Terminally Ill Adults (End of Life) Bill

Rachael Maskell Excerpts

Friday 16th May 2025 Commons Chamber

[Liz Jarvis (Eastleigh) (LD)]

I am grateful for the opportunity to contribute to this vital debate. It is imperative that we get the Bill right and that the protections and procedures are watertight. I thank my constituents on both sides of the debate who have written to me.

I support amendment 4, tabled by my hon. Friend the Member for Harrogate and Knaresborough (Tom Gordon), which would allow those with neurodegenerative diseases to be eligible for an assisted death if they are within 12 months of dying. Nigel Hartley MBE, the chief executive officer of Mountbatten Hampshire hospice in my constituency, told me that palliative care and assisted dying are not and should not be at odds with each other. Palliative care can provide incredible support. I am very glad that this debate has reopened the national conversation about funding for palliative care. However, as I know from my personal experience with my mum, who died last March after a seven-year struggle with Alzheimer’s, sometimes palliative care can only go so far. Amendment 4 recognises that those with neurodegenerative illnesses deserve the same compassion, control and dignity as others at the end of their lives. By extending the timeframe to 12 months, they will be given more control over their ultimate decision.

I support new clause 10, which extends the right for any professional to opt out of providing assistance under the Bill, and extends the protections to a broader range of professionals who may be involved.

I also support amendments 59 and 62, which relate to training on domestic abuse. Those amendments are critical to ensuring that the co-ordinating doctor can identify signs of domestic abuse. The inclusion of training enhances the Bill’s protective framework, as no medical professional without specific and up-to-date training on domestic abuse will be able to serve as a co-ordinating doctor. Importantly, amendment 74 defines “domestic abuse” using the language of the Domestic Abuse Act 2021, which explicitly includes coercive, controlling and economic abuse.

Amendment 63 removes any ambiguity about the scope of eligibility, and makes it clear that only terminal illness qualifies under this legislation. That clarity is essential to maintaining public trust and ensuring that the Bill is not open to misinterpretation or misuse. It can be incredibly difficult for people with disabilities, and their families and carers, to get their concerns across—they can often feel unseen and unheard—so the amendment is vital.

Finally, I pay tribute to the hon. Member for Spen Valley (Kim Leadbeater) for her work on the Bill and her tremendous courage, determination, willingness to engage and resilience. As others have said, the decision before us is fundamentally about whether we believe in an individual’s right to have choice at the end of their life. I know what my mum would have said.

[Rachael Maskell (York Central) (Lab/Co-op)]

I rise to speak to amendments 26, 45 and 46, which stand in my name and the names of other Members. I am grateful for their support.

On amendment 26, hospice care is not a formulation of care, but a clinical setting where palliative care is delivered, so I trust that the House will accept my amendment in the interests of accuracy.

On amendment 45 and consequential amendment 46, the literature points to complex clinical decision making—which the subject of the Bill is—being safer if it happens in the context of multidisciplinary teams, as was advocated for by the professional bodies at the very start of the process. Such a context screens out unconscious bias and provides for clinical accountability with robust interdependency. It demands a deliberative process and it safeguards clinicians and patients with more secure outcomes. I have talked extensively to the professional bodies and clinicians, and I have read the academic evidence. In drawing on best practice, this amendment would provide such safeguards and ensure that the patient is at the heart of the process.

Members will know from the evidence given to the Bill Committee that the initial assessment is the most important part of the process, and clinicians and professional bodies do not understand why psychiatrists and social workers are being placed in a quasi-judicial role, rather than being used for their clinical and social expertise. The process makes the wrong assumptions. Without the amendments, there is a predication towards an assisted death, rather than the Bill recognising the insecure position that someone with a terminal illness finds themselves in and the safeguards that are required. There are many reasons for suicidality, and they should be explored.

In clinical practice, should someone determine that they want to end their life for whatever reason, a clinician would seek to ensure that the right professionals were involved in the care of the person, with exploration, diagnosis and, where necessary, therapeutic and pharmacological interventions.

[Sir John Hayes]

Will the hon. Lady give way?

[Rachael Maskell]

I will not. Dr Lade Smith, the president of the Royal College of Psychiatrists, could not have been clearer, and academic research says the same: when someone is in receipt of a terminal diagnosis, there is frequently an episode of depressive disorder. Dr Price said in evidence:

“Those who had a wish to hasten death were 18 times more likely to also feel suicidal”.––[Official Report, Terminally Ill Adults (End of Life) Bill Public Bill Committee, 30 January 2025; c. 275, Q359.]

They say that mental disorders are treatable. The spike in suicidal ideation and action is highest in the first few months following terminal diagnosis and then dissipates with time or intervention. Again, that is evidenced. People change their mind and no longer want to die.

As with other aspects of the Bill, poor care, poor pain management and poor symptom control—or the fear thereof—are reasons why people seek to end their life. That can be palliated. Colleagues must recognise the paucity of mental health provision given to somebody when they receive a terminal diagnosis. Often there is no psychological aftercare. People are failed, but that should not be a reason to die.

I ask for a panel, which would include a social worker, to assess the psychological needs of a patient. They are experts in detecting coercion, whether intrinsic or extrinsic, and understanding people at their most vulnerable with a fusion of complex emotions, anxiety and fear. Solutions can be found by them. There would also be a psychiatrist. Depression, anxiety and fear are natural responses to trauma, but they can be treated with the right interventions, if detected at the point that somebody expresses a wish to die, and a person can have a wish to live. The travesty of getting it wrong is unconscionable.

There would be a palliative care consultant who is registered on the GMC’s specialist register. They would understand the actions that could alleviate someone’s suffering. Evidence to the Bill Committee from Sue Ryder showed how poor provision led to someone considering an assisted death. Likewise, the president of the Association for Palliative Medicine, Dr Sarah Cox, said:

“We know that effective palliative care can change a terminally ill person’s point of view from wanting to die to wanting to live.”––[Official Report, Terminally Ill Adults (End of Life) Public Bill Committee, 28 January 2025; c. 70, Q84.]

That is evidence. It is a point I have heard from all leaders on the Commission on Palliative and End-of-Life Care. These are the specialists who know how to palliate the physical, psychological, social and spiritual problems of a patient, and they have techniques that many people have not had access to, because of poor provision.

The palliative care commission reported on Tuesday and I urge hon. Members to read its evidence-rich report, which draws on best practice. We reported that excellence in end-of-life provision is achievable, but that too many people are not getting access to it. Without that, I fear that the Bill only leads the patient down one route—to die. This is not a choice at all, but a path to an assisted death.