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Assisted Dying Law — [Sir Graham Brady in the Chair]

– in Westminster Hall at 2:56 pm on 23rd January 2020.

Alert me about debates like this

[Sir Graham Brady in the Chair]

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities) 3:00 pm, 23rd January 2020

I beg to move,

That this House
has considered the law on assisted dying.

It is a pleasure to serve under your chairmanship, Sir Graham. I wanted specifically to examine the law on assisted dying as it stands, given that it affects not just those who want to have some control over the manner of their death, but those closest to them. The current law in this country simply is not working. I hope that we can begin to address today the effect of that law on terminally ill people and their loved ones, and on public servants such as doctors, health and social care professionals, police and coroners. They are all, in different ways, profoundly affected by our laws on assisted dying. I am well aware that this issue is hugely evocative, can involve issues of faith and puts the medical profession in the most difficult of positions. It is also, of course, the most personal, intimate and ultimate of decisions.

Like many people—possibly many people in the Chamber—I have been on a journey over this issue. I am not sure when it began, but I know it started with the point that it was not up to me. I did not know whether I would ever be in the position to have to make the decision, but I knew I had no right to interfere with anyone else. I suppose I could have been described then as a passive supporter, but over the years there have been several landmarks on my journey, to the point that I now see it as incumbent on me—on all of us, particularly all of us here—to ensure that our law is the best and most supportive law we can have, and that it puts the interests, needs and wishes of individuals first.

Photo of Andrew Selous Andrew Selous The Second Church Estates Commissioner

Does the hon. Lady agree that we need to be very careful to ensure that old and sick people do not feel a pressure to end their lives, perhaps from their children, who might want to inherit their assets and to whom they may feel they are being a burden?

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities)

I fully appreciate that point. That is why I am so concerned that we should have a very narrow and precise definition if we change the law. However, it has been ascertained that a third of patients who request assisted dying and meet the eligibility criteria in Oregon, for example, do not actually take the life-ending medication. They request it as an insurance policy—not because they feel they are being a burden, but because they want to have the opportunity to make the choice themselves.

As I said, there have been several landmarks on my journey to this point. The final one was just a few weeks ago, when I was chatting to a friend. We were talking about nothing in particular, but we decided that when people say, “You only live once,” they are not quite right; actually, you can have many lives. I certainly have, and I am sure many other hon. Members have. I been a journalist, a mother, a university lecturer and a politician, and I hope one day to be retired, but I will only have one death. When my time comes, I would like it to be the easiest possible for me and my family, and I would like to be able to choose for it to come at the end of a happy day.

The first step on my journey was, as I am sure it was for many other people, watching someone I loved go through an experience far from that: a long, painful death, which I still wonder about now, more than a decade later. Could it somehow have been eased? It took me years to come to terms with the emotional conflict between the despair over losing my mother and the relief I felt that she was no longer going through the pain of having her lungs destroyed a little bit every day. I have to be honest: I do not know whether she would have wanted the choice of how or when to end her life. Frankly, there would have been no point even asking, since it is not a choice allowed by the current law here, with its blanket ban, and most people cannot afford the fees to travel to Switzerland or elsewhere.

That is not in any way to criticise the standard of care in our hospitals or hospices in this country. Both provide a marvellous service.

Photo of Bambos Charalambous Bambos Charalambous Labour, Enfield, Southgate

Does the hon. Lady agree that palliative care needs to be better funded? No matter the excellent care that is provided in hospices, it is funded nowhere near well enough. Many areas do not have hospices, and we need to ensure that they are fully funded to meet the need. That would greatly assist people as they face the end of their life.

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities)

I absolutely agree. I have also experienced final moments with a loved one who was being cared for in a hospice. They were incredibly well looked after. The whole family was looked after and supported. Changing the law should not under any circumstances mean depriving anyone of the option of palliative care. Indeed, palliative care is as important as a choice at the end of life. Again, it should be available to everyone, and we should support it in any way we can.

