)]

To get everyone in, I will have to reduce the time limit to four minutes. If there are interventions, not everyone will have a chance to make a speech.

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[Lucy Allan]

Will my right hon. Friend give way?

[Steve McCabe (in the Chair)]

I would rather the right hon. Gentleman did not, actually.

[Lucy Allan]

My right hon. Friend says that this debate is about suicide, but I wonder whether he has a family member, as I have, who took their own life through suicide, and whether he understands the difference between that and what we are talking about today?

[Sir Edward Leigh]

I have not had a family member do that, but we have all encountered friends and relatives who have been under intolerable pressure. Hon. Members have cited examples, and I can do so too.

I simply take a very pro-life point of view. It is not from my religious conviction or my belief that everybody is beautiful and wonderful, however small, however tiny in the womb, however old or frail, how much of a burden they are, whether they are a convicted murder or whether they are one of our military enemies. I take a pro-life view, and I think so much of the misery in the world in the last 100 years has been because people are casual about taking life. Many of the arguments that we hear in favour of assisted dying are based on very appalling, horrible and extreme cases. They are similar arguments to what we heard when we had the initial debates on abortion, with foetal abnormality, rape and all the other things. Then we had abortion on demand, and now we are going to get death on demand. That is what it is all about. All the pressure, particularly on the frail and vulnerable, will be about that.

I want to make a theological point. A friend of mine died in the first months of covid. He died in agony. He died in a part of the country where he was sent out of hospital because the medical profession was panicking. He was not given adequate palliative care and he died in agony. It was appalling. We are all agreed that we are still not doing enough about palliative care. We have to do much more. We have to tell everybody that they have the right to go into a hospice—a right that so many people are not given—and receive the full benefit of modern medical technology to die peacefully and painlessly. For the overwhelming majority of people, if they are given palliative care, it is an option they can enjoy.

I actually watched another friend of mine die. He was my best friend and former colleague in this House. He was dying of terminal cancer; I was sitting beside him and I could see the morphine pumping through his wrists. He died peacefully and painlessly, but I have no doubt that it was the morphine that killed him. Theologically, morally and legally, there is nothing against a doctor helping me to die by pumping morphine into me, even if that is the immediate cause of my death. [Interruption.] I can see people shaking their heads, but I have actually seen it happen. Is there anyone in this room who would blame a doctor who helped someone to die if they were in agony? The doctor was not trying to kill them—they were trying to ease the pain. And in easing the pain by delivering that amount of morphine, that might have hastened their demise.

Let us be realistic about it. Let us try to take a pro-life view, and let us remember—

[Steve McCabe (in the Chair)]

Order. I call Wera Hobhouse.

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[Robin Millar (Aberconwy) (Con)]

It is a pleasure to serve under you, Mr McCabe. I have been contacted by many constituents eager for me to engage on this matter, but I make my contribution also as someone who has experienced the loss of a loved one through suicide and as someone who has witnessed at first hand his mother wrestle with a chronic degenerative disease, Parkinson’s, which ultimately claimed her life.

It seems to me that already in this debate clear positions are emerging. A summary, which I offer humbly for colleagues to consider, is the saying, “We shape the law and the law shapes us”, because on one side I hear arguments for the former, and on the other for the latter. On one side, I hear story after moving story of suffering—not least from the hon. Member for Gower (Tonia Antoniazzi), whom I thank for introducing the debate—and on the other, I hear concern for the impact that these laws would have on others.

I want to start by just thinking briefly about the importance of language, because today’s debate is looking at the e-petition relating to “assisted dying”, but that is an undefined term, without clear meaning. It does have the attraction of a blank canvas, in that we can ascribe to it whatever meaning we may desire, but it should also give us cause for caution. The proactive ending of one’s own life, by consent or otherwise, in law is suicide—in this case, presumably, by the self-administration of lethal drugs. The House of Commons Library’s own briefing note adopts the term “assisted suicide” in order to reflect the law. Therefore, another title for this debate, which would reflect where we actually start from, might have been, “Debate on e-petition relating to assisted suicide”. I think that this is an important place to start—not to cause offence or distress and not for any obstacle that it may present, but simply because it is where we are. We cannot start in some place yet to be defined, where some may wish us to be one day.

