Rob Marris
Main Page: Rob Marris (Labour - Wolverhampton South West)Department Debates - View all Rob Marris's debates with the Ministry of Justice
Assisted Dying (No. 2) Bill
Rob Marris Excerpts(8 years, 7 months ago)
Commons ChamberRead Full debate Read Hansard Text Read Debate Ministerial Extracts
Rob Marris (Wolverhampton South West) (Lab)
I beg to move, That the Bill be now read a Second time.
I thank all Members for giving up their constituency Friday to take part in this debate. I also thank Lord Falconer, who was the original author of the Bill, and Dignity in Dying—I have never been a member, but it has given me assistance on the Bill. I would also like Members to pass on my thanks to their staff, who have been dealing with quite a large volume of correspondence in many constituencies. Now we have got that vote out of the way, I hope that today will see Parliament at its best, with an open debate and a free vote on a matter of conscience.
I will take interventions, but, as you have requested, Madam Deputy Speaker, I will take very few because so many hon. Members wish to speak. So that hon. Members have some idea of where I am going and when I may address particular issues of interest to them, let me say that my speech is in three parts. I will start with the context of the debate, move on briefly to the content of the Bill and then seek to address the concerns that many people have raised with me.
The context is that the current law does not meet the needs of the terminally ill, does not meet the needs of their loved ones and, in some ways, does not meet the needs of the medical profession. We have amateur suicides and what is technically illegal assistance going on, and those who have the means to do so are going off to Dignitas in Switzerland. In the Tony Nicklinson case, the Supreme Court recognised that there is a problem that needs to be addressed by Parliament.
Fiona Bruce (Congleton) (Con)
If I am correct, in the Nicklinson case only two of the judges recognised that there was an issue. Seven of the judges—the majority—indicated that the law on this is in accordance with the margin of appreciation under the European convention on human rights, and that has recently been confirmed by the Strasbourg Court.
Rob Marris
My understanding is that five judges expressed grave concerns about a possible breach of article 8 of the convention.
The Supreme Court has indicated that Parliament should address this issue. We have a situation in which Directors of Public Prosecutions—principally, the previous DPP, my hon. and learned Friend the Member for Holborn and St Pancras (Keir Starmer), who hopes to speak today—have felt it necessary to issue pages and pages of guidelines on when it would be in the public interest not to prosecute in possible cases of assisted death. It is time for Parliament to grasp the issue.
Social attitudes have changed in the past 50 years. As politicians, we all know not to rely too much on opinion polls. However, opinion polling of 10,000 people by Dignity in Dying, carried out independently by Populus, has suggested that there is extremely strong support for the kind of measure I am proposing.
Susan Elan Jones (Clwyd South) (Lab)
Can my hon. Friend tell the House why he thinks that so many disability organisations and the British Medical Association are opposed to the Bill?
Rob Marris
Many disability organisations appear to think that this Bill has particular relevance to those with disabilities, but it does not. Disability is not an illness—it is rather old-fashioned to suggest that it is—and disability is certainly not a terminal illness. Despite repeated requests from its members, the British Medical Association has refused to debate this issue since 2012, and it has refused to poll its members. That is regrettable. In that context, The British Medical Journal editorial supports the Bill.
Andrew Bridgen (North West Leicestershire) (Con)
Will the hon. Gentleman give way?
Rob Marris
No, I will not for the moment. I must make some progress.
I respect the views held by people who are strongly opposed to my Bill. I share their motives for wanting a better society and to ensure that we have a law that protects people. On the tube this morning, I stood next to a man in a hoodie on which it said, “Understand difference”, which I thought was quite appropriate. This debate is not about opinion poll numbers; it is about a matter of conscience, ethics and the kind of society in which we live. We need such a debate, and Parliament should not only debate this issue today when 85 hon. Members wish to speak but scrutinise the Bill in Committee in detail, and it should come back to the House for further scrutiny.
John Pugh (Southport) (LD)
Will the hon. Gentleman clarify something that has been bothering me? He has called this Bill the Assisted Dying Bill but there is not a person in this room who would not assist the dying. In the interest of clarity, why did he not call it the assisted suicide Bill?
