Terminally Ill Adults (End of Life) Bill

Nusrat Ghani Excerpts

2nd reading
Friday 29th November 2024 Commons Chamber

[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Colleagues will realise that we have only a few hours to go. Without absolute speaking limits, if colleagues could keep their contributions to shy of five minutes, I will do my best to get in as many speakers as possible.

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[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. In consideration of colleagues, please keep speeches under five minutes.

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[Several hon. Members rose—]

[Madam Deputy Speaker]

A very considerate five minutes—thank you.

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[David Davis]

I am afraid not, as I have only five minutes.

I will pick one of those areas, as it is technical and awkward. Clause 4(2) appears to give doctors the right to initiate the process. But after the “Do not resuscitate” scandal during the covid crisis, I do not want that at any price—I do not want the state initiating this process. That is critical for me. I am really making the point that the decision on Second Reading is about principle, not outcome.

The hon. Member for Spen Valley (Kim Leadbeater) has said that she will work hard to make the Committee work. I am sure she will, and she may succeed. But I say this to the Government. I understand perfectly well that they are trying to maintain a route of strict neutrality, but there is a distinction between neutrality and responsibility. They need to focus on responsibility. This Bill is more important than most of the Bills in their manifesto; I am not trying to be rude. Is the hon. Member for Clacton (Nigel Farage) here? He got mobbed over breakfast by people talking about this. More people in the Dog and Duck care about this than they do about most other things that we are doing, so it deserves four days on Report in Government time over the course of several weeks.

We do not need a royal commission. The House can do this, but it needs to be given the option. I say to the Government that the path of responsibility is to give us the time to get this right. If we get it right, it will be one of the things that we can be proudest of in the coming years. I reiterate that I want the Bill to succeed. It is more important than most Bills that we handle. It cannot be dealt with in five hours here and a few hours in Committee. I will vote for it today, but I want the Government to help me be able to vote for a good Bill at the end.

[Madam Deputy Speaker]

I ask Members to please face the Chair, so that we can pick them up on the microphones.

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

I start by commending the hon. Member for Runnymede and Weybridge (Dr Spencer) for outlining some of the complications with the legislation as it stands. I also put on record my admiration for my right hon. Friend the Member for Birmingham Ladywood (Shabana Mahmood), who has, in my opinion, been disgracefully singled out in comparison with others for her view of the Bill.

The Bill could be the most consequential piece of legislation that has been considered during my time in this House, and is at the heart of the matter of why I came into politics. Many Members have spoken about coercion and about providing a voice for people who often do not have one. It is that principle which has guided my decision to oppose the Bill. I know there are sincerely held beliefs on both sides of the debate. They can seem completely at odds with each other, but it is my firm view that everyone speaking today shares the same goal: a more compassionate society in which everyone can live and die with dignity. But true compassion should have equality at its heart. It is for this reason that I cannot support the proposals as they stand.

We must recognise the hard truth that health inequalities are wide and persistent. We know that black and minority ethnic disabled people have far worse health outcomes than the national average. I saw that at first hand when caring for my mother, who suffered with sickle cell anaemia. As a teenager, I would be by her side when she was in excruciating pain, explaining to a doctor who would not believe her when she told him that she needed life-saving medication. Sadly, that is still the reality today. I am reminded of the death of Evan Smith on 25 April at North Middlesex university hospital. Evan suffered from sickle cell too. He was in so much pain that he had to ring 999 from his hospital bed, because he was denied oxygen and basic care by the doctors. Put simply, we should be helping people to live comfortable, pain-free lives on their own terms before we think about making it easier for them to die.

Colleagues will be aware of clause 15 of the Bill, which outlines the provision for signing by proxy. I am worried that this could create issues for vulnerable groups who are more prone to coercion by family members. As many Members have said, assessing beyond doubt whether someone has been put under pressure or coerced would be difficult. If this legislation is passed, even the legal experts seem to be in disagreement on this, so I do not believe that there has been enough scrutiny. The risk of coercion will be highest for some of the most disadvantaged people in our communities. As a society, we risk pushing people to seek an early death. I cannot, in good conscience, support this.