Photo of Fiona Bruce Fiona Bruce Conservative, Congleton

What is the hon. Lady’s response to the evidence that, in countries where assisted suicide has been made legal, investment in palliative care has fallen?

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities)

I thank the hon. Lady for that point. That is something we would have to be aware of, but I believe it is up to us to address it. It is up to the lawmakers and the Government in this country to ensure that we increase our investment in palliative care as a choice. There is that word again: choice. Free will—the ability to choose.

Seven years ago, in another landmark, my belief in that was firmed up by a conversation following a newspaper article I had written. At the time, the late, irrepressible Margo MacDonald was guiding her second, ultimately unsuccessful bid to make assisted dying legal in Scotland through the Parliament at Holyrood. I originally met Margo while I was a young journalist, and her amazing personality and commitment had a huge impact on me. That did not have an impact on my politics, of course—we had very different views—but I recognised in her someone who lived their beliefs and their politics. I had spoken to her while I was writing the piece, and I visited her office afterwards. On this issue more than any other, she had a profound effect on me. It was several years ago now, but that conversation has stayed with me and made me determined to protect the right of the individual—my right; your right—to choose to have the dignity that we want in our final moments. Why should any of us, knowing that we are not going to survive, be forced to endure unnecessary pain?

Photo of Rupa Huq Rupa Huq Labour, Ealing Central and Acton

The hon. Lady is making a powerful speech. I am pleased that she has not brought any legislation before us, because I found this issue very difficult when we last faced it, in 2015. I actively abstained by voting in both Lobbies, and I was told off by the then Speaker for doing so. I get her point that saying goodbye in an airport is not the best thing for people who choose to go to Switzerland, but at the same time I worry about safeguards. This could be exploited as a shortcut if NHS funds are not as we want. Does she agree, at least, that more research is needed? Nothing seems to have happened in Parliament since 2015. We need more evidence before we decide on this.

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities)

I take the hon. Lady’s point. That is the purpose of this debate. It is intended to get the ball rolling, look for the evidence, find out what people are afraid of, and consider the safeguards we need and how the law can be improved. We are not going to do that overnight. We certainly are not going to do it today, and I will not suggest any changes today, other than to say that we should look for the evidence and at what people want from the law.

Since this debate was publicised, I have been contacted—I am sure we all have—by a number of constituents. In some cases, they called for caution; in others, they expressed their opposition. However, in very many more, they expressed support. One in particular that I found moving came from a woman who was a palliative care nurse for more than 20 years, and who during that time witnessed numerous examples of the current assisted dying law failing dying people. One example she gave was of a gentleman with motor neurone disease who had a particularly undignified final few months of life. He was cared for at home at first before moving into a hospice, where he clearly expressed the wish that he wanted help to die. The staff had to explain to him and go over the reasons why they could not do that; it simply was not possible.

This gentleman’s motor neurone disease had affected him in such a way that his legs were still working, but he was not able to use the top half of his body. One day, he tried to throw himself down the stairs as a way of ending his life. Despite him fully admitting that he was trying to end his life, some of the staff understandably claimed that he had probably fallen, and that it was an accident. Perhaps they did not want to admit or acknowledge what he had tried to do, because of the position in which the law put everyone, but that gentleman did not get to express his distress about the way he would die or have it addressed as he wanted. I understand he lived for another two months or so before he died in a hospice. I am grateful to my constituent for sharing that story because it highlights the invidious position in which the current law puts everyone.

Photo of Sarah Olney Sarah Olney Liberal Democrat Spokesperson (International Trade), Liberal Democrat Spokesperson (Business, Energy and Industrial Strategy)

Does my hon. Friend agree with me that that story highlights a key issue that we are all wrestling with: the capacity to consent? My hon. Friend has made the point clearly that this has to be a choice, and that safeguards must be in place to ensure a person has the capacity to make that choice.

