Terminally Ill Adults (End of Life) Bill

Ben Spencer Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Prior to my election to Parliament, as a consultant psychiatrist with a PhD in decision-making capacity, I would have met both criteria to be a medical expert assessor under clause 9(3)(b), so I have a particular perspective as someone who, in different circumstances, might have been called upon to make these assessments.

I strongly believe that we should respect and support the right to bodily autonomy for people with full decision-making capacity, subject to the caveat that it does not cause serious harm to others. I argued for this when I was on the working group of the independent review of the Mental Health Act 1983 and on the pre-legislative scrutiny Committee on the Mental Health Bill, which, among other things, aims to prevent people from coming to harm when suffering from severe mental illness. These reforms were debated in the House of Lords this week, and they demonstrate how Parliament should legislate in complex areas that balance individual autonomy and risk.

In contrast, as a private Member’s Bill, there is limited ability for scrutinising this Bill’s provisions. It has had no independent review, no pre-legislative scrutiny and no impact assessments. Many MPs support the principle of assisted dying yet have concerns about implementation, resource implications and safeguarding. That is why I, along with colleagues on both sides of the House, tabled a reasoned amendment calling for an independent review and consultation before a vote in Parliament, to provide a third way through. I thank the Members who supported the amendment, particularly the hon. Members for Shipley (Anna Dixon) and for Twickenham (Munira Wilson), for their work and their extensive and careful consideration.

Although the general debate on assisted dying may focus largely on the principles, legislation must address the limits to and the safeguards on consent. Should people be able to agree to a medically assisted death? If so, what restrictions, if any, should there be on people who can make this decision—age, capacity, terminal illness, intolerable suffering? And then, what safeguards are there to uphold these limits and to prevent abuse—assessments by two doctors, judicial scrutiny?

Given that the main argument I see in favour of assisted dying is the exercise of personal autonomy, I believe the most substantive issues we need to wrestle with are the limits that we set. Why is this Bill limited to the terminally ill and not those who are suffering without that being terminal? What even comes within the scope of terminal illness? With the refusal of treatment and medication, conditions such as type 1 diabetes and HIV can be designated as terminal, despite being fully treatable.

There are many questions, but in this Bill the most prominent problem is that, in a legal context, if the availability of assisted dying is limited only to those who are terminally ill, it is discriminatory either to those with or without terminal illness. Either their right to autonomy is greater than others’, or the value of their life is worth less.

We must also ask whether autonomy can be exercised where there is no choice. If good palliative care is simply not available, can we really rely on this as a true and free decision? I would argue that we cannot, and that this Bill does not safeguard against coercion through state neglect.

[Lola McEvoy (Darlington) (Lab)]

Will the hon. Gentleman give way?

[Dr Spencer]

I usually would, but unfortunately that would impact on other Members who wish to speak. I apologise.

What is fundamental to me, given my interest in capacity, is that we have not considered how much human decision making is driven by altruistic intentions. “I did it for my children” is rightly a primary motivation in many settings, but as a society are we comfortable with a decision to seek a medically assisted death so as not to be a burden on one’s family or to save them money?

This will not impact on capacity. We cannot pretend that capacity assessments will be a shield for these moral concerns. Where is the line, if there is one, between indirect coercion and the natural human responses in a stressed family unit looking after a sick loved one?

I believe that we could introduce legislation on assisted dying that has fully reviewed and addressed these issues, but parliamentarians must deal with what we have in front of us today. Proponents on both sides of the debate frame this vote on Second Reading as a vote on the principle of assisted dying, but in reality it is a vote on implementation as put forward in this Bill.

As a former mental health doctor, I am proud that I was there for the most vulnerable. Today, I think about those without a voice in this debate or in the TV studios. I think about the elderly woman in the care home with mild cognitive impairment, who retains capacity but is nevertheless vulnerable to coercion and undue influence, or the sick mother whose child may lose their job or their relationship due to the burden of caring responsibilities. The Bill would not protect them. It risks placing implicit pressure on people already vulnerable at a time of life when they should receive our unwavering care and support. We should and must vote it down.

Terminally Ill Adults (End of Life) Bill (Money)

Ben Spencer Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Unfortunately, this debate and the circumstances of this money resolution are a manifest example of the concerns I have raised about this Bill and the process of taking it forwards. Many Members talk about debate, and it is important that this issue is debated; however, what is critical is scrutiny—ensuring that we can properly scrutinise the Bill, the work that is put into a very complicated area of law, and what would be, if the Bill were to pass, a manifest change in the relationship between the state and its citizens.

This money resolution is in the name of a Treasury Minister, the response at the Dispatch Box on Second Reading was from a Justice Minister, and we have a Health Minister here today. We cannot say whether the Bill will be paid for by the Ministry of Justice, and what the liability will be. What is the health liability? How much will be in private hands, and how much will not? What about legal aid? There are all these spin-out costs from the Bill.