My late mother lived with chronic illness all her life, and I knew that one day her pain would be too unbearable for her, but she did not let that limit her. She wanted to live. I do not believe that the Bill would protect the wishes of people in her situation, because freedom in death is possible only if we have had freedom in life. How can we possibly be satisfied that this Bill will deliver equality and freedom in death when we do not yet have it in life?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

If colleagues continue to work with me, I will try to get in as many people as possible.

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

Nusrat Ghani Excerpts

Money resolution
Wednesday 22nd January 2025 Commons Chamber

[The Minister for Care (Stephen Kinnock)]

I beg to move,

That, for the purposes of any Act resulting from the Terminally Ill Adults (End of Life) Bill, it is expedient to authorise the payment out of money provided by Parliament of:

(1) any expenditure incurred under or by virtue of the Act by the Secretary of State, and

(2) any increase attributable to the Act in the sums payable under or by virtue of any other Act out of money so provided.

The Government are of the view that the Bill is a matter for Parliament rather than the Government to decide. In order for the Public Bill Committee that is now scrutinising the Bill to consider the clause that would have spending implications, the Government must first table this money resolution. This is purely to allow the Bill to be debated in Committee, and the Government have taken the view that tabling this motion does not act against our commitment to remain neutral. Only the Government can table such motions, so tabling it allows further debate to happen. To assist that debate, the Government will also assess the impacts of the Bill, and we expect to publish the impact assessment before MPs consider the Bill on Report.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I call the shadow Minister, Dr Kieran Mullan.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Members should keep their contributions within scope. This is about the financial implications of the Bill if it is passed, so let us keep contributions within scope.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

To ensure that as many colleagues as possible can get in during the time allowed, there will be a speaking limit of four minutes.

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[Brian Mathew (Melksham and Devizes) (LD)]

Let me start by saying that I am in in favour of the motion, so I will vote for it, if it comes to that. However, would the hon. Member for Spen Valley (Kim Leadbeater) and the Minister consider the inclusion of two social workers on the group, made up of two GPs and a High Court judge, that assesses requests for assisted dying?

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Your contribution has to be within the scope of what we are discussing, which is the financial organisation of the Bill.

[Brian Mathew]

I was making a point about the added expense.

[Madam Deputy Speaker]

You need to get to that point very quickly.

[Brian Mathew]

There would be added expense. Social workers are trained in understanding family dynamics, and need desperately to be involved in these situations.

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[Liz Saville Roberts]

Let us imagine what the public would make of our role in this place if this legislation were to fall at this point.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. We are going to drop the speech limit to three minutes.

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[Jim Allister]

I would be happy to do so in a moment.

It is quite clear that the measures will impose huge costs on the health and justice budgets. Given the provisions in the Bill, is it impossible for that not to be the consequence, so when the Treasury Minister produces the financial information, will he include current Government expenditure on palliative care and suicide prevention, so that we can look at and balance what we are spending? The Bill invites the Government to move from funding charities to prevent suicide to becoming facilitators and providers of suicide.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Mr Allister, we must confine our remarks to the money resolution for the Bill.

[Jim Allister]

Madam Deputy Speaker, I was seeking to do that by asking the Treasury Minister to give us a comparison. What is this Bill going to cost our health service and justice system? How does that compare with what we are already spending on palliative care and suicide prevention? Those are pertinent questions and we need the answers.

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[Jim Allister]

I agree. We all have our views on the merits of the Bill, but fundamentally we have a duty to our constituents to handle public money properly. In handling that money, we must know how much the Bill will cost. When it comes to that financial statement, it must not be fudged or opaque; it must be absolutely clear and it must—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. I must now call the Minister.

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[Jim Shannon (Strangford) (DUP)]

On a point of order, Madam Deputy Speaker. The right hon. Member for North West Hampshire (Kit Malthouse) made a comment that I feel impinged upon my integrity. I have spoken to the right hon. Gentleman and he knows what I am referring to. I underlined and highlighted that the Terminally Ill Adults (End of Life) Bill Committee went into private session; some 15 Members, who support the Bill, voted for the private session and nine Members, who oppose the Bill, voted against the private session. The record must be corrected about what the right hon. Gentleman said about the comments I made about that. Facts are facts; they matter to me, as does my integrity.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Thank you, Mr Shannon, for letting me know you would be making a point of order. The Chair is not responsible for the content of Member’s speeches, but I remind the House of the advice in Erskine May on the importance of good temper and moderation in parliamentary language.

