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

Debate between Danny Kruger and Rachel Hopkins

Committee stage
Tuesday 11th March 2025 Public Bill Committees

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

It is a pleasure to serve under your chairship, Sir Roger. I rise to speak in support of amendments 201, 422 and 423, which stand in the name of my hon. Friend the Member for Spen Valley, and against amendment 468.

On amendment 201, a point was made earlier about the relevance of records. It was mentioned that it might well not be relevant to look at a childhood tonsillectomy. However, I wish to speak in slightly more specific terms, in support of women and their reproductive rights, and to highlight the risk of unconscious bias if all records are to be looked at.

If a woman had a termination in her teenage years, that will be highly irrelevant to her decision, many decades later, whether to choose an assisted death. Relevance is very important, because there will be a high level of record keeping in the process. It is not only the doctors working with the patient on the assessment who will read the records and reports; ultimately, it will also be the panel. I make the point again that so many parts of a patient’s medical records are highly irrelevant to the diagnosis and prognosis of a terminal illness, and to the six months under the eligibility criteria. Indeed, there is a risk of unconscious bias in the judgment. It is about the professionalism of the doctor in respect of understanding the records that are relevant for the process.

[Danny Kruger]

Will the hon. Lady give way?

[Rachel Hopkins]

I will continue, if I may.

I turn to amendments 422 and 423. The importance of a rounded, holistic assessment and discussion with the patient has been pointed out in many of our discussions, as has the importance of the multidisciplinary team and the other health and care professionals who support the patient with health and social care. That would all have to be recorded—the conversations that have been had, and why the assessing doctors and other health and social care professionals were involved. In oral evidence, many doctors in other jurisdictions said that they worked in multidisciplinary teams. The amendment would firm that up. It is about being clearer, because the clarity that the amendments provide would make for a stronger process.

On amendment 468, the hon. Member for Reigate pointed out that it asks a very simple question. However, I return to the point about the professionalism of the doctors involved in the process, who will be working within the legal requirement under the Bill that the individual have a clear, settled and informed wish. The doctors will have to check individuals’ eligibility under the requirements, for example that they are over 18 and have a terminal illness with a six-month prognosis. The doctors will use their expertise and professionalism, and that of the multidisciplinary team, to make assessments about coercion. They have strong rules about assessing for capacity.

The requirement to ask why someone wants an assisted death is a requirement to police the conversation that the doctor has with their patient. Setting it out in primary legislation would lead to a tick-box exercise, with doctors saying, “You’ve told me a number of times already in our conversation that I’ve been having with you, but I’m sorry: I have to officially ask this question and tick the box.” That could lead to an insensitive conversation and relationship between the relevant people in the process.

To a certain degree, the patient may think, “So what? Do I have to tell you why? It is none of your business why I want to pursue this legal course of action down the line.” I appreciate where the hon. Member for Reigate is coming from, but with the best of intentions, her amendment would actually lessen the individual’s autonomy and their right to choose what if the Bill passes will be a legal course of action. I am content that the stringent training that will be required for any of the assessing healthcare professionals will enable a good holistic conversation so that good judgments can be made. Adding this extra sentence would detract from that, so I cannot support the amendment.

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

Debate between Danny Kruger and Rachel Hopkins

Tuesday 11th February 2025 Public Bill Committees

[Danny Kruger (East Wiltshire) (Con)]

Before the break, the hon. Member for Penistone and Stocksbridge gave a helpful account of the operation of the Mental Capacity Act 2005, with particular reference to the concept of “best interests” that applies in that Act. She explained that the best interests consideration kicks in only once the capacity test has been failed—once it has been concluded that someone does not have capacity. Therefore, there would be no best interests consideration in the case of assisted dying. Either a person has capacity and that is that—a rather low bar, which is, as we have discussed, appropriate for buying a cup of coffee, is got over, and they are off to the assisted dying commission, or whatever process we eventually try to set up—or they do not have capacity and are ejected from the system, and there is no best interests consideration.

I reference that because my whole point is that the Bill does not use the Mental Capacity Act; it just uses the definition of capacity that is in it, and that definition is very weak. It is designed to assume capacity in the patient and, as we discussed earlier today, it can include somebody who has impaired judgment—they could be depressed or even suicidal. Indeed, my hon. Friend the Member for Solihull West and Shirley said earlier, very honestly, that he would be content with somebody who had depression accessing assisted suicide, as would be possible under the legislation.

The point is that once the test of capacity has been passed, there is no best interests consideration. It is a great abuse of the Mental Capacity Act, the whole purpose of which is concern for the vulnerable, for that purpose to be ignored once the usefulness of the Act has been fulfilled. This Bill does violence to the Mental Capacity Act in using it for this purpose. The fact is that that Act was designed for the opposite situation: to protect people from having things done to them.

I will conclude shortly, Sir Roger, but that brings me to the point we have discussed at length already today: the crucial question of whether the decision to have an assisted death is different from the decision to decline or to cease treatment. I start by pointing out that case law specifies that to decline treatment is not to commit suicide —I recognise that the hon. Member for Spen Valley does not like the term suicide, and I apologise, but we are using legal terms here. The fact is that there is a distinction in law between the act of suicide and the decision to decline treatment.

