Statement on the Assisted Dying Bill (Third Reading)

An intense day at Westminster.  I’m not sure I’ll be in a debate again so charged with emotion and passion.  It has been a challenging and deeply personal experience and I think all of us have struggled with such a momentous decision.  Ultimately one can only use one’s conscience and the representations from constituents as a guide.  I am grateful to the many constituents who met with me and shared their stories with me.  To see my speech and some of the reasons behind why I voted against the bill you can read below.

What makes this Bill so difficult is that involves a direct conflict between two moral imperatives:  reverence for the sanctity of human life for its own sake and a sometimes opposing principle of personal autonomy.  This has no satisfying answer.  Which is why I think the House of Commons was silent, when the result of the vote was read out.  So many of us in the Chamber found this decision difficult.  And to finally choose one side or another does not denigrate the other side – but in my case at least, opened learnings from both sides, demanded empathy, and took hours of consideration.  I sat through all the debates in the Commons.  After voting against it at the second reading I supported amendments to try and strengthen safeguards within it – most of these amendments were voted down.  Ultimately, I did not think the bill provided adequate safeguards for the vulnerable and disadvantaged which I saw it as my duty as a legislator to protect.

I had prepared a speech but was not called to speak as we ran out of time – but I’ve published it here so you can see what I would have said, had I been called. Hopefully it gives some sense of my reasoning for voting the way I did.

The Bill now goes to the Lords for further scrutiny.  I expect it will come back to the Commons at some point with proposed amendments.  I continue to appreciate your thoughts and considerations as the debate continues.   I assure you of my compassion and respect of your position on whatever side you fall.

My reason to vote against it, in the end came down to a number of factors.

My reasons for voting against the Bill:

My concerns about lack of scrutiny for this bill.

I worried that the bill did not have the sufficient debate or scrutiny I wanted to for a bill of such import.  I would have liked more time for scrutiny, including an independent review, an equality impact statement, an impact assessment on palliative care provision and a public consultation on the existing law and proposals for change.  This would have helped with my concerns about the Bill as set out below:

Lack of access to palliative care

Before entering Parliament I was a Trustee at Princess Alice Hospice in Esher.  As I wrote in the lead up to the debate, legalising assisted dying with the aim of giving people choice about how they die, when there is not a well-functioning alternative consistently available across the UK seemed to me to be no choice at all.  

I am glad that this was recognised across both sides of the debate and that it has shown a light on the lack of resource and funding for the sector.

Palliative care in the UK, as Marie Curie puts it is ‘patchy, inconsistent and inequitable’. Every year over 100,000 people in the UK die with unmet palliative care needs.  The Bill made no requirement that palliative care be available to the person seeking assisted death, nor were there provisions to safeguard palliative care provisions across England and Wales.  Instead, the assumption of the Bill was that assisted dying will be state run and funded, while palliative care is largely funded by charities.  Hospices are under enormous strain, with a fifth of hospices cutting their services in the last financial year despite growing demand and the sector headed for an estimated deficit of £60million.  Our own Princess Alice Hospice in Esher only receives 20% of its funding from the Government and relies for the rest on charitable donations.  It is only able to meet a third of the need in the area it serves.

 Coercion and protection of vulnerable and marginalised groups.

 In this Bill it does not seem possible to prevent the abuse or misuse of assisted dying even if assisted dying is introduced for the very specific group of people identified in this bill. 

The safeguards within the bill seemed ambiguous and also open to loopholes. 

 Without good palliative care options delivered consistently across regions in England and Wales, legalising assisted dying could force those fearing pain or worrying about being a burden to their families into an assisted death. This is particularly pertinent for marginalised communities.  In Oregon where assisted dying is legal 54% of those who had an assisted death felt a burden. 

 The Bill did not specify how to identify coercion, whether emotional or financial.  Coercion is difficult to prove without witness from the victim who will be dead.  There was no recognition of subtle internal coercion from the person feeling a burden, or being made to feel a burden by the behaviour of others or societal pressures.  If a doctor has doubts regarding coercion or pressures, they would not be required to refer the person to a professional who is experienced in detecting coercion. 

 And patients are very vulnerable to whatever a doctor suggests. Doctors can - under the provisions of this Bill – introduce the idea to the patient – which may of itself be coercive.  Point 4 (2) of the bill permits a doctor to raise it even if the patient has not.  This is a particularly worrying point to me – I have seen cases of coercion amongst elderly people even in the few months I have been an MP.  Age UK has reported a disturbing rise in the numbers of reports of possible abuse of vulnerable elderly people in England with a 4% rise in cases referred for investigation.

