THE first steps in introducing assisted dying into English and Welsh law were taken by the House of Commons on Friday afternoon, when it voted to progress a Bill giving permission in limited circumstances (Comment, 29 November).
The first parliamentary debate on the Terminally Ill Adults (End of Life) Bill was followed by a free vote, carried by 330 to 275.
The Bill will now go to Committee Stage before another reading in the House of Commons. If it passes a further vote, it will go to the House of Lords, where the process is repeated.
The Private Member’s Bill was introduced by the Labour MP Kim Leadbeater, who described the proposals as “a piece of legislation which would give dying people, under very stringent criteria, choice, autonomy, and dignity at the end of their life”.
On concerns about the state of palliative care, and calls for improvements in end-of-life care before any further consideration of assisted dying, Ms Leadbeater said: “Assisted dying is not a substitute for palliative care; it is not an either/or.”
The DUP MP for Strangford, Jim Shannon, asked what guarantees Ms Leadbeater could give on the restriction of assisted dying to patients with a terminal illness and no more than six months to live.
Ms Leadbeater said that her Bill laid out “strict, stringent criteria . . . that cannot be changed”, and so fears of a “slippery slope” leading to an expansion of those eligible would not take place.
Sir Oliver Dowden, Conservative MP for Hertsmere, asked how they could be sure that “judicial activism” would not shift these criteria. Ms Leadbeater countered by saying that the courts had consistently deferred to Parliament on this issue.
She drew attention to the name of the Bill, saying that it outlined the fact that it would apply only to adults who were terminally ill and at the end of their life, and that this could not be changed. “It is does not apply to people with mental-health conditions, it does not apply to the elderly, it does not apply to people with chronic illness, and it does not apply to disabled people — unless of course they have a terminal illness,” she said.
Dangers of a “slippery slope” were unfounded, she said, as, in jurisdictions around the world in which assisted dying had been passed solely for those with terminal illness, there had not been any widening of its scope.
The Conservative MP for East Wiltshire, Danny Kruger, made the first speech in opposition to the Bill, saying that he bore “heavily” on his conscience the pain of people whose pain would be prolonged as a result of rejection of the Bill. But supporting the Bill would leave on his conscience “many more people whose voices we cannot hear”.
Mr Kruger said that the Bill would need “wholesale restructuring in order to make it safe”, and this would not be possible in the confines of the Committee Stage — an argument disputed by some MPs, including the Reform MP Richard Tice.
Mr Kruger went through the Bill, pointing out his concerns: they included the term “terminally ill”, which was of “great elasticity, almost to the point of meaningless”, he said, and it was impossible for doctors to predict with any accuracy that someone was going to die within six months.
He argued that the safeguards that supporters of the Bill had outlined would, in time, be dropped, as they would be considered barriers to the “new human right” to have an assisted death.
He said that the Bill would “not just create a new option for a few, and leave everyone else unaffected, but impose on everyone . . . this new reality”. It would, he said, “change life and death for everyone”. Better end-of-life care should be the focus, not a “state suicide service”, he said.
The Labour MP Diane Abbott, Mother of the House, said that she was not against assisted dying in all circumstances, but did not believe that the safeguards in the Bill were sufficient.
She asked whether the justice system had the capacity to deal with the requirement for each application to be scrutinised by a High Court judge, and she feared that this step would become simply a “rubber stamp”.
Ms Abbott said that protections against terminally ill patients’ being coerced to opt for assisted death were insufficient: it was hard to detect coercion.
The Conservative MP for Sutton Coldfield and a former health minister, Andrew Mitchell, said that he had changed his mind about assisted dying, after hearing the stories of constituents whose family members had suffered.
“The current law forces people to plan their deaths in secret. Their bodies are found by their loved ones. They often die in the most horrific circumstances; they have no chance to say goodbye to their loved ones. It’s devastating for their families,” he said. He referred to the Office for National Statistics’ estimate that between 300 and 650 terminally ill people took their own lives every year.
Mr Mitchell said that, as drafted, the proposals were “modest and controlled”, and he was confident that there would enough committee time to scrutinise the Bill in detail.
The Conservative MP for North West Hampshire, Kit Malthouse, a co-sponsor of the Bill, said that he saw “no compassion and beauty” in people suffering on their deathbed, and took up Mr Mitchell’s point about suicide: “People with terminal illness will still take their lives. If the Bill falls today, we are consigning those people to take their lives in brutal, violent ways,” he said.
The Liberal Democrat MP for Oxford West and Abingdon, Layla Moran, who chairs the Health Select Committee, spoke in support of the Bill, but called for more than “woolly words” from the Government about how palliative care would be improved.
ALAMYKim Leadbeater, MP for Spen Valley, speaks in the debate
The Labour MP for Hackney South and Shoreditch, Meg Hillier, spoke against the Bill and the principle behind it. “This is a fundamental change in the relationship between the State and its citizens,” she said. Members who had “a scintilla of doubt” should vote against the Bill.
She said that the proper discussion about palliative care had not take place, and conversations must continue, but “this Bill must stop today.”