As a parliamentarian, I like to scrutinise. I want to see impact assessments; I want to see what the spending that I am being asked to vote for looks like, yet we do not have that information. Members have said that the Bill will come back on Report, and the Government are in a hokey-cokey position: sort of in, sort of out—what’s it all about? I am sorry, but I do not think that is good enough for something of such importance to our constituents and for Parliament to get right.

Terminally Ill Adults (End of Life) Bill

Ben Spencer Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Kim Leadbeater]

I am afraid that I am going to have to make some progress, based on the number of Members who wish to speak today.

I thank the hon. Member for West Worcestershire and the hon. Member for Reigate (Rebecca Paul) for working with me on amendment 73, and I am very pleased that they support it.

[Dr Ben Spencer (Runnymede and Weybridge) (Con)]

Will the hon. Lady give way?

[Kim Leadbeater]

I will not—sorry.

New clause 15 and amendment 54 make changes to the Coroners and Justice Act 2009 that the Bill would necessitate. They would insert a new clause into the Act to provide that deaths that occur in accordance with the Bill will be certified by an attending practitioner and medical examiner and will not be subject to a coronial investigation.

[Dr Spencer]

Will the hon. Lady give way?

[Kim Leadbeater]

I am afraid not.

Coroners investigate suspicious or violent deaths, or situations in which the cause of death is unknown. Assisted deaths would not fall into these categories, and there would therefore be no need for a default coronial investigation. This will ensure that any unnecessary delays and distress for bereaved families are avoided. These are not unexpected deaths; sadly, they were inevitable.

--- Later in debate ---

[Rachel Taylor]

I begin by thanking my hon. Friend the Member for Spen Valley (Kim Leadbeater) who has exemplified the integrity and transparency that we need in public service.

I will speak about amendments 82 to 86, which were introduced by the right hon. Member for Salisbury (John Glen) earlier, because as a former lawyer, they concern me. In Committee, the Minister of State, Ministry of Justice, my hon. and learned Friend the Member for Finchley and Golders Green (Sarah Sackman) was clear that the panel’s decisions will be subject to public law principles. That will include procedural propriety and an absence of bias, including the appearance of bias. My concern is that the panel is deliberately designed to be inquisitorial. It is intended to collect information; it is not meant to be adversarial like a court.

[Dr Ben Spencer]

Will the hon. Lady give way on that point?

[Rachel Taylor]

No, I will make some progress. Requiring a judicial oath would be inappropriate because the panel is not performing a judicial function. It is a specialist, administrative panel whose first priority must be focused on safeguarding and the review of evidence.

[Rachel Taylor]

No, I will make some progress and expand on my point. Disqualifying retired and deputy judges would only shrink the pool of experienced candidates, and I do not believe that those changes would make the process safer, more effective or better. Instead, they would make it more difficult to appoint experts to allow the panel to function as the necessary safeguard that it needs to be.

Finally, I turn to the most important aspect of the Bill, which is those who are affected directly. Opponents present hypotheticals, but I have heard real stories from my constituents who support the Bill. One constituent told me about her husband who died of metastatic prostate cancer. He wanted to die at home, and despite the efforts of a dedicated palliative care team, his final month was marked by excruciating pain. Our constituents deserve better. They deserve the choice to say goodbye in peace, surrounded by loved ones, without unbearable pain. For me, this debate is about whether the status quo is acceptable. After hearing these stories and listening to lawyers and doctors, I know that it is not. If we vote in favour of the Bill, our constituents must be able to expect that it will be brought into law quickly. I therefore oppose amendment 42.

The British public overwhelmingly support the Bill. They are looking to this House for courage and leadership. That is why I will vote for the Bill, with the amendments that strengthen it. Let us bring dignity, peace and choice to those facing the end of their lives in difficulty and pain.

[Dr Ben Spencer]

Before I come to the substantive part of my speech, I would like to pick up on the comments of the hon. Member for North Warwickshire and Bedworth (Rachel Taylor). I have signed the amendments tabled by my right hon. Friend the Member for Salisbury (John Glen). I support them because I think the panel needs strengthening. It is not the case that courts have to be adversarial. Tribunals are set up to be inquisitive. In fact, the mental health tribunal is set up to be inquisitive. That is why, in Committee, I tabled amendments to use a tribunal panel as the mechanism for scrutinising decision making.

It has been a real pleasure to listen to the debate, particularly in relation to the prohibition of advertising, because the debate started to move to focus on the issue of suicide promotion and prevention. I have been quite concerned from the beginning that that has not been part of what we have been talking about. Duties to prevent suicide—whether they be doctors’ duties under article 2 of the European convention on human rights, the NHS’s clinical duties around suicide prevention, or duties relating to the Mental Health Act 1983—are a blind spot in the Bill.