There are many terminally ill people—those without name and number, as my hon. Friend the Member for Devizes (Danny Kruger) said—who want to live and who need to know that society wants them to live. They want and need to feel valued. They need to feel safe. A move towards an assisted suicide society risks introducing an obligation on an individual who is terminally ill to seek or consider an assisted death through lethal drugs, and suggests that it may even be their moral duty to do so. We cannot simply dismiss that unintended consequence. Assisted suicide legislation has the potential to create exactly that powerful counter-narrative of a duty to society or family and loved ones to remove the inconvenience, the burden and the cost. That is not a message I believe we should send or have bound into the fabric of our society through law; nor is it a duty that should bind those in the caring profession, which is driven by the preservation of life.

I say to my right hon. Friend the Member for West Suffolk (Matt Hancock) that the 2020 survey of BMA members that he referred to showed in fact that the majority of those licensed to practise and closest to terminally ill and dying patients—those in palliative care, geriatric medicine and oncology, and GPs—do not support legalisation. As it stands, the best that can be argued is that the BMA’s position is one of neutrality.

It is worth mentioning, in the context of other countries —for example, Belgium and the Netherlands have been mentioned—that there was in fact no growth in services per 100,000 of population in Holland from 2012 to 2019. That must be a concern for all. It is also important to note the context, and the context must include reference to the fact that Holland has approved plans—

[Steve McCabe (in the Chair)]

Order. I call Joanna Cherry. [Interruption.] Sorry, I mean Christine Jardine. My sincere apologies—I will get these glasses fixed. I call Christine Jardine—my apologies.

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[Kevin Hollinrake]

I will look to the Chair—who says no; I apologise. We will talk about it afterwards.

As has been said any number of times this afternoon, this is about choice. Of course, all of us in this country are so lucky to have this free society we live in. This is about freedom of choice, but it is not about freedom of choice over anything; it is about freedom of choice about the thing we fear most in life: death.

I would say today that I do not actually fear death; I might think differently in a few years’ time—that point in time is getting closer—but I will tell you what I fear, Mr McCabe. I fear a painful death. I absolutely fear a painful death. I may have options. Some of us are lucky enough that we could plan ahead and say, “Well, we’ll make that trip to Zurich”, or we might take the terrible path that the father of the hon. Member for Sheffield Central (Paul Blomfield) had to take. People have a choice, of course, to do what they think is right and not to take that option, but instead to take the natural path. However, I think it is wrong to remove from people the choice, a choice that other countries and other places allow and that we can choose to have, as well—the ones who are lucky enough to have that choice.

There is one thing that we have probably not discussed in this debate. It is not just about the fear of dying; it is about the fear of what might happen. There is a quote from Dr Sandy Briden, who died of a form of cancer that is rare in the UK:

“Knowing I had the option of an assisted death when things get too much would allow me to live now, without the constant fear of what might happen at the end. For me, assisted dying isn’t about dying; it’s about living.”

It is about living that last time we have, knowing we have the choice—away from that anxiety, which must be terrible for people nearing these situations—and it is certainly something that I would have wished for my mother when she passed away at the end of 2019. The palliative care was there, but still it was, for all those around her, a traumatic experience.

I do not get the slippery-slope argument. We have seen that in Oregon, which has not changed its law in 25 years, a very low percentage of people—0.7%—take this path of death through assisted dying.

However, I understand that there are really cogent arguments as to why we would not have this law, which is why I support an inquiry. I just do not see what the argument against an inquiry is. We could look at best practice around the world and decide what is best practice for the United Kingdom.

