Terminally Ill Adults (End of Life) Bill
Jess Asato Excerpts(2 days, 17 hours ago)
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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.
Kim Leadbeater
I will not, I am afraid.
It is the manner and timing of their death about which the patient will make a legal, informed choice, having been thoroughly assessed. As Professor Aneez Esmail has said, “I cannot think of any death that would be the subject of greater scrutiny in advance of the person dying than an assisted death. The process far exceeds the level of safeguarding that is in place for many of the deaths that are, at present, routinely reviewed by medical examiners and not referred to a coroner.” Of course, anyone can report a death—including an assisted death—to the coroner, or indeed to the police, if they have any concerns that it was not carried out in accordance with the Act, and if any offences have been committed, they will be investigated.
Alison Hume (Scarborough and Whitby) (Lab)
I rise to speak in favour of new clause 15, which clarifies that an assisted death would not be classified as an unnatural death and that a full coroner’s inquest would not normally be required.
My constituent Antony Shackleton lived with motor neurone disease for six long years. As his condition worsened, his options narrowed until there was only one choice that preserved his dignity, autonomy and peace: to travel to Dignitas in Switzerland and end his suffering on his own terms. Louise, as his wife of 25 years, and someone who had known him since the age of 18, did what any loving partner would do: she stood by him. She helped him on to that plane and held his hand through the most difficult decision of their lives, and now, for that act of love, she is under police investigation.
That is precisely why we need new clause 15. If the Bill is passed, assisted dying would be a legal, strictly regulated and monitored choice made by the individual concerned.
Jess Asato
I recognise that the situation facing my hon. Friend’s constituent is awful, but we are here today to balance such situations with the choices of people who may not be loved as dearly as him. Our concerns would be about the fact that many of these killings could be mercy killings, and if there is no recourse to the coroner, some people may be taking their own lives under coercion and pressure that may never be discovered, because the full law will not be applied.
Alison Hume
New clause 15 particularly addresses the role of coroners. Coroners investigate deaths in which there is a reasonable suspicion that the deceased has died a violent or unnatural death, where the cause of death is unknown, or if the deceased died while in custody or state detention. This is not the case with an assisted death, and there would already be strong safeguards in place, including multiple layers of oversight and assessment. The process is cautious, thorough, and heavily safeguarded. There is no need to investigate an assisted death, as it is not unnatural. In this country, it is still a crime to help someone die peacefully and with dignity, even when they are suffering unbearably from a terminal illness.
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 Rupa Huq (Ealing Central and Acton) (Lab)
I rise to support amendments 34 to 36 and new clause 6, tabled by my right hon. Friend the Member for Walsall and Bloxwich (Valerie Vaz), who sadly cannot be here today.
Health inequality shapes life expectancy and outcomes —covid deaths illuminated that—but it is absent from the Bill. A younger me would have been 100% behind this Bill. I am very pro body autonomy when it comes to abortion, but 10 years of being an MP has exposed me to coercion, duress, the billionaire price of London property, and elder abuse. It is no coincidence that, like me, the majority of London MPs and of black and minority ethnic MPs oppose the Bill.
Let us look at amendment 34. The experience of my aged parents—now no longer with us—opened my eyes to a world of pills, incontinence pads, hoists, power of attorney, key safe boxes and carer worries. I saw how non-native English-speaking pensioners—I am not talking about Welsh speakers—have their agency denied, perhaps unconsciously, by health professionals in a stretched system. My mum’s GP had a clear contempt for her accented words. At every appointment she would say to her, “One question only”. As my mum grew frailer and began to lose the power of speech, she reverted to her mother tongue and was seen by hospital teams as an annoyance, a time waster, and bed blocker. Similarly, the disabled are often written off. People cannot see beyond the wheelchair or the non-verbal. Amendment 34 would place a duty on the chief medical officer to provide information at every step of the way
Jess Asato
I thank my hon. Friend and I recognise the time constraints. On the issue of vulnerable groups, she may know that a letter has been sent about eating disorders but the spokesperson for the Bill’s sponsor dismissed it, saying that the concerns raised were old news. Does she agree that there is a problem with the way the Bill is being run, as so often the concerns and evidence presented by groups have been dismissed out of hand?
John Grady
I am obliged to my hon. Friend—that is precisely why I joined the Labour party as a 16-year-old. Faced with terrible circumstances, some people will seek an assisted death. I find it hard to accept that those will be truly autonomous choices. We must be clear that the very same circumstances that have denied people dignity and robbed them of autonomy throughout their lives will drive them to an assisted death. I find that deeply troubling, and I worry that we are placing too much confidence in concepts of capacity, autonomy and self-determination.
Everyone accepts that coercive control is common—indeed, it is incredibly common, as is domestic abuse and elder abuse. There are very clear risks of coercion. I recognise that the supporters of the Bill have sought to improve protections, and to protect people in those types of circumstance. I have anxiously scrutinised those protections, and I do not believe that they will achieve their aim. That is why the amendments are so important.
Jess Asato
Last weekend my hon. Friend the Member for Spen Valley (Kim Leadbeater) posted on X a story of two older people who wanted to die together, and who had found doctors to sign off their assisted death. Is my hon. Friend concerned that this debate might be romanticising suicide pacts given that, as we know, there are mercy killings, which are, unfortunately, actual deaths? Does he share the fears of the Government’s suicide adviser that the Bill will undermine suicide prevention efforts?
John Grady
I think everyone in the House debates this issue in good faith, and in the courts there is a general view that one should be reluctant to attack otherwise. I am sure that question was meant on that basis. However, one must not lose sight of the fundamental point that the protections in the Bill will not address the profound societal pressures that people will face. One must not lose sight of the fact that, whatever protections are included in the Bill, it will not protect people against coercion.
