The assisted dying bill, officially titled Terminally Ill Adults (End of Life Bill) 2024-25 will have its Second Reading in the House of Commons this Friday. If approved, it will go to the Committee Stage which will involve a small number of MPs reviewing and revising the bill, and then Third Reading, again in the Commons. If it falls on Friday, it can be proposed again in the future although it is unlikely it would be for some time.
I would like to thank all those in St Helens North who have contacted me about it from both sides of the debate, and all those who have given me their time to discuss the bill and answer my questions. I have heard the views of local hospice and palliative care specialists, doctors, individuals working in social care, community groups, faith leaders, clinicians, carers and hundreds of constituents from all walks of life.
I have decided to vote against the bill on Friday, and would like to explain why.
Let me say first of all that I have enormous respect for those in favour of the bill and I have no doubt that they are supporting it in good faith and with the very best intentions. There are strong arguments in favour, and I have considered them carefully. In principle, the idea of ‘my death, my choice’ is a clear and logical one. And I have been incredibly moved by the personal stories and experiences of those whose loved ones have suffered painful or undignified deaths. But in deciding how to vote on this issue I wanted to consider the wider implications and particularly the impacts on vulnerable groups, both intentional and unintentional.
As I have previously stated, I came into this with an open mind and with no strong views either way. If pushed, before giving the issue due consideration I would most probably have been inclined to support the bill for reasons of personal choice and liberty. However, it wasn’t something I had ever had great cause or inclination to think deeply about, so I have come into this ready and willing to study all the evidence and arguments.
Having done so, I can say that the more I have read, the more I have listened, the more conversations I have had, the more I have become convinced that this is the wrong bill at the wrong time.
Firstly, I have heard the concerns of those who work in end of life care and with vulnerable people who are convinced that the risk of coercion is impossible to eliminate. There are safeguards in the bill but they simply do not and cannot prevent incidents of vulnerable or frail individuals being coerced, consciously or subliminally, into ending their own lives early.
In the view of Not Dead Yet, a network of disabled people who oppose assisted dying: “We’re concerned that disabled people and people who are seriously ill could feel pressure (real or imagined) to request an early death. That’s particularly true if people are anxious about being a financial, emotional or physical burden.” This view has been echoed by many others I have spoken with who work in healthcare and with vulnerable people in particular.
Already around 375000 people over the age of 60 are subject to abuse every year in England and Wales. This is a shocking figure.
Supporters of the bill state that its safeguards are “the most robust in the world”. In their own view therefore, this bill is as good as it gets, and so no amount of debate at Committee Stage, should the bill pass this Friday, will be able to address concerns regarding the very real risks of coercion.
And even if we were to accept that this bill makes it unlikely that vulnerable adults might be deliberately coerced, I feel the greater risk which will inevitably exist is people taking the decision to end their lives because they feel like a burden to their loved ones or to the NHS – something they are more likely to feel given the current state of palliative care and social care more generally, which brings me to my next major objection.
I have heard the concerns of constituents, social care workers, palliative care specialists and hospices about the current state of palliative and social care. It is a scandal. There is a huge amount we need to do in order to fix in our health system and end of life care must be high on that list.
In and of itself this is no reason to oppose assisted dying. But the fact that as a whole the system is currently ill-equipped to offer real choice should give us all pause for thought.
There are many outstanding people and groups providing end of life care but the system right now leaves too many patients not only fearful about their own possible pain and discomfort, but also at risk of feeling like a burden to their loved ones.
85% of the Association for Palliative Medicine members oppose a change in the law, and those working in the sector have told me clearly that they believe the government should be prioritising improvements in end of life care, not assisted dying.
In the words of one local doctor who specialises in palliative care: “I am extremely concerned that allowing assisted dying as a choice without getting the support to make the full spectrum of choices available to a person will potentially skew their decision towards that.”
“I have consulted with many people over the years who are facing the end of their life. In the vast majority of cases where they have expressed a wish for their life to be over it is because of poor symptom control or fear of pain or other symptoms. Often with good palliative care we can alleviate those things but we are a precious commodity in specialist palliative care and not everyone can access it across England.
“How can we offer people the option to end their life sooner without first ensuring that they have had the opportunity for the best possible symptom control and advanced care planning?”
I have also heard concerns from clinicians and those in the health system that the proposed process set out in the bill is problematic.
The bill states that the patient must be terminally ill and have been given a prognosis of six months, and then two doctors and a judge must approve the patient’s request for an assisted death.
Firstly, I have heard overwhelming evidence which suggests giving a six month prognosis is far from an exact science. I have heard clearly from doctors and end of life specialists the concerns they have about this key premise of the bill. They have shared with me many examples from their own work over many years in which patients have lived far beyond the six months they were given, and have lived well thanks to good care and pain management.
The definition of terminal illness in the bill has also attracted criticism, with one eating disorder charity expressing fears that the wording would mean that disorders such as anorexia and bulimia might qualify.
Second, I have heard significant concerns from clinicians including doctors about the expectations placed upon the ‘coordinating doctor’ and others in the process. They will require extensive knowledge of the patient, their condition, symptom control, advanced care planning, assessing capacity, and safeguarding. In the words of one doctor who has contacted me, the requirements placed on the doctor “describes a palliative care doctor […] but there are not enough of us.”
We also have to consider that a survey by the British Medical Association which represents doctors found that 45% of their members said they would be unwilling to participate in the process in any way, and under the proposals in the bill they would, rightly, be under no obligation to be involved. The current health and care system is already stretched; to introduce new demands of staff is a challenge at any time, but when nearly half are unwilling to participate questions must be asked about its practicality.
Finally, I have considered the arguments about a ‘slippery slope’. The bill is clearly defined and constricted to terminally ill adults with six months to live (though I have referred to concerns about these points above) and I find the steps the bill’s authors have made in this regard reassuring. However, the worries from many quarters about this bill opening the door to further expansion are understandable. I have heard from constituents and end of life care specialists who are concerned about this, and I do believe that it risks fundamentally shifting our perceptions of death, end of life care, the role of physicians and the health system more widely.
When considered in the context of current pressures around palliative and social care, I do not believe that such a shift is in society’s general interest. Furthermore, the experience in other territories is that we should expect legal and political efforts to try and expand the criteria. We need to think very carefully before opening the door to that.
For all these reasons I will be opposing the bill on Friday. It has been suggested that those with doubts should support it at this stage and then there can be a longer debate at Committee Stage, but there has already been years of debate over this and the concerns people have are well documented. Many MPs might be new to it – including me – but the debate itself isn’t new. A small committee of MPs looking at the bill line by line is not going to be able to address the concerns which are already well known. If the problems I have outlined above could be addressed, I think they would have been in the version of the bill in front of us.
I know my decision will be disappointing for those constituents who have urged me to support it, but I hope this statement at least explains my reasons and shows how deeply I have considered this issue. It is not something I have taken lightly.
I have no doubt that the majority of MPs, whether we vote for or against the bill, want to see improvements in the NHS, social care, and in palliative care too. It isn’t right that any patient suffers a painful death in discomfort or without dignity, and without access to the highest quality palliative care. We need to focus our time and energy on improving that situation urgently.