Rob Marris
It is quite simple: it was called the Assisted Dying Bill in the House of Lords. I refer hon. Members to the Bill’s long title, which is often overlooked:
“A Bill to enable competent adults who are terminally ill to choose to be provided with medically supervised assistance to end their own life.”
I think that is pretty clear.
Rob Marris
I am sorry but I must make some progress. The Assisted Dying Bill has a clear process with multiple safeguards. I will briefly go through that because there has sometimes been confusion about what I am and am not proposing. The Bill covers a patient who is terminally ill, which involves a prognosis of less than six months.
Helen Jones (Warrington North) (Lab)
The Bill is founded on the belief that it is possible to predict the time of death accurately up to six months. In fact, most doctors would say that that is impossible. It is certainly impossible to predict death beyond a week or two. Is that not the case?
Rob Marris
My hon. Friend, like me, is a solicitor, and she will know that professionals commonly give advice on a balance of probabilities. That is the same for medical professionals. On the gross statistics, when errors in prognosis occur for the terminally ill, it is usually an overestimate of life expectancy.
The second point is that the patient must be aged 18 or over and ordinarily resident in England or Wales. The patient must be of sound mind, and must voluntarily sign a declaration that they wish to embark on this process. Then the attending doctor, as defined in the Bill, countersigns the declaration—
Barbara Keeley (Worsley and Eccles South) (Lab)
Will my hon. Friend give way on that point?
Ms Gisela Stuart (Birmingham, Edgbaston) (Lab)
Will my hon. Friend give way?
Rob Marris
No. I will make some progress. The doctor countersigns the declaration that the patient is terminally ill and of sound mind, is acting voluntarily, and has been informed of palliative and other care available. A second independent specialist doctor with expertise in that area countersigns that declaration. If a medical person has a conscientious objection to any of that, she or he—quite properly—does not have to participate in any way. Having had the signature of two doctors, the declaration has to go to a High Court judge. If the High Court judge agrees and makes an order, there is a 14-day cooling off period.
Mr David Jones (Clwyd West) (Con)
On the High Court judge’s agreement, what independent inquiries does the Bill provide for that judge to make?
Rob Marris
Like many Bills it does not fetter the discretion of the High Court judge. It is up to the High Court judge what inquiries they feel it appropriate to make. After the 14-day cooling off period, if the patient still wishes to proceed a medical person takes the lethal medicine to the patient and waits. At that point the patient could decide not to proceed. The medical person stays there until that decision is made. If the patient decides to take the lethal medication, the medical person waits there. If the patient decides not to take the medication, the medical person takes the medication away. There is no question of it being left on the premises.
Ms Stuart
I held two public meetings, including one at the Birmingham Medical Institute. This part of the Bill worried the medics most and they were deeply opposed to it. They said, “If I am the attendant medic, what do I do if the person starts choking? Do I intervene?” They felt that it put them in an absolutely impossible situation. What is the answer to that?
Rob Marris
That has not been the experience in other jurisdictions.
The operation of the Bill will be monitored by the chief medical officers of Scotland and Wales who will lay an annual report before Parliament. For further reassurance, there is a sunset clause of 10 years. Those are the contents of the Bill.
Sir Peter Bottomley (Worthing West) (Con)
The hon. Gentleman introduced the idea of comparison with foreign jurisdictions. The Netherlands has a different law from ours, introduced originally on the same basis. When it was introduced over 10 years ago, on euthanasia, there were 1,600 deaths a year; now there are 4,100. On a UK scale, that would be 15,000 so-called voluntary medically assisted suicides a year. Are those the sorts of numbers the hon. Gentleman recognises, or is he saying we will not be like that?
Rob Marris
The Bill is not about euthanasia; it is about the self-administration of lethal medication at the end of life. [Interruption.] I hear an hon. Gentleman chuntering about Dignity in Dying. If he recalls, I said I have never been a member of that organisation. It may have other agendas. This Bill is not about euthanasia.
Siobhain McDonagh (Mitcham and Morden) (Lab)
Does my hon. Friend accept, however, that there are people who will be voting with him today for whom this is the start of the process? I went into the Lady Members room on Monday night to see a Minister and one of my own Back Benchers, who is here today, talking about how this is a start. They are coming here to vote today because they want something much more permissive in the future.
