Terminally Ill Adults (End of Life) Bill

Tim Farron Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

[Tim Farron (Westmorland and Lonsdale) (LD)]

The motives of those proposing the Bill are grounded in compassion—in the heat of this debate, I want to seriously acknowledge that—particularly the hon. Member for Spen Valley (Kim Leadbeater), who has conducted herself with great dignity throughout. Neither side has a monopoly on compassion—I will always be affected by watching my mum suffer at her death at the age I am now—so let us not think badly of one another’s motives; let us instead be courteous and let us be curious.

My opposition to the Bill is grounded in compassion. To legalise assisted dying would be to create the space for coercion that would undoubtedly see people die who would not otherwise have chosen to do so. There are no safeguards in the Bill that would prevent that.

[Naz Shah (Bradford West) (Lab)]

Will the hon. Member give way?

--- Later in debate ---

[Tim Farron]

I had better not.

To be fair, no safeguards would be possible, even if we were not going through this hasty process. First, there is the risk of self-coercion. Many of us will have heard older relatives utter words similar to, “I am a burden to you. You would be better off without me.” We all know reasonably instinctively that people will present it as making a sovereign choice, but it will be a choice born out of coercion. Unless there is a clause in the Bill that I have missed to employ mind readers, no amount of doctors, safeguards or bureaucratic mechanisms will prevent those who self-coerce from opting to die simply because they assume that no matter what their loved ones say, everyone would be better off if they were dead.

To add to the stats we just heard from the hon. Member for Cowdenbeath and Kirkcaldy (Melanie Ward), we know that in Canada more than one in three people opting for assisted dying gave as their reason for choosing to die that they felt they were a burden on others. Honestly, I do not see how we need any further discussion to push us into the No Lobby than that clear evidence from where it is legal.

Secondly, there is coercive control. In the last Parliament, we passed groundbreaking and long-overdue legislation on domestic violence. As society’s understanding of that often hidden evil has developed, our eyes have been opened to one horrific factor in particular: that of insidious, manipulative coercive control. Thousands of people have been—and are today—victims of those who seek to manipulate their will, take over their lives and coerce them into believing that their perpetrator’s will is actually their will. We all know through our constituency casework of people who have been victims. One common theme is that victims often did not realise that they were being controlled until long afterwards. It can take years for the penny to drop. I do not need to spell it out, then—do I?—that for those coerced into choosing assisted dying, that penny will never drop. They will no longer be with us.

Thirdly, people will choose assisted dying because of their pain when they would not do if that pain was properly managed. Here is where the evidence from other countries becomes truly disturbing—in fact, terrifying. In the last decade, the countries in Europe without assisted dying increased palliative care investment by over three times more than those that had legalised it. In the United States, those states without assisted dying saw an increase in the size of their palliative care teams that was also three times greater than that in states that had legalised it. That is clearly no accident and no coincidence. Indeed, the group that have contacted me who are most vociferously against the Bill are palliative care doctors.

[Sorcha Eastwood (Lagan Valley) (Alliance)]

The discussion we are having—and I pay tribute to the hon. Member for Spen Valley (Kim Leadbeater) for the way that she has conducted it—almost implies that palliative care is of the same excellent standard across the UK. I have to inform the House that it is not, which is a matter of deep regret. I cannot stand by the Bill because many vulnerable, marginalised people will be impacted by it. I want to support and affirm life, and I want that to be with dignity.

--- Later in debate ---

[Tim Farron]

I thank the hon. Lady for her important and powerful intervention. Those palliative care doctors who have been in touch with me know that to opt for legalised assisted dying is to opt, inevitably, to divert resources away from palliative care—that is the evidence. I spoke to one of those palliative care doctors this week, who works in a hospice. She said:

“The only patients I care for, are those who are dying”.

We all know what is coming. Assisted dying means a shift in focus away from helping people to live in dignity and comfort, towards simply helping people to die. Then, it becomes a self-fulfilling prophecy. Let us not kid ourselves: palliative care is a postcode lottery in this country, especially for the poor and the old. If the motivation of those who choose assisted dying is to end their pain, we can be absolutely certain that those NHS trusts with the weakest palliative care offer will be those with the highest incidence of people choosing to die. In other words, it will not really be their choice at all.

An observation made to me by a senior oncologist just last week was that there are fewer more stressful situations in a person’s life than to be given a terminal diagnosis—I remember being with my mum as she was given hers—and to be told you are going to die. The oncologist then explained that among terminally ill people there is a vast amount of severe but undiagnosed depression and psychological illness. Similar but distinct from the danger of self-coercion, there is nothing in the Bill to safeguard against people who suffer like that from choosing to die before their time, yet in so many cases it will be people’s mental health that leads them to choose to die, not their physical condition. We simply cannot be all right with that.

Here we are, on the precipice of agreeing to sanction and support the deaths of people in despair. Our society has chosen a dystopian and contagious path if it chooses to facilitate the death of those who have a terminal illness rather than standing with them, weeping with them, valuing them and loving them against the desolation that any of us would feel if we were given a diagnosis of that sort. It is no wonder that the Government’s own suicide prevention adviser is strongly opposed to the Bill.

I totally respect that many of my colleagues in our corner of the House—my fellow liberals—will take a different view. I am opposed to the Bill because I am a liberal. Libertarians believe that personal liberty is so important that there can be no fetters on it. But I am liberal, not a libertarian. I believe that freedom is essential and that the rights of the individual underpin a decent society, but my rights must be held in check if they nullify your rights.