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities)

My hon. Friend makes an excellent point. Capacity is important. As I have already said, it is not for me to say what the law should be; I simply ask that we address it, and that we take such points into account. I ask that we look at mental capability to make the decision, at when the decision might be made and at safeguards.

Photo of Lisa Cameron Lisa Cameron Shadow SNP Spokesperson (Mental Health)

I thank the hon. Lady for giving way and for securing this important debate. Often, when people face debilitating illness or very difficult life events, suicide may come to their minds. Does she agree that at such times, we should provide better mental health support, psychological support and counselling to enable people to come to terms with their feelings and look much more positively towards their abilities and the contribution they make?

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities)

I agree that better mental health care should be available at all points in our lives. For every decision that we have to make, we should have support. If we are allowed to look again at the current law and the blanket ban, the question of what mental support exists is the sort of thing we should look at.

As I said, I am grateful to the constituent I mentioned, because that example highlights the invidious position in which everyone is put by the current law and its blanket ban. That includes the patient who knows they are going to die, and who simply wants help to ease their way through it; the medical staff who must not help; and the families who are powerless to support their loved ones, because the law threatens them with criminal procedures.

A recent policy paper considered by the homicide committee of the National Police Chiefs’ Council showed that investigators are frustrated with the current legislation, and that families whose loved ones have had assisted deaths are losing confidence in the police and criminal justice system. Families such as the Whaleys and Ecclestons, who suffered the ordeal of court cases, are perhaps the highest profile examples of how the law fails those who are facing their final days, and fails their loved ones. Sadly, they represent merely the tip of the iceberg.

Dignity in Dying has calculated that every eight days, someone from the United Kingdom travels to Switzerland for an assisted death, with their grieving families often treated as criminals once they return. Every year in England and Wales alone, an estimated 300 people take their own lives because they are faced with a terminal diagnosis and it seems their only option. A great many more are beyond the reach of palliative care, which, sadly, needs more investment, and they die in agony. Perhaps the cruellest thing of all is that this can all be avoided if people can afford it.

The law has created a two-tier system. If someone has more than £10,000, they can travel to Switzerland or elsewhere for the end-of-life care of their choice. It is time to look at whether and how our law can be improved. There is ample evidence that the majority of the public would support a change. According to the most recent surveys, 84% would like to see a change. They want a very narrow and specific change—perhaps that addresses some of the points that have been made—for those in the final stages of a terminal illness who are mentally capable of making a decision, but they do want a change.

Photo of Jim Shannon Jim Shannon Shadow DUP Spokesperson (Human Rights), Shadow DUP Spokesperson (Health)

I thank the hon. Lady for giving way. We had a discussion today, and we have very different opinions; clearly, I do not agree with what she is saying. The answer is not legalising assisted suicide. The answer is to help, to support and to be compassionate towards families. Does she acknowledge the good work that is done by many charities, particularly Macmillan, whose compassion and love make the unimaginable a little bit more bearable?

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities)

I absolutely agree with the hon. Gentleman that Marie Curie, Macmillan and other charities do outstanding work. The people who work in hospices up and down the country, and those who provide palliative care in our hospitals, perform an unenviable role and they are beyond reproach. However, it is not my view that people should have only that choice. For me, this is about being able to decide either to have palliative care—it should be there, and it should provide support—or to make another choice. That should be up to the individual, and the law should support them in that. As I said, 84% of people, according to the most recent surveys, would support a change.

Photo of Kevin Hollinrake Kevin Hollinrake Conservative, Thirsk and Malton

As parliamentarians we are here to use our judgment, not simply to represent the views of our constituents. However, 84% of the public are in favour of a change. The last time the issue was voted on, in September 2015, 75% of parliamentarians voted against changing the law. There is concern among the wider public that Parliament may be out of step with the public on this. Does the hon. Lady agree?

