Terminally Ill Adults (End of Life) Bill

Paula Barker Excerpts

Friday 16th May 2025 Commons Chamber

[Rebecca Paul]

I will not because I do not have much time.

I will move on to the lack of a best interests test in the Bill, which my new clause 16 seeks to remedy. Patient autonomy is of course important, but it must be balanced against what is in someone’s best interests. In certain situations, when it is in their best interests, treatment can be given against a patient’s will—for example, force-feeding a young girl with anorexia. It is not an easy balance to get right, but in the absence of any best interests test in the Bill, following the process rigidly would lead to devastating results in some cases.

The Bill currently prioritises autonomy of the patient in a specific moment of time, rather than what might be in their best interests in the long run. It makes no allowance for the fact that someone may feel a certain way temporarily due to other considerations. For example, when someone has just received a terminal diagnosis, it can understandably cause a depressive state and suicidal feelings, but those feelings do not necessarily last, so it may be in the best interests of the patient to allow a little time to pass, to give them a little breathing space before considering the assisted death route.

New clause 16 essentially tries to provide a best interests test by excluding certain reasons, other than the alleviation of pain, that might be driving a patient’s decision. For example, we have heard a great deal about the internal pressure from patients themselves that is driven by their concern not to be a burden, and we heard clearly in Committee that a patient could tell a doctor that they are want an assisted death only for financial reasons, and that would still be approved. We know from the experience of overseas territories that patients will often opt for an assisted death because of social and welfare issues, such as being homeless.

[Paula Barker (Liverpool Wavertree) (Lab)]

Will the hon. Lady give way?

[Rebecca Paul]

I am sorry, but I do not have much time and I wish to get through my points.

How can we be happy with a process that does not exclude such reasons? Instead of providing the support that is actually needed, the state is content to put them on a pathway that leads to their death. I hope that the House will recognise that, whether one supports assisted dying in principle or not, it is morally bankrupt not to have some kind of best interests test to protect those who are not seeking death to alleviate pain from a terminal illness.

Another group that is particularly vulnerable is those with eating disorders. In Chelsea Roff’s oral evidence, she set out that

“at least 60 people around the world have been euthanised or assisted in suicide”

with

“anorexia nervosa listed by name as a terminal condition.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 29 January 2025; c. 139, Q175.]

To paraphrase her, these were young women who were not terminally ill and had decades of life ahead of them. It is important to make the point that someone suffering—

--- Later in debate ---

I am deeply concerned that new clause 10, which the hon. Member for Spen Valley (Kim Leadbeater) has portrayed as a safeguard, does not replace or disapply amendment 341, passed in Committee, which, while removing the duty of referral for healthcare professionals, still requires them to point people in the direction of where they can “obtain” information and have a “preliminary discussion” about assisted suicide. Indeed, the new clause not only does not repeal that requirement; it reinforces it.

[Paula Barker]

Will the hon. Lady give way?

[Carla Lockhart]

No, I will not give way because of time.

The new clause would not affect any duty relating to a requirement to provide information. That concern over conscience was raised earlier this week by the Royal College of Psychiatrists in its press release, which announced its opposition to the Bill and set out its concerns that clinicians are still required to signpost patients to information on assisted suicide. It noted:

“For some psychiatrists who wish to conscientiously object, this would constitute being involved”

in the assisted suicide process. New clause 10 will not allay such concerns. When those representing clinicians express such concerns, we ought to listen to them—listen to the professionals. I encourage Members to listen to the royal college and the 250 GPs opposed to the Bill.

Turning to amendment 101, I have a word for our Down’s syndrome community. In a statement published on 9 May, the Down’s Syndrome Research Foundation said:

“We are deeply concerned about the risks of coercion and undue influence. In particular, people with Down’s syndrome and intellectual disabilities are at significant risk of coercion and undue influence, in part because of their need to trust and rely upon caregivers and medical professionals.”

I cannot comprehend why the hon. Member for Spen Valley declined to accept an amendment in Committee that would have provided explicit protections for people with Down’s syndrome. Again, that highlights the flaws and the risk of coercion. The reality is that vulnerable people who are more prone to coercion—for example, people with learning difficulties or a history of depression—have not been explicitly protected in the Bill.

This Bill is not safe and cannot be fixed. It is weaker than it was before the Committee began, and I encourage all concerned Members to recognise that it is flawed and that no amendments or tightening up will ever make it right to legislate to end one’s life with a legal drug.