Terminally Ill Adults (End of Life) Bill

Zubir Ahmed Excerpts

2nd reading
Friday 11th September 2026 Commons Chamber

[Lauren Edwards]

No, I will make some progress. We heard difficult stories about patients with bile duct cancer facing the prospect of faecal vomiting as their illness progressed. We listened as Members recounted memories of watching patients bleed to death while conscious, cancer having eaten away at their carotid artery. We felt their frustration when the maximum dose of sedatives could not alleviate the choking and suffocation of someone with peritoneal cancer. Those people deserved choice and a dignified end, too.

[Dr Zubir Ahmed (Glasgow South West) (Lab)]

As a practising surgeon who deals with bile duct cancer, I can reassure my hon. Friend that there is almost never a reason that someone should be in that state, with feculent vomiting, if they were treated appropriately and all the relevant palliative care measures were in place.

[Lauren Edwards]

The position that I take is that we can, and must, both improve palliative care and support assisted dying. We must grasp the opportunity that is in front of us to create a holistic end-of-life care system that will deliver choice and dignity for every single one of our constituents.

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[Dr Zubir Ahmed (Glasgow South West) (Lab)]

I speak on this matter as an active medical practitioner, a transplant surgeon and a cancer surgeon. Much of my clinical practice for the last 20 years has revolved around caring for unwell complex patients, many of whose illnesses flicker between the labels of “terminal illness” and “life-limiting illness”. It is some of that experience that I wish to bring to bear on this debate.

Let me start off by acknowledging the varied experiences people have at the end of their life, or their loved ones’ lives. I have cared for and operated on thousands of patients in that position, and I have helped many, but I have often fallen short, and some of those stories have played vividly in my mind over the last few days. When they have, I have reflected on the fact that more often, when things have not gone right, it is not because of a failure, but rather an absence of universally available good-quality palliative and psychological care. Today, as a Member of this place and as a surgeon, my job is to help move this discussion beyond the emotive and the case study to level-headed analysis that will serve our society well, not only today but for decades to come.

Having read this Bill again, and with the hindsight of ministerial experience in the Department of Health and Social Care, I am more convinced than ever that our social care and palliative care systems simply are not ready to meet the demands of this Bill—at least not equitably.

The Bill, when taken from the laboratory of legislative text and dispatched to the bedside and the clinical frontier, will not serve its laudable aims of bringing choice and control over a pre-emptive, quick death, which is what many desire and expect from this legislation. While it will not fulfil those aims, it will expose millions: the quietly vulnerable. I think of constituents and patients of mine in Glasgow South West, more often than not women, who quietly concede to me, usually in the sanctity of a clinic room, that they do not wish to be a burden, and who have on many occasions asked me to end their life because they have suffered multi-generational financial strains and do not want their illness to hold back their children and their grandchildren. When you visit places like Govan and Pollok as a parliamentarian, as well as a doctor, you understand that as a society, we are only scratching the surface of understanding the full extent of coercive control in this country.

[Sorcha Eastwood (Lagan Valley) (Alliance)]

It pierces my heart whenever cancer is mentioned in this conversation, and I am grateful to the hon. Member for West Lancashire (Ashley Dalton) for her advocacy. A person may have cancer, and a terminal diagnosis, and still want to live. We should support those people to live first, before we contemplate their death.

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[Dr Ahmed]

I commend the hon. Member for her powerful testimony. I know that she has personal experience of this matter.

When you visit places like Govan and Pollok, you know what vulnerability looks like. Those people cannot send their voices down here via the mic, the TV studio or a billboard in Westminster tube station. We need to make sure that they do not feel the burden of making what some call an option, or a choice, their obligation or duty.

[Dr Opher]

Will the hon. Gentleman give way?

[Dr Ahmed]

Not at the moment.

It is on the foundational principles of the Bill that I primarily want to concentrate today. The first is the idea of a “six months to live” label. “Terminal illness” is a fast-changing medical diagnosis in the modern medical world, and it is becoming an increasingly meaningless term. Only yesterday evening, I was in the company of a professor of respiratory medicine who, with rightful satisfaction, told me that many of his stage 4 lung cancer patients who were designated with six months to live in 2023 are being managed as having a chronic disease in 2026.