[Kit Malthouse]

Further to that point of order, Madam Deputy Speaker. There was no intent in my remarks to undermine the integrity of the hon. Member for Strangford (Jim Shannon). I may have misunderstood his remarks, but he implied that the Committee was adopting some kind of veil of secrecy over our affairs and I was pointing out to him that, in my view, that was a misunderstanding of what we were attempting to do yesterday. I am sorry if the hon. Gentleman was offended, as he knows I hold him in great affection and I had no intention to do so.

[Madam Deputy Speaker]

Thank you, Mr Malthouse. I can see Mr Shannon nodding, so hopefully your apology has been accepted.

Terminally Ill Adults (End of Life) Bill

Nusrat Ghani Excerpts

Report stage
Friday 20th June 2025 Commons Chamber

[Rachel Hopkins]

I am sorry, but we are short of time.

The changes that have been made, including many proposed by Members who do not support a change in the law but which have been adopted by the promoter of the Bill, my hon. Friend the Member for Spen Valley (Kim Leadbeater), as well as those proposed during the process she has led in response to evidence submitted during the scrutiny process have led to a better Bill. The Bill has greater safeguards for more vulnerable people, with mandatory training requirements, including in relation to coercion and capacity. The Bill ensures judicial oversight of decision making by a range of experts, including psychiatrists, social workers and senior legal professionals. The Bill will set out statutory protections for those workers who do not wish to take part in the assisted dying process on the basis of conscience, and quite right too.

The Bill will provide for one of the tightest, safest assisted dying laws in the world. Importantly, the Bill has compassion at its core by affording dying people choice at the end of life. I thank every one of my constituents who shared their views with me, whether for or against a change in the law. I particularly thank all those who have disagreed with me, because good democracy and the right to disagree respectfully is hugely important; perhaps it is a debate for another time.

I also thank all those who have shared their personal stories of loved ones’ deaths, some brutal, painful and traumatic—a stark reminder that the status quo is simply unacceptable. Others have shared experiences with loved ones who, in other jurisdictions, such as Australia, were able to have a peaceful death, surrounded by loved ones and at a time of their choosing.

As I come to a close, although not everyone would want to choose an assisted death, I believe that everyone should have the opportunity to choose one if they so wish. It really is time that this House takes the important, compassionate and humane step towards making that a reality by voting for the Terminally Ill Adults (End of Life) Bill.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

That was a four-minute speech—thank you very much. I now call the Father of the House.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Colleagues can see how busy the Chamber is, and will understand that not everybody will get in, but if speeches are longer than five minutes, even fewer colleagues will get in. I call Dr Beccy Cooper.

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[Luke Taylor]

I will continue.

Nothing I say, however, is intended to simplify the issue, and I acknowledge the fears of many that the palliative care sector is not funded sufficiently for there to be a rational and viable choice between managed care at the end of life and the choice to end one’ own life. I therefore welcome the inclusion of amendment 21, which matches my priority of the improvement of palliative care.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Ahem.

[Luke Taylor]

In conclusion, in the heart-wrenching words of Decca Aitkenhead, who wrote in The Times last week, and which I found particularly moving:

“critics of the bill have begun to frame the debate as if leaving the law as it stands does not hurt anyone. It does.”

She said that opponents

“worry about speculative, hypothetical victims—but the status quo creates indisputable, real life victims”.

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[Madam Deputy Speaker]

If colleagues do not want me coughing at the end of their speech, it is best to keep them under five minutes.

Terminally Ill Adults (End of Life) Bill

Nusrat Ghani Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Sir Desmond Swayne (New Forest West) (Con)]

On a point of order, Madam Deputy Speaker. I wonder if you can assist me as I am at a loss as to what amendment we are discussing.

[Madam Deputy Speaker (Ms Nusrat Ghani)]

I have no doubt that if the right hon. Member gives the hon. Member for Gosport (Dame Caroline Dinenage) a moment, she will address it quickly, because even Members who are contributing do not have long.

