Terminally Ill Adults (End of Life) Bill (Thirteenth sitting)

Sarah Olney Excerpts

Committee stage
Tuesday 25th February 2025 Public Bill Committees

[Naz Shah]

I accept that the majority of those 60 cases are in such jurisdictions, but to me it does not matter whether it is the majority or one—one death is too many, as I am sure my hon. Friend will agree. In Oregon, the evidence was that it was two, but it is also important to reflect on the fact that Oregon does not record these things. There is no record of the people who had anorexia—by and large, it is women—and who felt that they fit the criteria for assisted death, or that they were on a trajectory to fit it, because they had decided not to eat. So we cannot exactly rely on the two cases that have been found—and those were found only because of the research that was carried out. That does not quite satisfy the question.

[Sarah Olney (Richmond Park) (LD)]

Does the hon. Lady agree that it really does not matter what happens in other jurisdictions? The question is, does this legislation prevent people who are currently suffering from anorexia from seeking an assisted death or not?

[Naz Shah]

I completely agree with the hon. Member.

Coming back to the physicians who justified eligibility by citing the physical complications of anorexia, not just the mental disorder itself, we know that in all 60 of the cases that have been cited, the person did not have a terminal illness other than the one that was caused by anorexia, because that then fit the definition. Under the Bill, the same could happen here. I say in response to the hon. Member for Richmond Park that eating disorders or substance use disorders could still qualify if a doctor determines that the resulting physical deterioration meets the criteria for terminal illness. I will speak to anorexia in much more detail when we debate a further amendment that I have tabled.

Amendment 181 would also remove references to the Equality Act and the Mental Health Act, and the Bill would not define disability or mental disorder. That raises serious concerns, so I will not support the amendment. I encourage Committee members to strengthen the Bill in this regard and not weaken it. The Acts define mental illness and disability as taking a clear medical model, and again it is not clear whether my hon. Friend the Member for Spen Valley is further suggesting that a new definition should be used—but I am going over ground that I have already been over.

--- Later in debate ---

[Naz Shah]

I thank the right hon. Member for his intervention. I have talked about that case, and the court concluded:

“The prospects of her recovery overall approach zero… Given that it is extremely unlikely that Ms L will recover from her anorexia it is…in her best interests to”

move to palliative care, as it was considered a terminal illness. In some ways, that makes my point for me: she was diagnosed as terminally ill. The purpose of the amendment is to close that loophole. The majority of these cases are young girls and young women. I do not want them to get to a stage where they qualify under the Bill because they have a terminal illness due to refusing food, because that can be treated. That is the point that I am trying to make.

Let us say that only one or two people with anorexia have an assisted death if the Bill becomes law without my amendment. I hope that every member of the Committee would agree that even one such death would be unacceptable. Some might say, “Oh, but we must not make the perfect the enemy of the good.” That has been said in the debate, or sentiments have been expressed that reflect that sentence.

That is a good argument to make when we are trying to persuade our teenagers to finish their homework for school and so on. It does not wash for me when we are trying to create a Bill with the strongest possible safeguards for vulnerable adults, and it is too close to the arguments made in favour of brutal actions across the globe. We say things like, “To make an omelette, you’ve got to crack a few eggs.” If we want to make the Bill the best it can be, we cannot use such arguments. Perfection is not the enemy of the good—perfection is absolutely what we should be pursuing in this Committee.

Reference was made to one of the witnesses who gave oral evidence. I remember being aghast at the idea that these two people who died in Oregon were somehow a red herring and that there had been only two. It was really disappointing, and I was extremely angry at that comment. That is not something we should be doing or the standard we should be setting. We cannot be saying that.

There is nothing good about letting people who have sadly reached an advanced state of malnutrition be given assisted dying. Surely we can agree on that. If this Bill does not include my safeguard, it will do two things. First, it will increase the dangers of anorexia. People already develop anorexia to such a degree that they perish of malnutrition. Allowing such people to apply for assisted dying will mean that more severe anorexics die. If we do not adopt my safeguard, we run the further risk that those who are not anorexic, but wish to hasten death, stop eating in order to qualify for an assisted death. Both of those would be truly malign. I would hope all Members of the Committee will accept my amendment to protect those who would otherwise be at risk of starving themselves to an assisted death.

I also want to bring to the Committee’s attention a public letter that has been released this afternoon by nearly 40 individuals who work in the field of eating disorders. They have said, on the amendment to which I am speaking:

“This amendment states that mental illness alone does not qualify as a terminal illness, but as the legal text (“Nothing in this subsection…”) makes clear it has no effect beyond restating that the condition must meet the requirements of clause 2(1). If a doctor holds that a mental illness meets the test in clause 2(1) for terminal illness, this amendment will do nothing to prevent that.”

They further say:

“Eating disorders are treatable. They are life-threatening when left untreated or poorly treated, but this risk is preventable, and deaths from eating disorders are not inevitable. As campaigners, clinicians, charities, and organisations working with those affected, we urge the committee to take these concerns seriously and ensure this bill does not put people with eating disorders at risk of premature death under the guise of assisted dying.”

