Thank you for writing to me about the Terminally Ill Adults (End of Life) Bill.
I am incredibly grateful to the many hundreds of constituents who have written to me over the last few weeks to share their experiences and voice their support or opposition to this Bill. Many of the emails have been incredibly personal, poignant and emotional, and I’ve wept more than once.
I am grateful too for your patience as I work through my own thinking on this legislation, which would, if it passes, bring about a very profound change in our society. Like many MPs, I feel the weight of this decision very acutely and consider it a huge responsibility to ensure that I am confident in the decision I take.
My voting intention for the Second Reading of the Bill
I know that many constituents are keen to know how I will vote this coming Friday 29th November.
At the outset, I’d like to explain that this week’s vote may not be the final vote on the Bill. That vote could be many months down the line. The vote this Friday 29th November is about the principle of the policy. It is not uncommon, on these types of Bills, for some MPs to vote for the Bill in order that it can receive more time for debate and scrutiny – even if they are unsure about the principle itself. If Parliament votes against the Bill, then it will not progress. You can see the stages that the Bill would need to pass here.
In short, I have still not come to a decision on the merits of this Bill. Notwithstanding, it is my intention to vote for the Bill this Friday in order that it can proceed for further debate and scrutiny, but don’t yet know what conclusion I will reach if, and when, the Bill returns for a final vote by MPs.
I would like to share my thinking so far:
Conscience vote
The vote on this Bill is a conscience vote. There is no party whip. Every MP of every party and none will have to make up their own mind.
In terms of my own personal values, I’ve always believed in freedom and the freedom to choose. I believe that each of us should have freedom over our own bodies, but there are questions about how free that choice is for some vulnerable people, and the scope for abuse.
Since being first elected, I have supported calls for the law in this field to be reviewed as it is badly letting some people down.
I have also said before that my instinct would be to support measures to allow assisted dying, subject to the scope of any given bill, and the detailed safeguards within it.
Over the last few weeks, I have felt horribly conflicted. I have read this specific Bill and the accompanying notes. I have read the House of Commons Health and Social Care Committee Inquiry Report on Assisted Dying / Assisted Suicide, published on the 29th February 2024. I have attended a Q&A meeting with the sponsoring MP of the Bill and have read a number of written briefings from expert organisations – both for and against. I have also read every single email from you, my constituents.
I have questions about the provisions in the Bill as they related to capacity and coercion and will be paying particular attention to these issues in the debate and if the Bill progresses through the next stages.
Time for debate
You may be aware that this Bill is being introduced by a backbench MP, using a “Private Members Bill.” It is not a government Bill. When the private members Bill was first announced, I was concerned that there may not be enough time for it to be debated. I signed a cross-party letter to the Prime Minister, asking that he set time aside for the Private Members Bill to be debated during government time, rather than just on sitting Fridays, which are allotted to backbench MPs.
When challenged about this in the House of Commons Chamber, the Leader of the House explained that if Parliament does vote for the Bill, then it will spend several weeks being debated in Committee, when MPs can table amendments, and it would likely not return for another vote until next April. This was reported here.
I’m therefore reasonably satisfied that there should be enough time for this Bill to be scrutinised and I am no longer objecting on this basis.
Scope of the Bill
It’s clear to me that the scope of the Bill has been very tightly limited. It will only allow adults aged 18 and over, who have mental capacity, are terminally ill and are in the final six months of their life, to request assistance from a doctor to end their life. The applicant must be resident in either England or Wales.
As currently worded:
It would not be available to children.
It would not be available to adults solely on the basis of unbearable pain (as it is in some other countries).
It would not be available for assisted dying “tourists”.
It is also worth highlighting that an individual would need to choose to apply for the assistance; and even then, could choose not to proceed with it. There is no obligation on someone to either apply or if they do, to legally proceed with it.
From all of the correspondence I’ve received, the argument for giving people who are facing death, some degree of control over the timing, location and people who will surround them, was incredibly powerful. Thank you for sharing your testimony.
Some people have written to me asking that I campaign for the scope to be widened to those who also suffer from insufferable pain. To those of you who wrote to me about the unbearable pain you are currently enduring – I’m so incredibly sorry, and my heart goes out to you.
