Terminally Ill Adults (End of Life) Bill

Florence Eshalomi Excerpts

Friday 16th May 2025 Commons Chamber

[Dr Neil Shastri-Hurst (Solihull West and Shirley) (Con)]

This House is now faced with a responsibility as profound as it is complex: to ensure that this Bill remains clear in its purpose, cautious in its application and compassionate in its impact. That purpose is simple, yet solemn: to grant adults of sound mind with a terminal diagnosis the legal right to seek assistance to end their lives in carefully regulated circumstances through a legal framework in which compassion and control co-exist. With that in mind, I rise to speak against new clauses 1, 2 and 9, which, while no doubt well intentioned, threaten to confuse, dilute or duplicate what is already a well-constructed piece of legislation.

I begin with new clauses 1 and 2. New clause 1 would prohibit healthcare professionals from raising the topic of assisted dying unless it is first broached by the patient. While that may be appealing superficially as a safeguard, it represents a fundamental misunderstanding of the doctor-patient relationship. We trust our clinicians every day to raise subjects of great complexity and moral weight.

[Florence Eshalomi (Vauxhall and Camberwell Green) (Lab/Co-op)]

Does the hon. Member agree that, unfortunately, some of our constituents up and down the country do not trust our clinicians? They have grave concerns about the way in which they are treated, because they feel that they do not have a level of equality within our NHS, which is sadly the case. That was explained and shown during covid.

[Dr Shastri-Hurst]

I am grateful to the hon. Member for that intervention. I fear there is some rhetoric that engenders a fear around the medical profession, which is misplaced.

--- Later in debate ---

[Tom Gordon]

I am bringing my remarks to a close.

If we believe in dignity, let us ensure it is a dignity that includes everyone; if we believe in autonomy, let us not deny it to those who may lose their voice tomorrow; and if we believe in compassion, let it be a compassion that recognises the lived reality of all terminal illnesses and does not consign those with MND to the status quo.

[Florence Eshalomi]

Mindful of time and of the need to allow other colleagues to speak, I have been carefully to ensure that my speech is short. I will therefore not be taking any interventions.

I voted against the Bill on Second Reading, on the grounds that there were inadequate safeguards against the coercion of minority communities. That was based on my belief that, if we are to legislate for something as serious as the end of someone’s life, then the bar that the legislation must reach in order for it to be deemed safe needs to be much higher than it is in other areas. In the time since, I have followed closely the scrutiny that the Bill has received at Committee and on Report. I had hoped that my concerns would be addressed, but I am sad to say that I am even more worried now than I was then.

Before getting to the new clauses and amendments that would provide important safeguards, I want to state again that I do not think the Bill is the appropriate mechanism for a national decision of this magnitude to be made, and ultimately, any decision on it should be led by the Government and the clear will of this House, not on promises made to people without an elected mandate.

I pay tribute to the work of tireless campaigners on a number of important issues in relation to the scrutiny of this Bill since Second Reading. That work resulted in many amendments and new clauses being tabled by Members from across the House to attempt to strengthen the protections for at-risk groups. As I alluded to, I sadly do not have enough time to speak to all of those that I support, but I am grateful for the efforts of the many who have led and spoken in this debate.

I will speak to amendment 16, which stands in my name. It would make it explicit in clause 28 that there would be no obligation on any care home or hospice that is regulated by the Care Quality Commission or the Care Inspectorate Wales to provide assisted dying on its premises. I understand that my hon. Friend the Member for Spen Valley (Kim Leadbeater) has tabled new clause 10 to replace clause 28 and thereby ensure that there is no obligation on anyone to provide assistance. While I welcome the expansion of protection that that provides to practitioners who do not wish to provide assistance, I do not believe that it is comprehensive.

Dr Jamilla Hussain, a palliative care consultant working predominantly with ethnic minority communities in Bradford, gave oral evidence to the Bill Committee. She said:

“I have gone into those communities and I have spoken to them about this Bill. What they say overwhelmingly to me is, ‘We’re scared. We’re really fearful that this is going to result in a disproportionate impact on our community. We have seen that through covid and we’re so scared.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 187, Q245.]

Heartbreakingly, she also said:

“Almost every week, one of the first things I have to reassure patients about is that I cannot legally do anything to shorten their life. This is front and centre of the fear for those patients and we see it all the time.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 190, Q247.]

This is not an academic or theoretical risk. Are we really prepared to sideline those unheard voices and risk embedding further inequalities in healthcare as we legislate?

We are all elected to this place to elevate the voices of those who feel that they are furthest away from power. If we are to achieve that, we must make decisions that honour their experiences, and legislate to protect them, but if hospices are unable to opt out of a collective policy of providing assisted dying, the people who already feel ignored by healthcare systems are more likely to fear accessing the care that they need at the end of their life. That would create further unnecessary suffering, and I know that we are all united in wanting to avoid that.

I do not doubt the good intentions of any Members choosing to support this Bill, and I thank the many constituents, on both sides of the debate, who have contacted me. However, we politicians have to be clear that Members with valid concerns about this Bill are raising them not because of some ideology or religious belief, but because we recognise that if this Bill passes, it may impact everyone, not just those who wish to die. It is not wrong or scaremongering to consider wider family life, relationships in which there are feelings of burden or coercion, and vulnerable women and people from the BME community at the end of their life. It is not wrong or scaremongering for us politicians, as we continue to receive correspondence from our constituents about the broken state of our NHS and social care, to think carefully about a Bill that may alter the relationship between doctors and their patients.

It is frankly insulting to disabled people and hard-working professionals up and down the country to have their many valid concerns about this Bill dismissed as religious beliefs. Sadly, I have come to the conclusion that instead of giving a universal right to dignity in death, this Bill would reinforce the health inequalities that deprive so many from our vulnerable communities of dignity in life. I urge Members to keep that at the forefront of their mind as we vote today, and to reject this Bill.

