Terminally Ill Adults (End of Life) Bill

Debate between Lizzi Collinge and Rachael Maskell

Report stage
Friday 13th June 2025 Commons Chamber

[Rachael Maskell]

I rise to speak to my amendment 27. The insufficiencies of clause 25 and new clause 13, and the mechanisms for substance approval, have attracted much criticism as they defy safe process. I have therefore undertaken extensive research with leading academics, toxicologists, anaesthetists, pharmacists and others to understand the safety concerns over pharmacology, prescribing and dispensing.

Normally, the MHRA would undertake research and trials to secure safety, quality and licensing. The British National Formulary focuses on dosage and side effects, and NICE or the All Wales Medicines Strategy Group focuses on showing that drugs work and are cost-effective. That safety regime underpins the reputation of UK pharmacology. So can this House assure itself that without due process, someone will have a safe and peaceful death? Let us look at the evidence.

First, the data is poor. The Health and Social Care Committee visited Oregon. We know there are varying times for how long it takes for someone to die—up to 137 hours. The research cites nausea and vomiting in 10% of cases, seizure, oral muscular burning, regurgitation and regaining consciousness.

[Lizzi Collinge]

Will my hon. Friend give way?

[Rachael Maskell]

No time.

There is a lack of consistency of approach and data across jurisdictions on the substances used, how they are titrated and the dosages administered. While ingestion can be a factor, absorption varies according to frailty, metabolism, diagnosis, body mass index and drug reactions. Pharmacokinetics and pharmacodynamics are complex.

However, it has been my discussions with toxicologists that have been most alarming. They highlight the high risk of acute pulmonary oedema. This is backed by research showing that 84% of cases using pentobarbital on death row have flash pulmonary oedema. The drug disintegrates the membranes in the lung tissue, filling them with fluid, causing shortness of breath and a sense of drowning. As a clinician, I have supported many people on intensive therapy units with such a diagnosis. High concentrations of the drug cause an acute assault to the cardiopulmonary function. If paralysed and conscious, a patient may look peaceful but is anything but.

Such physiological distress needs research. It is unclear how the Government will identify data, process and safety. The risk to those handling toxic substances also needs to be examined, and in the light of the Government identifying that a pregnant woman could opt for an assisted death, that clearly needs examination.

There is no formulation for safe titration or dosage. If pentobarbital is to be used, as it is in Australia, the Government’s impact assessment did not examine it, so it needs revision. Also, the drug is not an approved substance for humans in the UK, licensed or unlicensed. The MHRA and NICE have a role to play. We are increasingly hearing that professional bodies are withdrawing their support from the Bill, because they know that the regimes that have been set out are just not safe, so it is our duty to examine the evidence.