The Liberal Democrat MP for Westmorland and Lonsdale, and former leader of the party, Tim Farron, said that he acknowledged that those proposing the Bill were motivated by compassion, but so was his opposition to it. “Neither side has a monopoly on compassion,” he said.
There was a risk that people would make a choice born out of “self-coercion”, and that there was no safeguard that could be in place to prevent people feeling that they should choose to die because they were a burden on loved ones, regardless of reassurances to the contrary.
People might also choose an assisted death because of pain that could be alleviated by better palliative care, and he joined the chorus of voices calling for improvements in such care.
He said that he was opposed to the Bill because he was a liberal, and not a libertarian. “I have no right to impose that ultimate and most appalling constraint on the freedom of the most vulnerable people in society,” he said.
The Labour MP for Penistone and Stocksbridge, Marie Tidball, said that she had been on a “difficult journey”, but would be voting for it to continue to the Committee Stage. A disability-rights researcher and campaigner before entering Parliament in the summer, Ms Tidball has a congenital disability which affects her limbs. She said that she was reassured that the Bill was tightly focused on terminally ill patients at the end of their lives, and would give people “the dignity they need”.
The former Conservative minister Sir David Davis said that he had changed his position, and was now in favour of introducing assisted dying. “I’m a believer in the sanctity of life, but I’m also an antagonist to torture and misery at the end of life,” he said.
The vote on Friday was about a point of principle, not the conclusion of the legislative process, he said, and, if the Bill seemed to be going in the wrong direction after the Committee Stage, he would vote against it at that point. He called on the Government to allot sufficient time to this.
Even the best palliative care had its limits, he said, and the option of assisted death should be there for those who had reached that point.
The Labour MP for Shipley, Anna Dixon, said that she would be unable to support the Bill without a detailed public consultation. She was sympathetic to the principle, she said, but had concerns about whether the NHS had the capacity to ensure that it could be delivered fairly and safely.
The DUP MP for Upper Bann, Carla Lockhart, was one of the few MPs to invoke a religious argument about the sanctity of life. “Life in all its forms is of inherent worth and value. But while I have come to that conviction partly because of my faith, like everyone across the House I have listened carefully to the evidence,” she said.
More high-profile Christian MPs who opposed the Bill, such as Danny Kruger, the Conservative MP for East Wiltshire, and Mr Farron, did not mention their religious convictions in their speeches.
Ms Lockhart said that the Bill was “rushed and ill-thought out”, and urged members to reject it.
The next speaker, the Labour MP for Luton South and South Bedfordshire, Rachel Hopkins, said that, as a humanist, she believed that life should be lived well, and that individuals should have autonomy and agency.
The Conservative MP for for Rutland and Stamford, Alicia Kearns, addressed members whose religious beliefs “drive” their arguments: “I will always defend your right to practise your faith and protect your own life choices. . . But to deny choice to others, especially those with only six months to live, where their personal choice does you no harm, is wrong.”
The Labour MP for Birmingham Erdington, Paulette Hamilton, said that Bill was not the answer. A former nurse of 25 years’ experience, Ms Hamilton said that she did not trust that the Bill could be implemented ethically and safely. “It is being rushed too quickly, and with too little scrutiny,” she said, and it would place “enormous pressure on disabled, elderly, and poor people to opt for ending their life so not to be a burden on their loved ones”.
She criticised the Bill’s failure to prohibit doctors from raising the issue of assisted death with patients, and said that the system being proposed was vulnerable to “misunderstanding, error, and, at worst, abuse”.
The Green Party MP for Brighton Pavilion, Siân Berry, invoked polls suggesting that a majority of the public were in favour of a change to the law, and that the testimony of constituents backed up this impression.
Dr Neil Shastri-Hurst, Conservative MP for Solihull West and Shirley, who worked as a surgeon and a health-care lawyer before entering Parliament, spoke of the patients whom, he felt, he had failed because of the manner in which they had suffered before death.
MPs were not, he said, faced with a “binary choice” between assisted dying and palliative care. While he understood the concerns expressed, they should continue to engage with the Bill rather than vote against it at this point.
The Labour MP for Brent East, Dawn Butler, emphasised that end-of-life prognosis was “not an exact science”, and there were many cases in which people lived far longer than doctors had expected. She said that 80 per cent of her constituents were against the Bill, and confirmed that she would be voting against its going to Committee Stage.
The Labour MP for Vauxhall and Camberwell Green, Florence Eshalomi, opposed the Bill on the basis that “freedom in death is only possible if you have had freedom in life”; and she drew attention to inequality in health outcomes. “We know that Black and minority-ethnic disabled people have far worse health outcomes than the national average,” she said.
The final backbencher to speak in the debate was the Liberal Democrat MP for Mid Dorset and North Poole, Vikki Slade, who said that calls for improved palliative care should not lead Parliament to “condemn those who are at their end of life to terror, loneliness, to be forced into terrible circumstances” — an argument in favour of the Bill.
The Shadow Minister for Justice, Dr Kieran Mullan, and the Parliamentary Under-Secretary of State for Victims, Alex Davies-Jones, made speeches that avoided taking a clear side: a reflection of the fact that both of the main parties had given their MPs a free vote.