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities)

I agree with the hon. Gentleman that it was unfortunate that on that occasion, Parliament took such a different position from that of the country. It is also understandable that the responsibility for making the decision is quite heavy. Many parliamentarians might like to see that change, but the thought of its magnitude perhaps makes them reserve judgment. If parliamentarians spoke to more people; if we had an inquiry and a public debate; if we had the opportunity to hear the views of the public; if we heard from the families of those who wanted to choose how to end their lives but were denied that choice by the law; and if we heard about what that had put them through, perhaps parliamentarians would have the confidence to reflect the public position.

The previous Government hinted at an inquiry into the law. When I asked about it yesterday in a point of order, Mr Speaker himself said that the time might have come for a debate. Perhaps the Minister will take the question of that inquiry back to the Government. Perhaps the time has come to think about whether the law is serving or protecting anyone. Perhaps we should have a public debate, which might allow parliamentarians to judge what is in everyone’s best interests.

I will say one last thing. Some Members may have noticed that there is a word I have not used—one that is normally central to this debate, and that is crucial to the campaigns that are going on outwith Parliament—and that word is “compassion”. That omission is deliberate on my part because, for me, there is no compassion in the law as it stands.

Photo of Graham Brady Graham Brady Chair, Conservative Party 1922 Committee

Order. Before I call the next speaker, it may helpful to say that because so many Members want to participate in the debate, I propose to start off with a three-minute time limit on contributions.

Photo of Fiona Bruce Fiona Bruce Conservative, Congleton 3:20 pm, 23rd January 2020

I will turn to the part of my speech that deals with some concerning developments from other jurisdictions that have legalised assisted suicide, as I prefer to call it. In Oregon physician-assisted suicide for the terminally ill was legalised 10 years ago. The annual Government report of 2018 stated that more than half of those applying now cite

“fear of being a burden” as their major end-of-life concern. Far fewer cite pain concerns. Disability groups are extremely concerned about what has happened, for example, in Canada since 2016. In just four years, under the law that has allowed terminally ill people to request assisted suicide and euthanasia, safeguards have been ignored, removed and extended to non-terminally ill people such as those with depression. In July a depressed but otherwise healthy man was killed by lethal injection, despite not being terminally ill. Another man who suffers from a neurological disease actually recorded hospital staff offering him a medically assisted death, despite repeated statements that he did not want to die. Only this week, on Tuesday, there was an article in The Times about three Belgian doctors on trial in relation to the euthanasia of someone reported to have a personality disorder and autism. The family believes that she was depressed but that she did not, as required by Belgian law, have a serious and incurable disorder.

The point to note is that, regardless of the wording of eligibility criteria in legislation, in practice safeguards are often discarded, and vulnerable and depressed people are assisted to end their lives. That applies in all jurisdictions that have legalised assisted suicide or euthanasia. In Canada, where medical aid in dying was legalised in 2016, the superior court of Quebec ruled last September that it was unconstitutional to limit access to medical assistance in dying to people nearing the end of life. That is particularly concerning because, while the ruling applies only to Quebec, the Canadian Government have now committed to changing the MAID law for the whole country, so it will no longer be, as was originally intended, limited to those nearing the end of life.

Photo of Karin Smyth Karin Smyth Labour, Bristol South

I am grateful to the hon. Lady for giving way; I realise that time is short. I do not have time to rebut all those arguments, and I will not do so in my speech, but will she address why more and more jurisdictions across the United States, Canada and Australia are changing the law and extending provision, if they think it is not safe?

Photo of Fiona Bruce Fiona Bruce Conservative, Congleton

Actually very few jurisdictions have legalised those issues, and the lessons that we are learning from them need to be learned now, so that more do not do so.

In Canada, for example, the Federal Government are now considering MAID for what they call “mature minors” and people with mental illness. It is easy to see from the example of Canada how quickly assisted dying laws have expanded, removing safeguards and protections for vulnerable patients. Tragically, in Belgium and the Netherlands, where the law allows euthanasia and assisted suicide, the original criteria have already been expanded to include children. Is that really what we want for the UK? Surely we can do better than that.