[Dame Caroline Dinenage]

Thank you, Madam Deputy Speaker. I am addressing new clause 13, which provides the strict regulation of life-ending substances and self-administering devices. That means there will be transparency about what substances are used and how they are stored, prescribed and delivered. We owe it to patients, clinicians and the public to ensure that every part of the process is governed by clinical standards and ethical safeguards. For those physically unable to swallow or self-ingest, the new clause ensures that devices to support self-administration can be safely used. Without that, we risk creating a system that excludes some of the very people it is meant to support.

While we must regulate the system properly, we must also reject amendments that would undermine or stall the Bill’s delivery. Amendment 19 proposes adding suicide prevention, the Mental Health Act and deprivation of liberty safeguards to the code of practice. As the Minister who put much of that legislation through, those are really important topics for me, but this is not the legislation to address them. Let us keep the code focused on the Bill’s core function of ensuring a safe, consistent and compassionate assisted dying process.

Amendment 20 would allow non-adherence to the code to be used in civil or criminal proceedings. That is not appropriate. Guidance is meant to help professionals navigate difficult decisions, not become a legal trap. If clinicians act negligently, existing law already applies. We should not be creating new liabilities for those acting in good faith in very difficult conditions.

I also oppose amendments 97 and 27, which would require the MHRA to license drugs specifically for assisted dying and the National Institute for Health and Care Excellence to recommend them. That would make the Bill unworkable.

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[Madam Deputy Speaker (Ms Nusrat Ghani)]

As Mr Speaker has already mentioned, in order for everybody to get in—well, in order for most to get in—we need speeches to be shy of six minutes, and interventions to be short. I call Gregory Stafford.

[Gregory Stafford]

Thank you, Madam Deputy Speaker. I am conscious of those comments and will try to limit my remarks to new clause 13 and some of the amendments to it.

The Royal College of Physicians, the Royal College of Psychiatrists, the Royal College of Pathologists, the Association for Palliative Medicine and the British Geriatrics Society have all said that there are problems with this Bill, and I have heard nothing from its sponsor, the hon. Member for Spen Valley (Kim Leadbeater)—despite trying to intervene on her a number of times—about what she has done to ensure that their concerns have been addressed. This brings us directly to a fundamental concern: namely, the means by which assisted death would be carried out under new clause 13. The impact assessment for the Bill recognises that

“The safety and efficacy of those substances used for assisted dying is currently difficult to assess”.

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[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.

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[Several hon. Members rose—]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. The hon. Lady has made it clear that she is not taking interventions at this time.

[Ellie Chowns]

The evidence shows that it is dying people themselves, facing the end of life, who wish to have the choice. Only small numbers of them will take up that choice, but it is crucial, humane and compassionate for us to offer them the choice. Assisted dying is complementary to palliative care, not contradictory, and this Bill has been through a huge amount of scrutiny—far more than any other Bill in this Session. Therefore, I deeply hope that the House will pass this compassionate, humane, clearly drafted and tightly structured Bill, to offer a dignified death to those who are facing death.

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[Andrew Pakes (Peterborough) (Lab)]

rose—

[Madam Deputy Speaker (Ms Nusrat Ghani)]

Order. Before an intervention is taken, may I put it on the record that Members should not be wandering into the Chamber and then very quickly making an intervention? Lots of Members are waiting to speak and to make interventions. Is that the case? Have you been in the Chamber for a while?

[Andrew Pakes]

indicated assent.

[Madam Deputy Speaker]

Okay, go on.

[Andrew Pakes]

I did use the facilities, Madam Deputy Speaker; I apologise for that. I am a gentleman of an age. [Laughter.]

I thank my hon. Friend for taking an intervention. We are about to reach the 80th anniversary of the landslide 1945 Labour Government, which set the NHS in train, and the 77th anniversary of the NHS. Fundamental to that is her point about the NHS being free at the point of need and being about care, compassion and life. What assessment has she made of how the Bill, if it goes through unamended, will fundamentally challenge that great victory and legacy that Labour Members cherish?

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[Dr Huq]

Will I get more time? [Laughter.]

[Madam Deputy Speaker (Ms Nusrat Ghani)]

indicated assent.

[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?