On my amendment 402, they say:

“Amendment 402: Explicitly states that a person cannot be deemed terminally ill because they have stopped eating or drinking.”

On amendment 48, they say:

“Amendment 48: Clarifies that a person is only considered terminally ill if their death is reasonably certain within six months, even with all recommended treatment.”

They are supporting those amendments, 9, 10, 48, 402 and 11. On that note, I will finish.

[Sarah Olney]

I rise briefly to speak against amendment 234 in the name of my good and hon. Friend the Member for Harrogate and Knaresborough. I will keep it brief as I know he is not going to press to a vote.

First, the Bill that was voted on on Second Reading was a Bill for terminally ill adults in the last six months of their lives. I do not believe attempting to amend the scope of the Bill in Committee is what the House has asked us to do. I think the House voted for a Bill that was specifically for people within the last six months of their lives and that to be amending it—although I accept he is not putting it to a vote—is not in order.

Secondly, I want to reflect on Professor Sir Chris Whitty’s oral evidence to the Committee about how difficult it is to determine when somebody is within six months of the end of their life and how much more difficult it would be to determine whether someone is within the last 12 months of their life, notwithstanding that we are talking about a very specific category of people. For me, that really does give rise to the fear that we would not be able to make a specific determination on whether somebody was in the last 12 months of their life. There would be a risk that people actually have many years left to live. In the case of motor neurone disease, for example, we have seen prognoses of between two and five years, so we risk shortening people’s lives unduly. Furthermore, people might not want to make the prognosis, and therefore people who would like to have the right to end their life in their final 12 months because they have a neurodegenerative disorder might be denied that right, because it is impossible to come to such a determination.

Terminally Ill Adults (End of Life) Bill (Fourth sitting)

Sarah Olney Excerpts

Wednesday 29th January 2025 Public Bill Committees

[The Chair]

Dr Griffiths, do you want to add to that?

Dr Griffiths: This issue highlights a fundamental flaw with the Bill, which is the nonsensical division between a terminal illness and what constitutes being a disabled person. Section 6 of the Equality Act 2010 states that a disabled person is somebody who has a “physical or mental impairment” and the impairment

“has a substantial and long-term adverse effect”

on their

“ability to carry out…day-to-day activities.”

If you have a terminal illness, it is likely that you will be defined within the terms of what is outlined in section 6, so it is a fundamental flaw, because disabled people will be incorporated within this.

The issue also highlights this arbitrary nonsense about a six-month perspective. What constitutes six months left to live, particularly if you are engaging with technological devices, medical assistance and so on? For example, I have a progressive condition that continuously makes me weaker and has respiratory complications and so on. If I remove the ventilator that I use at night, if I remove my other medical devices and if I stop my engagement with therapeutic services, does that constitute me having a terminal illness, because my rapid acceleration towards death becomes more evident?

These concerns highlight fundamental flaws, but they also play into what a key issue: the campaigning that will continue after the Bill, if it is to succeed. You will get people who will say, “Why not five months, or seven? Why not other conditions that are not being highlighted in our current discourses?”

[Sarah Olney (Richmond Park) (LD)]

Q Dr Griffiths, do you think it is possible that disabled people are likely to be or potentially more at risk of being coerced or otherwise persuaded to seek assisted dying as a result of the Bill?

Dr Griffiths: I think so—I think the coercion principles outlined in the Bill are incredibly weak in terms of the scrutinising and the process of how you judge whether coercion has taken place. We know that coercion is a complex issue, but put that against the context of disabled people’s lives; we are talking about disabled people who are struggling day to day to access sufficient support and to live in participatory, accessible societies. The feeling, then, of societal coercion—the feeling that this is a tolerable idea—highlights my concerns about coercion.

It also plays into the issue of support and assistance to understand what your rights are, not just in terms of what we are talking about here but broader disabled people’s rights. There is a lack of advocacy services available to disabled people, and there is a lack of support for disabled people to have accessible information about their rights. If you feel that assisted dying is your only choice—as opposed to accessing support or calling out discriminatory practices in, say, access to social care and healthcare—that highlights, again, situations where coercion will manifest. The infrastructure to support people either to respond to coercion, or to understand that they do not have to be in that position in the first place, is non-existent.

[Tom Gordon (Harrogate and Knaresborough) (LD)]

Q One of the things that we have heard from other countries that have assisted dying is that this is one of the strongest and most robust laws. I wonder whether Professor Shakespeare has any more views on how we could make the Bill even tighter, and provide support and further peace of mind to people who might be worried about it?

Professor Shakespeare: When I read the Bill, I thought that it did have many safeguards. It has, for example, five opportunities for a conversation with doctors or other supporters. That is a good safeguard. I think it makes a criminal offence of dishonesty, coercion or pressure, so that would scare off people. Miro is quite right—there are people who might put influence on somebody, but I hope that they would be covered under clause 26 as having committed an offence. That would scare people who may have a particular view against assisted dying.