Rob Marris
My hon. Friend knows the constitution of our country. If someone wants to change the law in another way, they will have to have the guts to introduce another Bill to this House.
Rob Marris
I will not; I must make some progress. I am conscious of the time.
I appreciate that in England and Wales the medical profession is divided on the Bill, and that, probably, the majority are against. However, as far as one can tell, there is a significant minority who are in favour of the Bill, some of them, one suspects—this is what polling indicates—because they would themselves like to have the proposed option were they terminally ill. There is no contradiction between what is proposed in the Bill and having widespread high-quality palliative care. It is not a contradiction; it is not a question of one or the other. A minority of patients’ needs cannot be met through palliative care. Despite the best efforts of palliative care from professionals, those patients keep suffering.
Dr Tania Mathias (Twickenham) (Con)
The Assisted Dying Bill can be debated only when we have universal, high-quality palliative care. In my constituency I have Shooting Star Chase, which is internationally top level. That is essential to giving people real choice if they were ever to consider assisted dying.
Rob Marris
I want good quality, widely available palliative care and I want people to have the choice, but I do not think the House should be holding terminally ill people hostage until we get good palliative care. The availability and funding of palliative care are not in my hands.
Rob Marris
No, I must make some progress. I am sorry.
The European Association of Palliative Care says there is no correlation between the quantity and quality of palliative care in any jurisdiction and whether or not that jurisdiction has legislation like or similar to the Bill. The legislation I am proposing today, as many Members will know, is broadly based on the Oregon Death with Dignity Act, which came into effect in 1997. It has been in operation for 18 years. My Bill has the additional safeguard of judicial oversight.
When the Act was passed in 1994, the Oregon Hospice Association was strongly opposed to it. It has reversed its position, and it now recognises—in my view correctly, although I am not an expert—that assisted dying is one of the choices that ought to be available to dying people. In Oregon, 90% of people who have an assisted death—0.25% of those who die each year—are enrolled in hospice care, and Oregon is ranked among the best states in the United States of America for palliative care provision.
Sir Edward Leigh (Gainsborough) (Con)
Would the hon. Gentleman care to comment on the Wagner case? Mrs Wagner was encouraged to take assisted suicide, rather than chemotherapy, on the grounds of cost. It worries many of us that market forces and family pressures will promote ever more assisted suicides.
Rob Marris
I will take a detour for the hon. Gentleman, because there are urban myths. Barbara Wagner was a 65-year-old lifelong smoker with lung cancer, who was insured—this is America—under the state plan. Her doctor prescribed medication that cost $4,000 a month which had an 8% chance of extending her life by four to six months. Her insurance health plan did not cover treatment where there was less than a 5% chance that the patient would be alive after five years. When she told her health plan provider that she would not be paying for the treatment, it informed her that one of the other options was the Oregon Act. It should not have done that, and it has since revised its notification process.
I am told that depression is often present among those who have a terminal illness. That is not surprising; if I had a terminal illness, I think I would get depressed. It is up to the two doctors to determine whether depression has driven someone to make this choice, or whether it is a free choice, and if those doctors have doubts, they can refer the patient, as part of the process, for an independent psychiatric evaluation.
Another concern is that patients will feel that they are a burden on their loved ones or the health service and so wish to exercise this option. I hope that patients do not feel that, but I cannot guarantee it. It is patronising and wrong to say that someone should be denied the choice because one factor in their decision making is that they would feel that they are a burden. They should have the choice.
Joan Ryan (Enfield North) (Lab)
To say that we hope that they will not feel a burden is not a reassurance, because hope is not enough. There is evidence that under the Death with Dignity Act in Washington state, 59% of people who went down this route felt that they were a burden on their family and friends. In Oregon, which my hon. Friend refers to as the model for the Bill, that figure is 40%. This is unacceptable.
Rob Marris
If my right hon. Friend looks at the figures again, she will find that for those people she mentions burden was not the major factor, but it was a factor, and people should be allowed to make a decision.
Rob Marris
No, I must make some progress now. I can take no further interventions, I am afraid.