Dental Healthcare: East Anglia
Jess Asato Excerpts(6 months ago)
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Jerome Mayhew
This debate is about the east of England, not the east of Northern Ireland, but I will take the hon. Gentleman’s intervention anyway. He is right that we learn our oral hygiene habits as children. It is primarily the responsibility of parents to look after their children’s oral health, as well as their general health; that has always been the case, and that should always remain the case. However, we recognise, as did the last Administration, the increasing role of primary schools in reinforcing the role of parents.
Jess Asato (Lowestoft) (Lab)
Does the hon. Member agree that it is appalling that my constituents have had to resort to pulling out their own teeth because no NHS dentists in my constituency are accepting new patients, and that we need urgent action now?
Jerome Mayhew
I am shocked to hear that. An example of that in my constituency was reported to me, but that was in the height of the covid lockdowns; I have not heard an example since then. However, irrespective of the headline-grabbing anecdote, it is almost impossible for new applicants to register to an NHS dentist, and I have the figures to back that up. Office for National Statistics data for November indicates that 98.4% of those who were not registered to a dentist but who wanted to access NHS dental care in the east of England were unable to do so. That is the worst rate of all English regions, yet over that period there was a £58 million underspend in the east of England’s NHS dental budget. That is not because the Government do not want to spend the money, and it is not because the money is not available; it is simply because we do not have enough dentists to satisfy the huge need.
Healthcare Provision: East of England
Jess Asato Excerpts(9 months, 1 week ago)
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Jess Asato (Lowestoft) (Lab)
I thank my hon. Friend the Member for Norwich South (Clive Lewis) for securing a debate on such an important issue, which I know is close to the hearts of all our constituents.
The NHS is clearly in crisis. Those who can afford to go private do so, while everyone else is forced to linger on long waiting lists. My constituents are frustrated, sometimes to the point of giving up waiting for urgent operations—and sometimes just for GP appointments. Lowestoft hospital in my constituency was closed a decade ago. The building now lies empty without a replacement, and we continue to wait for a long-term solution that benefits the community. As has been mentioned, the James Paget University hospitals rebuild is desperately needed. It is one of the two hospitals worst affected by RAAC—reinforced autoclaved aerated concrete—in the country.
It seems clear that the crisis in the NHS is no longer just an issue of funding and that investment must be coupled with reform to fundamentally improve health outcomes. I have been impressed, for example, by East Coast Community Healthcare, a staff-owned social enterprise that provides community-based NHS healthcare across Norfolk and Suffolk. ECCH demonstrates that things can be done differently, and that technical solutions and the freedom to innovate can allow providers to do more with the same funding and operate a system that is able to absorb rises in demand.
We sorely need to improve experiences of NHS care. For many, it has become something of a nightmare. I will focus on dental health. My constituents are particularly concerned about their inability to access NHS dentistry, and rightly so. Over the past 14 years, as we have heard, areas such as mine have become so-called dental deserts. As it stands, east Suffolk ranks seventh out of the 39 districts in the east of England for the lowest number of dentists.
Even where dentists are practising, residents find it impossible to get an appointment. In 2022, it was found that not a single dental practice in Suffolk was accepting new NHS patients. I have talked to far too many of my constituents who have been forced to rip out their own teeth. As we have already heard, that is happening right across East Anglia, and that is why I made improving access to dentistry one of my six election pledges. Although some progress has been made by the formation of the Norfolk and Waveney integrated care board, it is the dental system itself that is holding the NHS back from making improvements to accessibility. We currently have a system that does not work for patients or dentists. A survey by the Dental Defence Union of its members found that 41% are looking to reduce their hours and 31% are planning to leave the practice or retire early because of the sheer pressures of the system.
As NHS dentistry crumbles, I am particularly concerned about the impact on our children and young people. Data shows that almost a third of the 100,000 people who are admitted to A&E with tooth decay each year are children. It is the most common reason for children aged six to 10 to be admitted to hospital. Analysis from the British Dental Association found that on average, 116 children had to have their teeth extracted each day in 2022. In that same year, it was revealed that 40% of children—4.4 million—had not seen a dentist in the previous 12 months.
This is clearly an issue of inequality. Children from disadvantaged backgrounds suffer from worse oral health than their more affluent counterparts. It is a significant gap: 34.3% of children from deprived areas had dental decay in 2019, compared with 13.7% in less deprived areas. Poor health contributes to poor life outcomes. For example, teacher surveys have shown that poor oral health contributes to social exclusion, leading to children missing school. Breaking that vicious cycle is essential. If we cannot improve people’s health, how can we improve their lives? Instead of ensuring children get the best start possible in life, we are handing them rotten teeth and rotten chances to succeed.
I am glad that the Government have set their sights firmly on revolutionising dentistry in this country. Rebuilding NHS dentistry will be a difficult job but, unlike the previous Government, this Labour Government will not kick the can down the road. I am delighted that we have said we will create an extra 700,000 urgent and emergency dental appointments each year, including 100,000 for children. I welcome the financial incentives for new dentistry graduates to work in dental deserts such as mine. We will ingrain the importance of good dental health practice in children from a young age and crack down on the prevalence of hospital admissions for rotten teeth by introducing supervised tooth brushing for three to five-year-olds in schools. Most importantly, we will reform the dental contract, which is not fit for purpose and pushes dentists into private practice.
With an active Government willing to attack issues at the root—sorry for the pun—of the issue, I am confident that we can make significant process in this and all other areas of healthcare. Ultimately, the NHS is the way in which most people interact with the Government. If we can rebuild trust there by delivering improvements, we can also rebuild trust in politics and the ability of the Government to improve lives. If we can get the basics right, then all the other issues become easier to solve.