Terminally Ill Adults (End of Life) Bill

Rachael Maskell Excerpts

Report stage
Friday 13th June 2025 Commons Chamber

[Dame Caroline Dinenage (Gosport) (Con)]

I intend to speak only briefly. We have to be really honest about where we are, and the current situation under the legal status quo is not working. It is failing terminally ill people who want choice, compassion and control at the end of their lives.

Right now, those with the means are travelling abroad to die, often alone, away from their loved ones, without medical support, and when they can physically make it rather than at a time of their choosing. Those without the means face suffering they do not want, or try to take matters into their own hands here in the UK unsafely and illegally. It is not humane, it is not fair and it is not sustainable.

I spent two years as a Minister in the Department of Health, with palliative care and end-of-life care as part of my portfolio, so this matter came across my desk on a regular basis. I have had a lot of time to think about it. It is not easy to find an answer and a solution, but we owe it to people to try to do that. That is why I support the Bill: it brings the issue out of the shadows and into a framework of regulation with safety and dignity.

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

I do not know whether the hon. Member has yet had time to read the report from the independent commission on palliative and end-of-life care, which goes into how pain and symptoms can be palliated. Ultimately, the problem at the moment is poor care and poor provision of specialist commissioned palliative care services. Will she read that report to understand the difference that palliative medicine can make for all the examples of poor care we have heard about in these debates?

[Dame Caroline Dinenage]

I certainly will read that report. The hon. Member makes an excellent point. Palliative care is really important and needs to be improved. In many cases it makes such a difference, but it is not the solution for everybody. There are the most heartbreaking cases—I have met people in these situations in my constituency—where that form of palliative care would not have made the difference. That is why I support the Bill, and that begins with new clause 13.

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[Richard Tice]

I will not, because so many hon. Members wish to speak.

In this country we are lucky enough to have some of the finest palliative care in the world, and it is a noble aspiration to want to improve that—to be the best in the world. Nevertheless, many of us will have seen loved ones, family members and friends, suffer huge pain even given the finest palliative care. The trauma that that leaves for those left behind can be painful and enduring, which is why we are where we are.

[Rachael Maskell]

On that point, will the hon. Member give way?

[Richard Tice]

No, that would be unfair as so many wish to speak.

In considering the Bill, I think, yes, let us improve palliative care, but let us remember that choice, when faced with certain unimaginable pain, is the right thing to provide. That is why I will be supporting the Bill.

--- Later in debate ---

[Madam Deputy Speaker (Judith Cummins)]

Members need to be aware that I will start the Front-Bench speeches at 1.30 pm. I call the final Back-Bench speaker, Rachael Maskell.

[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.