Others have expressed concerns about the Bill leading to a “slippery slope”, referencing Canada as an example of this.
Having made enquiries about this, I understand that the UK Parliament’s legislation works differently to some other countries. Once a Bill becomes law, the Title and scope of the Bill cannot be amended. This Bill is tightly limited to people with a terminal illness – in the title of the Bill. So long as the title of the Bill is not changed before it becomes law, then I believe it is tightly worded enough (referring to Terminal Illness only) that it will guard against any ‘slippery slope’.
Palliative care
A number of constituents have argued that palliative care should be improved, instead of providing for assisted dying.
I am hugely sympathetic to the cause of improving palliative care. Some of you may know that I am an Honorary Patron of a local hospice and that since I was first elected, I have pressed Ministers – of the last government and this one – on hospice funding and services, in particular.
Having researched this issue, I have concluded that it is not an ‘either or’ question. Some (albeit not all) jurisdictions that have introduced a form of assisted dying have seen their palliative care improve. And just in the last few weeks, I’ve been struck by the fact that the issue of good palliative care – which has been long ignored here in the UK – is now finally being spoken about and perhaps finally getting just some of the attention it deserves.
I have also read and heard powerful testimony about people who died in deeply traumatic and undignified circumstances where palliative care could only do so much: whilst it reduced pain it could not ultimately stop the mechanical cause of death. Some of you wrote to me describing the horror of seeing a loved one choking to death – either from a tumour in their throat or vomiting their own excrement. The limits of pain relief are clear. The trauma and PTSD arising from those excruciating final moments, which continue to affect you and your families, is palpable. I’m sorry that you have relived this horror again in writing to me but am immensely grateful that you found the capacity to do so.
Capacity and coercion
These are the two areas where I have reservations and questions.
Currently, the Bill requires that an assessing doctor has any doubt as to the capacity of the person being assessed, they “may” – not “must” – refer the person for assessment. Having made enquiries, I am not currently satisfied that this wording is sufficient. I am acutely aware that for people with learning disabilities, capacity is not always black and white. Many people have capacity for some things, and not for others. And whilst people with learning disabilities should be able to exercise the same rights as non-disabled people with a terminal illness and six months to live, I am not yet reassured that this safeguard is sufficiently strong.
Similarly, the Bill currently requires that the referral is to someone registered in the specialism of psychiatry in the Specialist Register or who otherwise holds qualifications in “or has experience of the assessment of capability.” Having supported learning disabled adults through capacity assessments, I am yet to be convinced that this wording on qualification is sufficiently strong. I’m also currently of the view that there should be a requirement for compulsory specialist training. I will be making additional enquiries.
If you would like to make any additional representations on this point, they would be most welcome.
With regards to coercion, I have read carefully the emails from constituents who describe their concern that older relatives in particular may feel “like a burden”. I’m acutely attuned to this concern too and will follow the discussion on it during the debate.
Parliamentary debate
I will listen to the debate on Friday carefully and if the Bill does pass to the next stage, then I will keep a keen interest in the Bill as it passes through the committee stage.
I recognise that this is a hugely emotive subject. As I say, I’ve received hundreds of representations from individuals, including from religious and medical viewpoints, both for and against. As I’ve researched the issue, read and heard testimony, I’ve been moved to tears too.
I feel the weight of this decision very keenly. And I’m acutely aware that if we parliamentarians get it wrong, then it will be on our conscience forever. That is the nature of a conscience vote.
It is my intention to cast a vote – for or against – rather than to abstain. I’m grateful for your patience and understanding as I follow the deliberations closely, and grapple with my own conscience.
I hope that the explanation of the detailed consideration I have given to the issue so far reassures you that I am taking this issue very seriously and that I am committed to being transparent with you about my thinking as it develops, and my current voting intentions.
For clarity, it is my intention to vote for the Bill this Friday in order that it can proceed for further debate and scrutiny, but don’t yet know what conclusion I will reach if, and when, the Bill returns for a final vote by MPs. Thank you all again for your correspondence.