[Sarah Bool (South Northamptonshire) (Con)]

I am grateful to speak in this debate, and I will focus on three amendments: new clause 9 and amendments 51 and 38. To save time, so that other Members can speak, I will not take interventions.

New clause 9, which is in my name, would essentially establish the standard of proof—namely, the degree of certainty and the amount of evidence—required in decision making under this Bill. Let me put that into context. Various standards of proof are used in law. At the very lowest end of the scale is reasonable belief, which is a belief that would be held by an ordinary person in the same circumstances. There is then the civil standard of proof, known as the balance of probabilities, which is sometimes known as the 50% plus one rule, or “more likely than not”. Finally, we have the most serious standard: the “beyond reasonable doubt” test, which applies for criminal cases. That goes further than the balance of probabilities, and requires the person to be sure.

Given the lack of clarity and confusion in Committee about whether the test for doctors should be reasonable belief or the balance of probabilities, I have proposed the new clause. As Members will see, it has three parts. Subsection (1) relates to the assessment by the co-ordinating and independent doctor. As Members will see, it has three parts. Subsection (1) relates to the assessment by the co-ordinating and independent doctor. Here I argue that the balance of probabilities test should be used, because it feels perhaps overly punitive to exclude someone from the process at the initial stage if it is more likely than not that they will meet the test, but there are some doubts. However, under subsection (2), when the assisted dying review panel is making its assessment, it must use the “beyond reasonable doubt” test. Given that, at this stage, it will have all the reports from the doctors and professionals, if it is not sure beyond a reasonable doubt, the application should not be approved. That is an essential safeguard.

Subsection (3) relates to the moment of supplying the lethal drugs. The doctor is required to satisfy themselves that the person has capacity and a clear, settled and informed wish to end their life, and is not being coerced. At that point, the “balance of probabilities” test does not suffice; it must be “beyond reasonable doubt”—this is life and death.

All hon. Members need to ask themselves whether, without this new clause, they are happy with someone being provided with lethal drugs to end their life by our NHS in circumstances where we are not absolutely certain of their intention. I acknowledge, for the record, that the hon. Member for Solihull West and Shirley (Dr Shastri-Hurst) has made an objection to the use of “beyond reasonable doubt”, asking whether it is right to apply a criminal standard of proof when a civil standard may be flexible enough. However, I note that in the House of Lords in re B case in 2008, Baroness Hale said,

“There are some proceedings, though civil in form, whose nature is such that it is appropriate to apply the criminal standard of proof,”

and a subsequent 2012 case affirmed that.

If we stay silent and let the assisted dying review panel and the courts try to work out whether they should interpret “satisfied” as meaning satisfied to the civil or criminal standard, it would merely result in numerous litigation battles. On a matter as serious as death, Parliament must provide the clarity needed. Without it, the Bill is simply not safe.

The second area I am focusing on is informed consent and complications, through amendment 51 to clause 11. The amendment would impose a duty on assessing doctors to inform individuals seeking an assisted death of any reasonable body of medical or scientific opinion indicating that the prescribed substance carries risks of complications, including pain. Clause 11 requires doctors to explain how the drug is expected to bring about death, and to discuss with the individual what ought to be done in the event of complications. However, it omits a critical element identified by the General Medical Council in its guidance on consent: the obligation to communicate known risks of harm and the uncertainty surrounding those risks. A patient cannot be said to give informed consent if they are not made aware of the full range of potential complications, including pain, distress and the possibility that the drug may not act as expected.

The state of Oregon’s most recent data shows that complications were recorded in approximately 3% of cases in 2023, but historical data shows a complication rate of 11%. Since the introduction of the law there, there have been nine recorded incidents of patients regaining consciousness after ingesting the prescribed substances, and time to death has ranged from three minutes to 137 hours—that is, more than five and a half days. Canadian studies indicate that around 5% of oral assisted deaths result in a prolonged and often distressing process. In some instances, medical intervention is required. Evidence also suggests that younger adults, particularly those aged 18 to 24, are more likely to experience extended and unpredictable deaths.

Furthermore, not all complications may be outwardly evident. High doses of barbiturates, combined with paralytic agents that suppress all voluntary muscle movement, may result in what outwardly appears to be a calm and peaceful death, but that may conceal considerable psychological suffering. The hon. Member for Spen Valley (Kim Leadbeater) talks about offering choice, but a choice made in the absence of information is not true autonomy; it is abdication. Making a meaningful decision requires the individual to be aware of not only what is intended to happen, but what may plausibly go wrong. In both Oregon and California, legislation explicitly requires that patients be informed of any known risks associated with the medication to be administered, so why would we adopt a lesser standard here? The amendment simply calls for honesty.

Finally, but briefly, I also want to add my support for amendment 38, which clarifies that an individual who is not already terminally ill under the definition of clause 2(1) cannot qualify by refusing standard treatment or taking steps to induce a terminal condition. I live with type 1 diabetes, which, for the record, is a progressive illness that cannot be reversed by treatment. This condition is managed—or not, in cases of extreme stress—solely by the individual. I therefore recognise that the amendment is an incredibly important protection. Diabetics face multiple daily injections, and have to think about and monitor everything that they do, 24/7, and they can be at risk of diabetic distress, or even develop disordered eating. That could prove fatal if standard treatments are not accepted. They should never be offered assisted suicide; they could recover with the right support. I have spoken to the hon. Member for Spen Valley about my concern that conditions like diabetes may be caught unintentionally. The amendment would be a step to protect those who may be unable to protect themselves using standard means. Diabetes and anorexia have been a reason for assisted suicide in Oregon, so please be aware of what could happen.