[Steve McCabe (in the Chair)]

We have got 31 speakers into this debate. We have had to squeeze the Front Benchers a little bit to do that, so if they could confine themselves to nine or 10 minutes, the mover of the motion might just get a last word.

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[The Parliamentary Under-Secretary of State for Justice (James Cartlidge)]

It is a pleasure to serve under your chairmanship, Mr McCabe. I congratulate the Petitions Committee and the hon. Member for Gower (Tonia Antoniazzi) on securing the debate. Introducing a debate on a matter like this means speaking at a very pressured moment. I thought she spoke with bravery and set the tone for what has been a very moving, powerful debate with high-quality contributions on both sides. It has shown Parliament at its best, as is often the case when we are freed from pre-set whipping, Government positions and so on.

I am grateful to the more than 155,000 people who signed the petition. Obviously, we must not forget the role of our constituents and the public in this matter. This debate is a welcome opportunity for the House to debate, for the first time in this new Session, an issue of such profound sensitivity and importance. We all experience the death of people we care about and, wherever one stands on the underlying issue, we must surely all want dignity and compassion for those in their final phase of life.

Before turning to the Government position and contributions from colleagues, I want to start with a note on the language, as referred to by my hon. Friend the Member for Aberconwy (Robin Millar). Some people draw a distinction between assisted dying, which they see as allowing dying people to have a choice over the manner and timing of their imminent death, and assisted suicide, which they see as helping people who are not dying to choose death over life. To be clear, the criminal law currently makes no such distinction; under section 2 of the Suicide Act 1961, the offence is “encouraging or assisting” suicide, and my use of the term “suicide” reflects that. It does not indicate prejudice either way, and it is not an indication of the Government taking one side over the other.

The Government’s view remains that any relaxation of the law in this area is an issue of individual conscience and a matter for Parliament to decide. To be clear, that does not mean that the Government do not care about the issue at hand—far from it. It means that the ultimate decision on whether to change the law is for Parliament to decide, in the tradition of previous matters of conscience that have come before the House.

While I note the petition’s call for the Government to bring forward legislation to allow assisted dying for adults who are terminally ill and have mental capacity, our neutral stance means that such a change would have to be made via private Members’ legislation. If, at a future date, it became the clearly expressed will of Parliament to amend or change the criminal law so as to enable some form of assisted dying, the Government would of course undertake the role of ensuring that the relevant legislation was delivered as effectively as possible.

Turning to the many contributions made by colleagues today—I apologise if I do not cover all of them—I think it is fair to say that there is a strong consensus on the need to ensure that we have high-quality palliative care. Those on both sides of the debate agree strongly on that. As my hon. Friends the Members for South West Bedfordshire (Andrew Selous) and for Devizes (Danny Kruger) mentioned, the Government have shown in recent legislation the importance that they attach to the matter.

I can confirm that NHS England is developing an ambitious programme focused on transformational approaches for the next five years. The programme will build on the work of the palliative and end-of-life care strategic clinical networks, which sit across the seven regional footprints. The Government recognise that high-quality palliative and end-of-life care should include the opportunity for individuals to discuss their wishes and preferences so that they can be taken fully into account in the provision of their future care—also known as advance care planning.

Of course, resources matter. Many Members made that point, including the hon. Member for North Antrim (Ian Paisley) and the hon. Member for Bristol South (Karin Smyth), who has NHS management experience. Obviously, the Government strongly agree. We are providing £4.5 billion of new investment to fund expanded community multidisciplinary teams providing rapid, targeted support to those identified as having the greatest risks and needs, including those at the end of their life.

On hospices, my constituency neighbour and right hon. Friend the Member for West Suffolk (Matt Hancock) —the former Health Secretary—made a point about the joint funding model. Most hospices are independent charitable organisations, and they receive around £350 million of Government funding annually to provide NHS services. As part of the covid response, which my right hon. Friend of course oversaw, more than £400 million has been made available to hospices since the start of the pandemic to secure additional NHS capacity and enable hospital discharge.