Rather than assisting vulnerable people to commit suicide, or administering euthanasia, we should be looking to improve palliative care provision and mental health treatment. Much has been done over recent years here in that regard, and more needs to be done. Let us keep our focus on that in this country. Marie Curie estimates that 25% of cancer patients do not currently get the palliative care that they need. That is an issue to which this House should turn its attention. I am pleased to note that Baroness Finlay has introduced a Bill in the other place to do just that—the Access to Palliative Care and Treatment of Children Bill. The UK is a pioneer in palliative medicine and a world leader in palliative care. Let us keep it that way.

Photo of Rachel Hopkins Rachel Hopkins Labour, Luton South 3:24 pm, 23rd January 2020

I congratulate Christine Jardine on securing this important debate. I am a humanist and I believe people should have complete autonomy over their own lives. As the Member of Parliament for Luton, South I am well aware of the case of fellow Lutonian Diane Pretty, whose hardship was publicised in 2002. She was paralysed from motor neurone disease and wanted to have agency, to enable her to make the decision on when and how she would die. Her appeal to have her husband David to support and assist her in her decision to die with dignity was rejected, and he was threatened with a significant jail sentence if he did. Diane’s case, and others since, show the glaring failure of current legislation. It creates an ultimatum whereby law-abiding people have to choose between supporting those they love and following the law.

It is vital that we seek to reform the current law. However, that is not to say that every example of assisted dying legislation has been successful. As has been said, we must consider how to prevent slippage and avoid a transition towards a lax law that would allow assisted dying without sufficient safeguards. Assisted dying should be an option for those who are terminally ill, and we must ensure that any legislation is not used as an alternative to effective palliative care. We have the tools to look into creating a narrow law that includes robust legal and medical safeguards, and to enable terminally ill people to have choice and access, and to have control of how they die. If we look to legislate to maximise the quality of life at the end of life, I am sure that that reform will represent a vast improvement and put an end to prolonged suffering and criminalisation.

We can guarantee only two things. We are born and we will all die, but why should someone suffer unimaginable pain to reach the point of death, when we have capabilities to allow those who are of sane mind to choose to die with dignity, and on their own terms?

Photo of Elliot Colburn Elliot Colburn Conservative, Carshalton and Wallington 3:26 pm, 23rd January 2020

It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate Christine Jardine on securing the debate and speaking so powerfully at the outset about why it is important that we are having this discussion. It is safe to say that politicians are opinionated people, with an opinion on just about everything under the sun. However, on this topic I am genuinely undecided. In my short contribution I want to talk about that conflict, which I think is felt by many right hon and hon. Members. I want to thank the Members who have so far made contributions, which have been incredibly interesting and have provided helpful insights. Like the hon. Member for Edinburgh West I also thank those of my constituents, on both sides of the argument, who have contacted me so far to express their validly held views, no matter what they were.

The battle that I am having is between two sets of principles that I think both fit well with my party, but also fit with my world view. One of them is my belief in the sanctity of human life, and my concerns about having adequate safeguards in place, and the possibility that they could be abused if a Bill were passed. I have a background in the NHS, and I am concerned that the Hippocratic oath that health practitioners take creates a very damaging conflict for them. Of course, the primary goal for all of us is to heal and improve our lives. Even with a sign-off from two separate doctors, can we really adequately say that we can protect people—that we can prevent people from feeling as if they are a burden? What test should we apply to mental capacity? How can we guarantee that mistakes will never be made about something as final as ending a life? As we have already heard, surely it is important to refocus our energies on finding cures and improving palliative care.

On the other side of the argument, however, there is something that I struggle with. When there is no chance of recovery and no quality of life at all, it seems almost cruel to let someone live with that and prolong their suffering for no reason. That represents to me the principle that people should be the masters of their own destiny, and that every individual should have the ultimate decision on everything that affects their life, including their death. So while I may not be any closer to deciding what Lobby I would walk through if the issue were to be brought to the House in the form of a Bill, I hope that any such Bill would recognise the need for adequate safeguards. If no Bill is introduced, I hope that we shall have a national discussion about how we move forward. Clearly, the status quo is not working, and we need to have a discussion about how we talk about and deal with the end of life.