The coercion of the vulnerable is the most difficult issue, for me and many people in the House and outside. That is where the context in which the Bill is being put before the House should be borne in mind. This Bill provides protection for the living. What we have at the moment is protection for the dead when it is too late. It is only after people die in questionable circumstances that the police and the prosecuting authorities investigate, and then a decision is made on whether a prosecution would be in the public interest. I make no criticism whatever of the prosecuting authorities or the police, who are doing the job and fulfilling the role that we in Parliament have asked them to do, but they are doing it after the fact—and the fact is that in many cases there are only two witnesses to what happened when the person died, and one of those witnesses is dead. There are safeguards in the Bill for the living: the two doctors and the judge.
In Oregon, there is not one documented case of abuse or misuse. There are many rumours and urban myths—the Barbara Wagner case is one of them. No one there has ever been charged with a crime. The Oregon health authority collects the data quite properly each year, as would be the case for chief medical officers under this Bill, and there are no documented reported cases of abuse in Washington state, Montana or Vermont.
The fact that other jurisdictions have this sort of legislation is not per se a reason for England and Wales to have it, but it does provide a significant body of evidence for us to look at. That evidence is felt so significant that in California it is likely that later today the upper chamber will sign off an assisted dying Bill and it will be sent to Governor Jerry Brown for signature. The indications are that he is very likely to sign it.
Rob Marris
No, I said I could not take any more interventions.
Let me quote from a report by Barbara Coombs Lee, published in the Annals of the New York Academy of Sciences, entitled “Oregon’s experience with aid in dying: findings from the death with dignity laboratory”. Barbara Coombs Lee declared no conflict of interest when she submitted that paper, although I have to tell Members that she is involved with Compassion & Choices in Denver Colorado. The paper was published in July 2014. I hope, Madam Deputy Speaker, in light of the need for evidence, that you will show me some latitude in quoting not at considerable length, but at a little more length than is usual. She says:
“The data set from a variety of sources confirms that those who complete an aid-in-dying request are equally divided between genders and mostly white, well educated, insured”—
this is the United States—
“and receiving hospice services. Several commentators who articulated concerns about the DWDA—
the Dying with Dignity Act or the Oregon Act—
“have publicly stated that their fears about abuse of the vulnerable have not materialized. One commented, ‘I was worried about people being pressured to do this. But these data confirm that the policy in Oregon is working. There is no evidence of abuse or coercion or misuse of the policy.”
Ten years after that Act had been in operation in Oregon, the University of Utah examined its operation and the data arising from it. I quote from it prudently again. The university
“found no evidence of heightened risk for the elderly, women, the uninsured, people with little education, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses or racial or ethnic minorities. The only group disproportionately represented among aid-in-dying patients was people with AIDS.”
It continued:
“The executive director of the disability advocacy group, Disability Rights Oregon testified before the American Public Health Association in 2007 that he had no knowledge of any cases in Oregon to contradict the findings of that report.”
[Interruption.] One of my hon. Friends says from a sedentary position, “So it is about disabled people.” No, it is not about people with disabilities. However, I understand, and so did the author of this report, that there are concerns and that is why that evidence has been looked at, and I seek, as did the author of that report, to allay those concerns.
Lord George Carey, the former Archbishop of Canterbury, has said:
“There is nothing sacred about suffering, nothing holy about agony, and individuals should not be obliged to endure it.”
I agree with him.
When we talk about choice, some hon. Members need reminding of section 1(4) of the Mental Capacity Act 2005, for which many Members present today, including me, voted. That subsection states:
“A person is not to be treated as unable to make a decision merely because he makes an unwise decision.”
We need to bear in mind that different people faced with the same set of circumstances on occasions make different choices, and at the moment the law in England and Wales has not got the balance right between protection and choice. My Bill would provide more protection, particularly for the living, and more choice. Most of those who would fulfil the criteria in the Bill will, for faith or other reasons, never choose an assisted death. I do not know whether I would, if I had a terminal illness and a prognosis of less than six months, but I and many others would find it comforting to know that the choice was available—to have the option of choosing a dignified and peaceful end at a time and place and in a manner of my own choosing at my own hand.
There has been a trend in our society, which I support, that if the exercise of a choice does not harm others, in a free society we should allow that choice.