Turning to some of the core issues raised today, a number of colleagues referred to what is happening in other jurisdictions. My right hon. Friend the Member for Sutton Coldfield (Mr Mitchell) and others made the point that change is happening in many other jurisdictions and argued that we should be reflecting that. Equally, however, my hon. Friend the Member for Hastings and Rye (Sally-Ann Hart) made the point that some evidence from those jurisdictions may be negative. I think she referred to the experience of the medical profession in Canada. Clearly, whatever we do and however we move forward, we should always be cognisant of what is happening in countries and jurisdictions where the law has changed.

Perhaps the key point of principle here, which is where this becomes a matter of conscience, is choice—choice versus the risk, shall we say, of abuse, and the need for safeguards and so on. Many colleagues spoke about choice, including my hon. Friends the Members for Thirsk and Malton (Kevin Hollinrake) and for Boston and Skegness (Matt Warman), the hon. Member for Brentford and Isleworth (Ruth Cadbury), and my right hon. Friend the Member for West Suffolk. The hon. Member for Glasgow Central (Alison Thewliss) said it is about the right to choose “a good death”.

I was particularly moved by the hon. Member for Sheffield Central (Paul Blomfield), who said that we should consider the choice not just of the individual but of their family, who, because of fear of the criminal situation, may feel that they cannot discuss the matter. His was one of the most moving speeches I have heard in my time as an MP, and I hope that people on all sides respect the fact that he spoke under great duress, shall we say, but added much to the debate.

Equally, there is a concern that choice is restricted by income, particularly when we are talking about Dignitas. That point was made by my hon. Friend the Member for Sevenoaks (Laura Trott) and others. However, against that—we must remember this—the right hon. Member for East Ham (Sir Stephen Timms), whom I support, spoke eloquently about the risk of pressure on those who may feel that they have to take an action that they would not have felt they should take before any change in the law. That is an incredibly important point. My hon. Friend the Member for Darlington (Peter Gibson) made a similar point, as did my hon. Friend the Member for Devizes, who said that it could be argued that that actually restricts choice because of the pressure it implies. My right hon. Friend the Member for Gainsborough (Sir Edward Leigh) spoke about the proposed change implying death on demand.

On the position of the public, polling does seem to have shifted. My right hon. Friend the Member for West Suffolk and the hon. Member for Gower both referred to what is happening with the opinion polls. However, my right hon. Friend the Member for New Forest West (Sir Desmond Swayne) made the point that a poll is not an argument and we are, after all, a representative democracy. Ultimately, it will be for this House, through a private Member’s Bill or another mechanism, to make the change.

As there are only three minutes left, I will rattle through my remaining points. There was much talk of the slippery slope from the hon. Member for Swansea West (Geraint Davies) and others. I just say to my right hon. Friend the Member for Gainsborough that if a doctor were injecting drugs with the aim of ending life, that would not be assisted suicide or assisted dying; that would be murder under common law. [Interruption.] I am afraid that, because of the time, I will finish with this point.

I think that colleagues on both sides are calling for a national conversation and, if not an inquiry, then certainly an investigation by the Health and Social Care Committee, for example. Obviously, if any of those steps go forward, the Government will do their best to assist, within the constraints of their neutral position, which I take very seriously. The matter was recently debated at length in the House of Lords. It is for hon. and right hon. Members, if they wish, to bring forward private Members’ Bills or debates in the usual way, such as through the Backbench Business Committee.

Wherever we stand, I think we can all say that this has been a very passionate debate that has moved forward the public’s understanding of the key positions on both sides. We should all be proud of the way in which the Petitions Committee has allowed the public to see all the arguments, and I am grateful to all hon. Members who contributed to the debate.

[Steve McCabe (in the Chair)]

I call Tonia Antoniazzi—you must conclude before 7.30 pm or the motion will lapse.