Photo of Karin Smyth Karin Smyth Labour, Bristol South 3:29 pm, 23rd January 2020

I am grateful for the chance to speak in this debate. I do so not only as the Member for Bristol South, but as chair of the all-party parliamentary group for choice at the end of life.

I want to pick up the discussion where we left it at the end of the last Parliament. We were hoping for a call for evidence and to have some discussion with the Government on that. The Government said that they would continue the debate but were not currently persuaded. We can indeed debate, but ultimately only the Government can make a call for evidence; only the Government have the power to gather evidence. Only this Government can show their own compassion and demonstrate to the people of this country that compassion is not a crime.

I was privileged last year to welcome Geoffrey and Ann Whaley to the House to talk about their experiences. I do not have time today to repeat their stories, but people like Ann Whaley and Adam and Kate Wellesley are still being investigated by the police. They dreaded that knock on the door, which did come. Police officers are required to intrude on a family in the last days and weeks before the loss of their loved ones. I therefore welcome the debate that is now happening within policing. It was surfaced by Ron Hogg, a police and crime commissioner, and many police and crime commissioners are now also asking for a review of the evidence. Ron sadly died in December, but that was a powerful call about how the law is currently impacting on policing.

The current law does not offer protection. Assisted deaths are very rarely investigated. Illegal and unregulated voluntary euthanasia happens now. Current end-of-life practice is, if anything, less safeguarded than assisted dying and it is just as ethically challenging. Who decides whether someone should be sedated until death? How do doctors check that someone is not being coerced into refusing treatment? Is it right to support someone to starve and dehydrate themselves to death? I do not think so. If assisted dying laws are not proven to work, why are more and more being introduced rather than the existing ones being overturned?

My own interest in this area came from my time working in the NHS with clinicians talking to people about how to live and die. I found that it is often no one’s job to talk to people about dying, and it is very lonely for those people. Despite the care from the NHS and our brilliant hospices, 17 people a day—

Photo of Luke Evans Luke Evans Conservative, Bosworth

I thank the hon. Lady for giving way; I appreciate that time is short. It is interesting that we are in a place that deals with finalities—death and taxes—yet we never have a wider debate about what death is. As a GP, I speak to people all the time, and it is very difficult to raise the subject of death. Fundamentally, as a society, we need to be talking about what death actually is, because it is inevitable. That inevitability means that we have to answer some of these questions. Does the hon. Lady agree with me that that may well be the best place to start to move the discussion on?

Photo of Karin Smyth Karin Smyth Labour, Bristol South

I wholeheartedly agree and am grateful for that intervention from a clinical perspective, because what the hon. Gentleman describes is also my experience. Around the world, the current law does not protect the doctor-patient relationship and people are not having those honest conversations. The law does not allow the doctor to really talk to people about end-of-life choices, because people are frightened that their intention to perhaps go to Switzerland will result in someone being fearful of breaking the law.

I am not sure what the Government’s response will be today. I hope that the Minister can respond with compassion for people who are desperate for some recognition of the way the current law is not working. We cannot keep ignoring that. Asking families to retell their stories only perpetuates the trauma that they are going through. Families will keep coming forward, and their experiences are shocking—heartbreaking. For me, representing the constituency of Bristol South, the fact that only people who have between £10,000 and £15,000 spare can access safe care—in Switzerland—is equally shocking.

Is the law working now? No, it is not. Are people safer now? No, they are not. I am disappointed not to have more time to go into why that is the case. That is why, beyond the debate today, we need a review of the current law and how it is working. People need to have time to review the law. It is not working for families at the moment, and I hope that the Government will meet me and others who would like to discuss how a review might work in practice.