I refer in particular to the famous case of Airedale NHS Trust v. Bland in 1993, and quote Lord Goff, of the House of Lords, who said that

“in cases of this kind, there is no question of the patient having committed suicide, nor therefore of the doctor having aided or abetted him in doing so. It is simply that the patient has, as he is entitled to do, declined to consent to treatment which might or would have the effect of prolonging his life, and the doctor has, in accordance with his duty, complied with his patient’s wishes.”

I also quote Sir Thomas Bingham, as he then was, who said that in the case of Tony Bland it was plainly not suicide, and that

“it was not the discontinuance of artificial feeding but the patient’s condition and its underlying cause which caused his death”.

In the withdrawal of treatment, it is not the act of withdrawing treatment that kills someone, but their disease, or the condition they have, whereas in assisted suicide it is the act that kills them. That is a crucial distinction, and that distinction is apparent. We heard it this morning in remarks from my hon. Friend the Member for Solihull West and Shirley and my right hon. Friend the Member for North West Hampshire, and I think from the hon. Member for Spen Valley, who pointed out that there is a difference between the two cases, as is evident with respect to advanced directives that allow for the withdrawal of treatment. They do not allow for the active administration of treatment; they allow for the withdrawal of treatment. They would not allow for assisted dying, as the hon. Member for Luton South and South Bedfordshire accurately said.

This goes to the heart of the matter. There is a difference between being left alone and demanding that something is done to us. The state protects our right to be left alone. It does not yet give us the right to have something done to us simply because we asked for it.

[Rachel Hopkins (Luton South and South Bedfordshire) (Lab)]

The proposal in the Bill is not about someone doing something to someone: it is about self-administration and someone being able to do something to themselves. The point is about the choice to do that.

[Danny Kruger]

I recognise that, and that the Bill makes a distinction in respect of euthanasia or physician-assisted suicide, which would be the doctor doing it to us. The Bill specifies that the drugs must be self-administered. I do not understand the logic of that distinction, but I recognise that there is an attempt to make the Bill more palatable and that the distinction has been preserved. Nevertheless, the Bill would enable a doctor to prescribe lethal drugs with the purpose of ending a life. That is an act that is performed: a person is prescribed drugs to end their life. Whether they take the pills or press the syringe themselves, the act has been performed, and the prescribed drugs kill the person.

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

Debate between Danny Kruger and Rachel Hopkins

Committee stage
Thursday 30th January 2025 Public Bill Committees

[Rachel Hopkins]

Q Thank you all for sharing your family stories today. It is really moving. Julie, I want to ask about your experience in Spain and how you found that particular process in comparison with what we have in the Bill. How did it work? What was positive or difficult for you?

Julie Thienpont: Guido had decided right from the word go, even before he got sick, that that was the way he would want to end his life, if there was a possibility of it. He was from Belgium originally, so he expressed a wish that if ever he needed it, he would like to go back there.

The law in Spain is very similar to the Bill, which I have read through countless times. There are a lot of similarities. There were very rigorous checks. It involved much paperwork, counselling and family liaison. The difference was that it went before a board, so it was a panel that would allow or not allow the decision—it was not decided in a court. That would be the main difference, but the process was rigorous. It was slightly difficult for me, because although I can speak Spanish, the terminology was frequently more difficult, so they very kindly translated for me. They explained everything: what would happen and how it would happen, if it happened. It was a big celebration for Guy when he was actually granted this. They also told us that he could change his mind after he had made the decision, should he wish to. He did once. It was me who asked him to do that, because I did not feel he was sick enough, which sounds a bit silly, I know.

He was an intensely private person. The palliative care in the part of Spain where we were is excellent, but it was quite irrelevant for him because he had already expressed that he wanted to die at home. We lived up a mountain; we were quite remote. Being such a private person, he never wanted to be in a situation where somebody else had to see him in any vulnerable situations, especially with personal hygiene and so on—even me, although I was able to help him in many ways. I had to do a lot of procedures for him, after being trained to do so, but he was more than happy with the situation of having assisted dying once it was granted. He did not need any other sort of care, although we still had a nurse coming every few days and the family doctor came up at least once a week. That does not sound much, but he did not want her any more often than that.

[Danny Kruger]

Q This is a question for Mr Malone. May I say how greatly I sympathise with what you have been through? I am very sorry to be fighting against you in this matter. I really can imagine how that feels. Thank you for what you said. I just want to ask about your sister’s experience. On the eligibility question, is it your belief that she would have qualified for an assisted death under the Bill, with the six-month terminal illness criterion? To follow up on that, do you think we should expand the scope to include people with motor neurone disease who might not fall within the six months?

Pat Malone: She would not qualify, because there was no telling how long she would live as a live brain in a dead body, as she said. It could have been months or even years, so she would not qualify in any case under this Bill. However, you have moved mountains to get to this point, so the last thing in the world I want to do is pile more requirements on the Bill. I would like to see some stuff stripped out of it, actually, to make it easier, but I am not going to ask for that because we desperately need to get away from the status quo. This Bill gets us away from the status quo.