Since we know—we really do—that to legalise assisted dying is to permit people to die who will self-coerce, as a consequence of manipulative coercive control, outrageously not because of a real, sovereign choice but because of a heartbreaking Hobson’s choice due to inadequate palliative care, I have no right to impose that ultimate and most appalling constraint on the freedom of the most vulnerable in our society. I urge all of us to stand in defence of those most vulnerable people, to defiantly defend their liberty, to make a renewed commitment to world-class palliative care and to human dignity, and to reject the Bill.

[Several hon. Members rose—]

Terminally Ill Adults (End of Life) Bill

Tim Farron Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Rebecca Smith]

On the first point, I do not believe that the Bill is strong enough as it stands. On the second point, we are already dealing with the fact that families are not even guaranteed knowledge of their loved one having an assisted death, so I do not think the hon. Lady’s point is entirely to be considered.

As it stands, the Bill would disapply the duty of the coroner to investigate in the case of an assisted death that has been carried out in accordance with the Bill’s provisions. New clause 15, specifically, would amend the Coroners and Justice Act to clarify that assisted death does not constitute “unnatural death” for the purposes of the Act. I think it takes an extraordinary leap of imagination not to conceive of deliberately self-administering lethal drugs as anything but an unnatural death.

[Tim Farron (Westmorland and Lonsdale) (LD)]

I am grateful to the hon. Lady for giving way; I want to support her in what she is saying. We are going through a process, as we consider the appalling situation of coercive control in domestic abuse cases, where a person who is a victim may not realise they have been a victim until years later. Obviously, a person who has gone through an assisted death will have no years later. Is the amendment not a way of making sure that we guard against the evil of coercive control?

[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.

--- Later in debate ---

Over the past months, I have tabled amendments that I thought would help get the Bill—if it becomes law—to a point of ensuring that the most vulnerable are protected. My amendments 19 and 20 would work to edit the code of practice for the Bill to ensure that there is clear guidance with regard to doctors’ duties, suicide prevention, article 2 on the protection of human life, and interaction with the Mental Health Act. The Bill is currently blind on what to do with people detained in hospital and patients presenting with suicidal thoughts. I have great concerns that many people who are quite unwell psychologically will start presenting to services seeking an “assisted death” rather than presenting with suicidal ideation.

[Tim Farron]

I will not be the only person in this place who has lost someone they loved to suicide. In listening to what has been said recently by the Royal College of Psychiatrists, which is not opposed to the Bill in principle, the penny dropped for many of us that many people given a terminal diagnosis will have mental health issues that come with that. How does the hon. Member think we can distinguish between a person who chooses to end their own life because of a mental health issue caused by despair from having a terminal illness and somebody who wants to end their life because of despair caused by something else? Does that not blur our approach to the importance and sanctity of life and to preventing suicide in every circumstance?

[Dr Spencer]

I thank the hon. Member for his intervention. Of course, these are difficult things to disentangle. People will say, “You would say this, wouldn’t you, Ben?”, but we should get the person in front of a psychiatrist or a clinical nurse specialist working in psychiatry. This is what psychiatry does; this is what it is about. That is why I tabled amendments to ensure that the person is put in front of a psychiatrist as part of the process to deal with the blind spot. [Interruption.] Apologies, Madam Deputy Speaker; I will finish now.

My amendment would ensure that the code of practice clarifies the interaction with services.

--- Later in debate ---

[Sir John Hayes]

I am afraid that I disagree. There are numerous cases where people will be encouraged, and perhaps even forced, to take a decision, when they are coping with illness and at their most vulnerable—when they are frightened, doubtful and distressed, and may be unbalanced. Of course we have to protect against that eventuality if the Bill is to be passed.

[Tim Farron]

On that point, evidence from exit interviews shows that 35% of people choosing an assisted death in Canada and 47% in Oregon listed as their reason for doing so that they felt they were a burden to their family.

[Sir John Hayes]

The hon. Gentleman anticipated what I was about to say; I have cited exactly that evidence many times during the debate. We need to look at the experience elsewhere to inform what we do here. We always do that when we pass the right laws in this place.

There is worse news than that, because rather than being improved during its passage, the Bill has in many ways got worse, in particular by giving additional powers to Ministers—so-called Henry VIII powers. When the two words “delegated legislation” are mentioned in this place, we should always be fearful; when the words “ministerial discretion” are used, be doubly fearful. I said that looking directly at Government Front-Bench Members, but I could have been looking at the Conservative Front Bench. The Bill gives permissive powers to Government to make all kinds of changes. I want to take some of those to illustrate my point.

The Bill empowers Ministers to amend the Suicide Act, including the offence of encouraging suicide. They can rewrite the principles of the NHS, in section 1 of the National Health Service Act, to read, “secure improvement in the mental health of the people of England and Wales and end the lives of the terminally ill”. They can amend the NHS Act to specify that this service is not free of charge. The Bill points only to the section of the National Health Service Act that says,

“services to be provided free of charge except where charging expressly provided for”.

They can amend the definition of a registered medical practitioner, so it is not a doctor carrying out the assessment. And so on and so forth.

That is why the amendment in the name of the hon. Member for Mitcham and Morden (Dame Siobhain McDonagh) is so vital. The speech she gave was among the best speeches I have heard in this House. The passion she feels for vulnerable people and the difference the NHS makes to them is not only felt on the Labour Benches, as she well knows, regardless of the theatre. We all come to this place to ensure that the least fortunate have a voice; that those with less power are given a little more by our advocacy.

In conclusion, I say to the hon. Member for Spen Valley (Kim Leadbeater) that there has never been any doubt about the depth of her piety. Let us now be sure about the breadth of her mind. If she really wants the Bill to be passed in a way that is palatable, then she must surely accept the amendments I have supported and highlighted in this brief—all too brief—contribution.