Photo of Desmond Swayne Desmond Swayne Conservative, New Forest West 3:34 pm, 23rd January 2020

It is estimated that some 400 people have taken their lives in the last year as a consequence of having a terminal illness. In the Netherlands, however, the service that provides assisted dying has assisted some 21,000 persons to take that route. With our proportionately larger population, are we prepared for the trajectory of increase in this phenomenon that will fundamentally change the nature of the medical profession when the clinician who brings healing is also the clinician who brings death?

The Royal College of Physicians has in the last year changed its position from one of opposition to this proposal to one of neutrality. When it took the vote of its members, more than 43% voted to maintain opposition, only 31% voted to change that to support, and 25% voted for neutrality. The college is in the absurd position of now supporting the position that was voted for by the smallest number of its members.

I have every sympathy for those who find themselves in the most awful position of having a terminal diagnosis with every prospect of an unpleasant and undignified end. They face the dilemma of whether to make the choice that has been spoken of or delay it to a moment when they may have lost the capacity to make that choice. It is a terrible position to be in, but there is no lever that we can pull to remove every aspect, every possibility, of human misery. If there were a lever, I am sure we would pull it. However, my belief is that the lever that is available to us will end up being something much, much worse. What will begin as a choice will end as an expectation. After all, Sir Graham, you would not want to be a burden, would you? Would you not actually want to follow the example of Uncle Quentin, who saved us all so much anguish and expense?

This possibility may begin with mercy killing—it ends with Logan’s Run.

Photo of Daisy Cooper Daisy Cooper Liberal Democrat Spokesperson (Justice), Liberal Democrat Spokesperson (Digital, Culture, Media and Sport) 3:36 pm, 23rd January 2020

I thank my hon. Friend Christine Jardine for securing this important and sensitive debate. Like, I am sure, other MPs, I have received a good number of emails on this subject. Many asked me to speak in favour of assisted dying, and many asked me to speak against it.

It is of huge regret to me that previous debates on such a sensitive and, for many people, deeply personal issue have become such polarised “for and against” discussions. Those who are for it refer almost exclusively to the need for people to be empowered while they still have the capacity to take the decision, so that they do not have to suffer an undignified and painful death. Those against raise concerns about the safeguards.

During the election campaign, I met a couple who pleaded with me not to vote for assisted dying. They told me about their disabled child, a child born disabled and with a life-limiting disease. She was predicted to live only a few years, but despite medical predictions, she has lived for many years and become a happy and joyous little girl. They told me about their fears that a permissive law on assisted dying could have been used to end her life even before she had had a real chance to start it. As a disability rights campaigner myself, I know that those living with a disability, or with experience of disability in their family, must be heard.

Both sides quote polls and “evidence”. One side says that it has the medical community on its side; the other says that it has police enforcement representatives on its side. For my part, I agree that the current state of the law is letting some people down, but everything that I have read over the years and recent representations from particular constituents mean that I say this with caution. As a new MP, I honestly do not know which way I would vote if there were a vote tomorrow, and I believe that scores of other MPs are in the same position as I am. And it is precisely because I do not know which way I would vote that I am in total agreement with this motion. For all of us as MPs and for the House as a whole to take an informed view, there must be an independent inquiry, so that we can take an evidence-based approach to the impact of the current law and enable those who would be most affected to be properly heard.

Photo of Martin Vickers Martin Vickers Conservative, Cleethorpes 3:39 pm, 23rd January 2020

I congratulate Christine Jardine on securing this important debate. As we always do in such debates, we have heard passionate contributions from all sides, with Members speaking from personal experience and discussions with constituents. I suspect I am no different from most Members inasmuch as members of my family have died from cancer; indeed, both of my parents did. My views are shaped to a considerable extent by my belief that life is sacred and God-given.

There will be those who will immediately say, “Why should you impose those views on the rest of society?” In actual fact, society is based on religious values—we might not think of them as religious, but that is certainly the case—and those values have shaped the law. The law must ultimately determine matters of this kind. I mentioned my parents. My mother died in a hospice, and I saw the change from the care she received prior to going there; likewise with my father. Our views are inevitably shaped by such personal and difficult circumstances.

