Terminally ill adults (end of life) bill (3rd Reading)

On Friday, the Terminally Ill Adults (End of Life) Bill passed its third reading in the House of Commons with a majority of 23.  I made the decision to vote against the Bill. 

Before I explain the thought process behind making this decision, I thought it would be useful to recap the process.

This Bill was introduced as a Private Members Bill and was brought forward by an individual Member of Parliament rather than being sponsored as Government legislation.  This kind of legislation is also seen as a matter of conscience and therefore was a free vote and not whipped on party political lines.

I know how important this Bill has been for so many of my constituents as this has been the single largest reason for constituents to get in touch with me.  The correspondence I have received have been on both sides of this debate and I have taken time to consider my constituents’ personal accounts, lived experiences and views.  I know how difficult it will have been to share these with me. 

I have also attended multiple briefings in Parliament to listen to experts on both sides of the debate.  At the start of this process, I have been consistent in my view, I am not against assisted dying in principle.  However, I wanted to see appropriate protections in place for vulnerable people.  I also feel that people need and deserve dignity in dying, and this should include making sure there is good palliative care. 

I voted for it to progress at the Second Reading so that Parliament could review, amend and scrutinise the legislation.  I also wanted to see the evolution of the Bill on how the practical realities of how implementing a Bill of this magnitude will impact on our NHS and Palliative Care.

The Bill that was presented to MP’s wasn’t about the principle of assisted dying, ultimately Members were voting to make assisted dying a reality, according to the specific details in front of us. The vote on Friday was potentially the final time that Members of Parliament have oversight of the proposals before they become law.

Those on the Bill committee and various colleagues have done a significant amount of work to try and bring forward a piece of legislation and my decision does not detract my thanks to them in the work they have done. 

I read through the Bill line by line, and upon seeing the final version with all amendments, I was left with several questions that I was unable to resolve including:

1. Safeguards were added to the Bill during its passage through the committee and introduced by the sponsoring through various stages. Including the amendment passed last week on the prevention of discussion on those under 18.   However, there were safeguards that didn’t reach the legislation as presented, including the risk for vulnerable people, the risk of coercion and those who sadly want to stop being a burden on others.  These elements were all going to be difficult to legislate, but the Bill will also permit doctors to raise the option of assisted dying with patients, regardless of how vulnerable they might be. 

2. The lack of a duty under the Bill, for relatives to be informed that a loved one is seeking an assisted death, meaning families could be none the wiser about their relatives’ plans.

3. The Bill gives powers to the Secretary of State, who could for some cases amend significant pieces of primary legislation without parliamentary oversight. This includes the potential for the Secretary of State to make changes to s1 National Health Service Act 2006, a piece of legislation which sets out the duty of the NHS as being to “secure the improvement in the physical and mental health of the people of England”. 

4. The Bill was always going to change the role of healthcare at the end of life, but whilst I agree poor palliative care funding is not on its own a reason not to support the Bill, I think that there are unintended consequence relating to inequality. People who would have chosen a dignified death in a hospice or care home may feel that they will not be supported to do so.

5. The Bill has made some amendments to independent oversight, such as the removal of the High Court which in my view does make implementation of the Bill work in practice, however, the replacement with self-selecting panels who will make the decisions is unsatisfactory.  In addition, there has been a change to introduce a Commissioner rather than have the current Chief Medical Examiner who is already in-place to take on this responsibility.

6. The final area of concern is the role of the Private Sector. I worry about commercial interests having a role in assisted dying. In particular, the inevitability of assisted dying consultancies which will coach people around the safeguards outlined in the Bill as time progresses.

I appreciate that some of my constituents will be disappointed with my decision to vote against the bill, I also appreciate that some of my constituents will be disappointed that the bill passed at the second reading. 

The Law will now make its progression through to the House of Lords.  The process the Lords follow will mirror the process followed in the House of Commons, where there will be 2 Readings of the Bill, a Bill Committee of Lords to review the bill before the Lords hear the Bill for the Third time.  If the Lords put forward amendments to the Bill, it will be for the MP’s  in the House of Commons to accept these amendments or not.