 Currently the Bill does not provide for a right to appeal when the court has approved an assisted death while a court refusal can be appealed against.  Talking to campaigners for assisted dying I understand the reasoning for this – to ensure that the patient’s will is delivered, but even if coercion comes to light while the patient is still alive there is no recourse to appeal by a loved one.  The provision for the courts seems inadequate. There seems to me to be no provision in the bill for how courts can adequately detect abuse. 

Judges are only able to hear from one of the Doctors but not the patient requesting assisted suicide. 

Expansion of Inclusion

 Lastly, I worry about the expansion of inclusion – the so called ‘slippery slope’.  Having spoken to disability campaigners I worry that this Bill will alter societies attitude to the elderly, the long term sick and to the disabled. I worry that the criteria for eligibility could expand over time as has been observed in other countries. Over the period that Canada and Oregon have legalised assisted dying the thresholds for permitting assisted dying and processes and safeguards to implement it have broadened and liberalised. 

And so, on balance, I felt that we are moving too quickly.  This is a hugely important vote in our country and is unlikely to ever be reversed.  That is why I wanted more time for scrutiny and discussion and more time to fix a broken NHS that I was elected to play my part in mending.  I want an NHS that can provide the best of end-of-life care so that all our loved ones have the best possible chance of a good death through universal palliative care through increased resource and a proper funding model, so that the choice at end of life is a real one.

 I hope this gives you a good explanation of why I chose to vote the way I did.  There will be time now for more scrutiny of this bill as it passes through the next stages and I hope some of my concerns will be addressed there.

 In the meantime, I assure you of my compassion and respect of your position on whatever side you fall.  I am sure we will continue this debate for some time as this bill goes through – and I appreciate and look forward to hearing your thoughts and considerations as we do.

The Speech I would have given:

Mr Speaker

It is hard to find a professional, expert medical body that does not have serious or prohibitive concerns about this bill. 

The Royal College of Psychiatrists say that they cannot support the bill and that this legislation risks the preventable deaths of people with treatable mental illnesses.

The Mental Capacity act on which this bill relies was never designed to assess capacity in people considering ending their own lives and is being asked to do something it cannot, leaving a gaping hole of protection in the bill.

Mr Speaker, with a few exceptions, we are not psychiatrists. We are law makers. And we are being asked to pass a law that leans on a legal framework that wasn’t built for this purpose but is being shoehorned in. Experts are warning us of this.

Like the Royal College of Psychiatrists, of Physicians, of General Practitioners- the latter of whom are neutral on the principle, but not one member of the Governing Council voted in support of legalising assisted dying.

The British Medical Association consultants’ conference supported a motion raising “serious potential moral hazards”.

The Royal Pharmaceutical Society has a representative view asking for improvements in palliative care to allow equity – but this bill guarantees nothing of the kind.

Are we a parliament who ignores experts?

Are we a parliament that brushes aside the unaddressed concerns of charities like Disability Rights UK, of Hospice UK, of Down Syndrome UK, of the British Association of Social Workers, of the British Geriatrics Society?

We have heard the impossibility of safeguards against coercion.  An NHS psychiatrist who gave evidence to the bill committee wrote that patients who resort to suicidal acts are often motivated by feeling like a burden but that these ideas rarely come from coercive relatives – but from cultural norms and societal precedents.   

Mr Speaker as legislators we set the tones of these norms and precedents.

The country is watching us now.

Our current norm – rooted in thousands of years of cultural, legal and medical history - that we live until the natural endpoint of our life – is the strongest safeguard we have.

Normalisation of individual choice over ending ones’ life removes this safeguard – sending a potential lethal message to the most vulnerable in our society like my constituent Janet:

‘As an older person with several medical conditions, the bill makes me feel dispensable – rather than loved and cared for to the end of my life.

Members must not close their ears to this.

The argument for this bill is autonomy.

But for every patient who will benefit from this bill it is equalled and surpassed by those numbers it puts at risk.

Members must go into these lobbies clear eyed – the safeguards within this bill are entirely insufficient to prevent the most vulnerable in our society from being obliged to end their lives prematurely.

When my father was dying from a terminal condition he had bout after bout of pneumonia.

At his first bout I was told that he was in a palliative state.

I asked how long he had left.

The consultant – a man so kind he made me cry, told me that it was an impossible question. ‘ I could tell you that it would be months and he might be alive in two years or he could be dead tomorrow.

The body does what the body does he said but what decides the point of death is the human spirit.

My father lived for another six months recovering each time from bouts of near-death pneumonia.

And beautiful in-between times.

I had always had a distant relationship with my dad and throughout my life I wished for closeness.

I got it in those days – some of the softest and most precious time we ever spent together.

My youngest son was with me too – and for all three of us it transformed our lives.

For those days and so other children might have those days I’ll be voting against the bill today.