Terminally Ill Adults (End of Life) Bill

Beccy Cooper Excerpts

Friday 20th June 2025 Commons Chamber

[Dr Beccy Cooper (Worthing West) (Lab)]

I thank colleagues across the House for bringing thought and sensitivity to the debates here and in Committee. I often think that this place does not show the best of us, but in proceedings on this Bill, I have heard considered debate; people have listened to each other set out both sides of the argument. As a new MP, I reflect on how this place legislates, and how it could evolve and improve, and I think that this Bill brings learnings.

Assisted dying was never going to be an issue without controversy, and there has been much to consider. I will take a few minutes to outline why, as a medical doctor specialising in public health, I am supportive of the Bill. I will include brief reflections on safeguarding and the provision of end-of-life care that have been raised by my constituents.

[Jim Dickson (Dartford) (Lab)]

My hon. Friend speaks of the views of constituents. At a very well attended public meeting of my constituents just before Second Reading, one key question they wanted an answer to was how the Bill could prevent vulnerable people from being coerced into taking a decision to end their life. Does she agree that as the Bill has gone through Parliament, it has been strengthened with safeguards against coercion, and that the impact assessment says that through the Bill, we would have the strongest safeguards of any jurisdiction in the world?

[Dr Cooper]

I agree with my hon. Friend, and I will come to that point later.

In public health, we focus primarily on prevention care for the population. In other words, we take decisions, using the best available evidence, that have the potential to impact the health of thousands, if not millions, of people. There is almost always a trade-off in these decisions. Quite often, one sees the label of “nanny state” thrown our way. That is because we deal with choice and freedoms on a population level.

When considering this Bill, I asked myself: which population is this legislation for? What are the needs of this population? What freedoms and choices are we being asked to legislate for? As for the people for whom the Bill will be relevant, it is a narrowly defined population who I can clearly see have specific needs. That is to say, it is people coming to the end of their life with a terminal illness. In public health, at this point in our consideration we are often met with—we have already heard about this—the slippery slope argument: “If you legislate for this group of people, it won’t stop there.” However, the criteria for someone to be considered for assisted dying are clear in the Bill. I have heard from constituents who think that the criteria are potentially too narrow, but that is not what is in front of us today, and any change by future Parliaments will have to go through another legislative process.

Looking at the needs of the population for whom the Bill is relevant, numerous concerns have been raised in this area, both from a safeguarding perspective and in the provision of end-of-life care. Constituents and fellow parliamentarians have voiced unease at the thought of coercion in this space—that is, if a person meets the criteria for the Bill but does not wish to access assisted dying, will they be coerced into doing so by a person or persons with malign intent? In public health, we often refer to this balance as the precautionary principle; we are supportive of people having a choice, but we need to be satisfied that the risk of harm is minimised. In the context of assisted dying, this translates into taking extra precaution to ensure that legislation does not lead to unintended consequences and abuse, and there has been much debate on this.

The concerns that have been raised are reasonable and valid, but I think they have been met with reasonable responses in the Bill. Safeguarding measures have been specified, including clinician awareness, support and training; referral mechanisms for any concerns; multidisciplinary board oversight; a specific disability advisory board; independent advocates; and multiple discussions to assure all parties that the person has come to the decision of their own volition.

Turning to the second area—the needs of this population—end-of-life care is a profound professional commitment for the people who provide it. My heartfelt thanks go to the healthcare teams in my constituency who have reached out during this process to tell me extraordinary stories of compassion, joy and hope brought to people in their final days. They have also reinforced the fact that excellent end-of-life care should be a standard offering in our healthcare system, and that this is not currently the case. As with public health, end-of-life care is often seen as a “nice to have”, rather than the essential part of our health system that it actually is.

[Josh Fenton-Glynn (Calder Valley) (Lab)]

I have the pleasure of sitting with my hon. Friend on the Health and Social Care Select Committee. I am well aware, as she is, that palliative care is not where it should be. That is one of the reasons I am voting against this Bill today, because we know—as my hon. Friend knows from her public health lens—that there are social determinants of health. Surely, we cannot vote for measures today that would lead to a social determinant of an early death.

[Dr Cooper]

I thank my hon. Friend for his intervention, but this Bill is not about negating end-of-life care. If anything, it is shining a spotlight on it and saying that care, dignity and choice at the end of our lives should be afforded to us all.

That brings me to my final thoughts on legislating for choice—our freedom from and freedom to. Currently, if a person would like to choose assisted dying, that choice is only open to them if they have sufficient financial resources. This is an equity issue: if a person is financially poor, terminally ill and nearing the end of their life, they do not have the freedom to choose assisted dying. That does not mean, of course, that they would, but this legislation will allow an equitable choice for this defined group of people. Much of public health is determined by legislation, and the underpinning premise is that we are creating a safe environment for a population, within which individuals can make their informed choice. I think that this Bill creates those conditions, and therefore as a public health physician, I am satisfied that I can vote for it.

Ultimately, a good death is something that we all want for ourselves, and for those we love and care for. My vote for this Bill is based on the arguments I have laid out today, but my broader vote and voice will always be for compassion, understanding, and continuing constructive dialogue to ensure we do our best to improve the lives of the people we serve until their dying day.