How can we make it stronger? We could have more of an advocate for the person who is requesting assisted dying—somebody who will support them, within the law, to make that decision or to think about their decision. We are trying to make sure that everybody who is thinking that this is for them has the opportunity to talk about it and to think about it. The time and the conversations are all about that, but maybe an advocate also would be the person who is requesting this step, who is not a beneficiary in any way of that death, and they could be a neutral party to give advice. I am not sure. However, there is a lot here. There are five conversations. I am not surprised that people thought it was strong. I think it is a strong Bill.

There is scope for doctors and other medical practitioners to act on their conscience and to withdraw from this. Miro made a useful point, which is that we do not want any disabled person frightened of their doctor or worried that their doctor, who has been supporting somebody else to die, might do that with them. In conversation, Marie, we have talked about an assisted dying service as being a part of the NHS, but I wonder whether it might be specifically around this. I think that it is worth considering whether the average doctor is the person to whom a person should take a concern or a wish to die.

So this is about advocacy and maybe having a specific service for people who want to go down that route. However, I think it is a strong Bill as it stands.

Health and Social Care: Winter Update

Sarah Olney Excerpts

Wednesday 15th January 2025 Commons Chamber

[Wes Streeting]

My hon. Friend is absolutely right. May I, through her, thank health and care staff in her city for the work they are doing to get the people of Birmingham through this particularly challenging winter? What we really need to do to make our health and care system more effective and more sustainable is shift the centre of gravity out of hospital and into the community. We need better and faster access to diagnostics and treatment, as well as a bigger focus on prevention—primary prevention to keep us all healthy and active, and secondary prevention so that fewer people need to call on health services, and particularly emergency departments, which are stretched at this time of year.

[Sarah Olney (Richmond Park) (LD)]

I was pleased to hear what the Secretary of State said about vaccine roll-out, particularly of the RSV vaccine. I am even more pleased that my constituents in Richmond Park are diligent in taking up all vaccines, but they have been puzzled to find that the RSV vaccine is limited to those between 75 and 79 years of age. What plans are there are to extend the roll-out to those aged 80 and above?

[Wes Streeting]

I am grateful to the hon. Member for her question and for showing off her constituents’ uptake—that is exactly what we want. Perhaps ahead of next winter, we should launch a parliamentary competition: who can boost uptake most in their constituencies? We will think about the prize.

More seriously, I am always glad when the pressure is to expand access to vaccines—that is exactly the sort of pressure that we want. We follow advice from the Joint Committee on Vaccination and Immunisation. We will review the experience this winter, and the JCVI will review evidence and data this winter and make recommendations, which we will take into account.

Oral Answers to Questions

Sarah Olney Excerpts

Tuesday 19th November 2024 Commons Chamber

[The Parliamentary Under-Secretary of State for Health and Social Care (Andrew Gwynne)]

The UK rare diseases framework aims to improve the lives of people living with all rare diseases. I am more than prepared to meet my hon. Friend to look at the adequacy of support available to people with Usher syndrome.

[Sarah Olney (Richmond Park) (LD)]

T8. Last Friday, I met GPs at the Fairhill medical practice in north Kingston in my constituency. They have told me that the increase in national insurance contributions will add £50,000 a year to their costs. Can the Secretary of State tell me whether GPs can expect to see an across-the-board cut in the NICs payable by GPs to help them manage to continue delivering services for families in the area?

[Wes Streeting]

We have not yet announced allocations for general practice for the year ahead, and we are taking into account all the pressures that general practice is under.

Government Policy on Health

Sarah Olney Excerpts

Monday 9th September 2024 Commons Chamber

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the Liberal Democrat Front-Bench spokesperson, Sarah Olney.

[Sarah Olney (Richmond Park) (LD)]

The Liberal Democrats find it deeply ironic that the shadow Health Secretary has raised this question on the involvement of people with no formal appointment in the development of Government policy. Are they forgetting their record in government? Perhaps we should remind everyone that, under the Conservatives, it was their friends that benefited from large contracts to supply the Government during the covid pandemic. The result is that, just today, as the hon. Member for Eltham and Chislehurst (Clive Efford) has already highlighted, Transparency International UK has revealed multiple red flags in more than 130 covid contracts totalling over £15.3 billion. With the Conservatives out of power, we have the opportunity to clean up our politics, so will the Secretary of State update the House on whether the Prime Minister plans to appoint his own ethics adviser or whether Sir Laurie Magnus will remain in the post? Will the ethics adviser be empowered to initiate their own investigations and publish their own reports?

[Wes Streeting]

I am grateful to the hon. Member for her serious contribution. She is right to say that transparency matters. That is why meetings in my Department, and their attendees, will be published in the right and proper way on a quarterly basis.

It is also right to draw a distinction between those areas of business and meetings in the Department that are about generating ideas and policy discussion, and those that are about taking Government decisions. It is right that people from outside government come into the Department for Health and Social Care, or any Department, to lend their expertise and share their views, and it is right that Ministers make decisions absent of those outsiders. That is the distinction I would draw. The hon. Member raises a specific point about the Prime Minister’s ethics adviser. This is a Prime Minister who does take ethics seriously and will not behave in the way that his Conservative predecessors did. As for individuals, that is a decision for the Prime Minister, but I will ensure that the hon. Member gets a more fulsome reply.