The reason why the issue has not been focused on until now is that the Bill has been framed as the assisted dying Bill, as opposed to the assisted suicide Bill. I blame myself in part for that, because I started by called it physician-assisted suicide, but then I started using the term “assisted dying” because it was in common parlance and it was what everyone was using. The problem is that it frames it as something else. It frames it as reducing the dying process as opposed to what it is, which is an act to end somebody’s life. That is why the Bill amends the Suicide Act, and it is why I have tabled similar amendments on how it is conceptualised.

[Caroline Voaden]

I take issue with some of the language being used. We have heard the words “murder”, “killing” and “suicide”. Twenty-three years ago next week, my husband died of terminal cancer. He was in extreme pain and was given morphine to relieve it. As the pain got worse, he was given more morphine so that he could die gently and not in complete agony. This is about helping people die in a civilised way, and helping their families to not go through the horrendous experience of watching a loved one die in agony. To call it murder and killing is so wrong, and we have a duty to mind our language with this Bill. It is about helping people die quickly and with dignity. It is assisted dying.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Before Dr Spencer resumes, I note that this has been a well-tempered debate. Let us keep it so. We know our constituents are watching.

[Dr Spencer]

I thank the hon. Member for her intervention. Of course there are situations in which a decision to end one’s life is perfectly understandable—indeed, rational. I spent my career looking after people, many of whom presented to me and to medical services with thoughts about wanting to end their life. Many of them had mental illness. Some had terminal illness. The fundamental problem with the Bill is that it has a complete blind spot for those people who are highly vulnerable. It is scandalous that we have got to this point and are still having a debate about the core concepts. The Bill should have been dealt with properly from the start with a royal commission or a review so that we did not get to the point where we are still debating core principles on Report.

--- Later in debate ---

[Tim Farron]

I will not be the only person in this place who has lost someone they loved to suicide. In listening to what has been said recently by the Royal College of Psychiatrists, which is not opposed to the Bill in principle, the penny dropped for many of us that many people given a terminal diagnosis will have mental health issues that come with that. How does the hon. Member think we can distinguish between a person who chooses to end their own life because of a mental health issue caused by despair from having a terminal illness and somebody who wants to end their life because of despair caused by something else? Does that not blur our approach to the importance and sanctity of life and to preventing suicide in every circumstance?

[Dr Spencer]

I thank the hon. Member for his intervention. Of course, these are difficult things to disentangle. People will say, “You would say this, wouldn’t you, Ben?”, but we should get the person in front of a psychiatrist or a clinical nurse specialist working in psychiatry. This is what psychiatry does; this is what it is about. That is why I tabled amendments to ensure that the person is put in front of a psychiatrist as part of the process to deal with the blind spot. [Interruption.] Apologies, Madam Deputy Speaker; I will finish now.

My amendment would ensure that the code of practice clarifies the interaction with services.

[Shockat Adam (Leicester South) (Ind)]

Will the hon. Member give way?

[Dr Spencer]

I think I am pushing it.

I tried to intervene on the hon. Member for Spen Valley (Kim Leadbeater) to ask what she thinks about that. She is welcome to intervene on me now if she has further points to add. Otherwise, I ask the Minister to address those points.

[Marsha De Cordova (Battersea) (Lab)]

I rise to speak to amendment 27, which would require the doses and types of lethal drugs to be properly licensed by the MHRA. It is important that I put it on the record that I do not think the Bill is safe. It does not provide adequate safeguards. Most importantly, it will deepen and exacerbate inequalities. On that, I know that I speak for tens of thousands of disabled people who rightly say, “We need assistance to live, not to die.”

Throughout the passage of the Bill, hon. Members across the House have received many letters and briefings from leading experts, including this week a letter from over 1,000 doctors across all areas of medical practice expressing their clear view that the Bill does not provide answers on how we can improve management of the end of people’s lives. They said that the drugs expected to be used in assisted deaths should undergo rigorous testing and approval, as would be required for any other prescribed medication. Those requirements are missing from the Bill. Indeed, there is nothing in the Bill requiring lethal drugs to be regulated by the Medicines and Healthcare products Regulatory Agency. That is contrary to good medical practice.

Many of us will have heard that in Oregon, complications with drugs used for assisted dying occurred in about 7% of deaths and included vomiting, seizures and prolonged deaths of up to 137 hours. Where is the requirement in the Bill to inform patients about how those risks, including prolonged dying, might be managed? Where is the plan to identify the most acceptable medications? If they have not already done so, I urge hon. Members to consider this letter, signed by many leading experts. If we do not listen to them—the very people who would have to implement the Bill—who will we listen to?