In my practice, if a patient comes to see me with stage 4 colon cancer that has spread to their liver, the advent of immunotherapy means that I have an equal chance of telling them they have six months to live or six years to live. Under this law, when I meet that kind of patient, it is unclear to me, with the Supreme Court precedents around consent, whether I should be offering them immunotherapy and an assisted death at the same sitting.

A six-month prognosis will take a new and unhealthy salience in every clinical conversation. It will be a label some will desire, and others will want at all costs to avoid being placed on their clinical record. It will fundamentally change and undermine the candidness and sanctity of the patient-doctor conversation and relationship.

[Torcuil Crichton (Na h-Eileanan an Iar) (Lab)]

My hon. Friend is making a very informed speech on how the medical landscape has changed, but while the arguments we make today are the same, the political landscape has changed as well. Would he agree with the Father of the House that we now have a Prime Minister committed to solving the problems with social care and palliative care, and that in Scotland, where the hon. Gentleman comes from, we saw the political landscape change in front of our eyes? MSPs initially voted for similar legislation, but ultimately voted against it. People can change their minds, and I hope that they do.

[Dr Ahmed]

I am grateful to my hon. Friend for mentioning the Scottish context. We voted down such legislation on Third Reading, when we understood the impacts and the wider societal ramifications.

I have to be honest. When I am asked to prognosticate on whether someone has six months to live, I am as often wrong as I am right. It is no longer a good enough marker for the DWP to use in discharging benefits for life-limiting conditions, and I do not see why it should be a good enough marker for prescribing death.

There is another paradox in this legislation: someone like me could write a prescription to induce death with less regulatory oversight than is on me when I have to remove a kidney to give life through transplantation. Of course, I sympathise with and endorse the desire of many colleagues who support this Bill to relieve suffering. To be clear, we have many tools to do this, and we must bust some myths today. Clinical discretion, for instance, means that there is no maximum dose of morphine, so I can give my patients whatever they need, in the setting in which they need it. But this Bill is less about relieving suffering and more about bypassing its possibility, and I understand that.

The Bill is in many ways advocating for death as prophylaxis. Under the definition in this Bill, death must be induced by medical prescription. It will be the only medical prescription that I will be able to write as a doctor but not administer, because the burden of administration falls to the patient, and the weight of expectation falls on the patient. We must discuss the mechanisms by which death will occur: muscle paralysis, slowing of the heart rate, sedation, and the possibility that paralysis will take hold before sedation does. Death will not be an event; it will still be a process. In 15% of cases, it will be subject to some form of complication, such as vomiting or seizures, and it will not always achieve its goal.

I wish I could give hon. Members more information about the complication profile, but despite this procedure being prevalent in other jurisdictions across the world, the data continues to be woefully lacking. Alongside that, the 14-day cooling off period means that the patient must remain lucid in that time. There have been cases elsewhere in the world where patients have denied themselves palliative care and pain relief to remain lucid in order to consent to their death. I am therefore of the opinion that the foundational elements of this Bill will create the allure of choice and control, but not the agency to pursue either.

Turning to safeguards, much is made of the provision requiring two doctors to assess eligibility, but the trouble is that neither has to know the patient well, or go to any great lengths to exclude the likelihood of coercion. Doctors are trained to do many things, but assessing and picking up on coercion is not one of them. In fact, consultant psychiatrists with PhDs in coercion, like the hon. Member for Runnymede and Weybridge (Dr Spencer), whom I hope we will hear from soon, have said in written testimony presented in court that they would find it difficult to exclude coercive controlling behaviour.

I came into medicine, and into Parliament, to act with compassion, and to provide dignity to those we serve. I believe that is why we are all here. Compassion and kindness is not the preserve of one those on one side of the argument or another, but for me, compassion and kindness also calls to courage—the courage to be honest with patient and constituent alike. We need the compassion and honesty to say that the Bill will not fulfil its aims; it will disappoint many who crave total agency and control, and it will expose and disenfranchise further the vulnerable in our society. We need the compassion and honesty to say that our NHS, while a great institution, is not, in its current form and state, ready. It is not safe for this conversation or for this Bill in this moment.

[Several hon. Members rose—]