Like Daisy Cooper, I offer a few reflections, rather than a clear direction because it would be difficult to decide how to shape a law that could cover all possible circumstances and justify a change. I do not think we can justify change at the moment, not just because I am personally opposed to it but because, as was mentioned, it would change the relationship between doctor and patient. We should treasure that relationship. Rather than opening the door to assisting us to die, patients—all of us—need to have confidence that our medical professionals are striving to keep us in good health and alive.

Photo of Fiona Bruce Fiona Bruce Conservative, Congleton

No major medical organisation is in favour of changing the law to promote assisted suicide in this country. What comment does my hon. Friend have to say about that?

Photo of Martin Vickers Martin Vickers Conservative, Cleethorpes

I thank my hon. Friend for her intervention. It is notable that most professional organisations favour the current arrangements, although, as my right hon. Friend Sir Desmond Swayne said, one of the royal colleges now has a neutral stance. That is regrettable. The key thing is that any change in that direction is a signal that society places a lesser price on the value of life.

My plea to those who favour change is to consider the relationship between the doctor and the patient, how we could frame a law that covered all circumstances and whether we would be taking a further step towards euthanasia. Society is moving towards a position where it might accept assisted dying, but the big danger is what could be the next step after that.

Photo of Ian Paisley Jnr Ian Paisley Jnr Shadow DUP Spokesperson (Communities and Local Government), Shadow DUP Spokesperson (Culture, Media and Sport) 3:43 pm, 23rd January 2020

I should declare that my daughter is an end-of-life nurse at the Marie Curie hospice in Belfast and my wife is a volunteer fundraiser for that organisation.

We will each have experience of a friend or dear loved one facing the end of life. Each of us can recount circumstances, some of which will be peaceful, some less so, some shocking and some sudden. In the midst of life we are in death. We do not continue on here—this is not our permanent resting place—and that is a shock to some people. I agree with Dr Evans that we should have a national conversation, because people wish to exclude discussion about faith and non-faith in the midst of this. Palliative care should also be part of that discussion.

Ninety per cent. of us who walked into the building today probably did not realise that we walked under a portrait of Moses carrying the ten commandments. The top one says, “Thou shalt not kill”. We are debating at what point we shall kill. The House debates it many times. Should we kill in the womb? Should we kill at the end of life? When should we do it? We have to take those tough, critical decisions, and sometimes the House gets it wrong. We should not get it wrong on this occasion.

We should not set a position on when is the right time to kill someone who is sick. We should be asking the positive, strong question: how much palliative care and support can we give people at the greatest point of need? What question does the House face? It should be about what we do to give hope, not what we do to continue with the heartache. We parliamentarians should be prepared to offer hope to people, not to say, as others have said, “You’re now a burden. It’s time to shuffle off this mortal coil.” We should be giving hope to people.

We should also not be discouraging those involved in palliative care—the doctors and nurses who train so hard to give their all. My father, my brother-in-law and my father-in-law have been in these circumstances, and I have known the people who were around them, caring for them. To be able to work with and talk to those people afterwards gives us emotional support. Therefore, in that conversation—“What is life? Where does it end and when should it end?”—we need those people to take us through that journey and not to give up. We should not be giving up on life. We should not be asking Parliament to create a law that says, “Now is the time to tell people it’s time to get off.” We should be supporting people to the very end, giving them palliative care and putting the money and resources into making that happen.

Photo of Alicia Kearns Alicia Kearns Conservative, Rutland and Melton 3:46 pm, 23rd January 2020

To discuss matters of life and death, and of choice and obligation, is to recognise the gravity of one’s role as a Member of Parliament. It is also to grasp the very essence of our moral conviction, while upholding our calling to represent the wishes of the people by whose wisdom we find ourselves here. To consider measures relating to assisted dying demands not just the fullness of empathy but the totality of our intellect.

My constituent Phil Newby is in a battle with motor neurone disease. Phil has pursued his right to die through the High Court. It stated that it was not the proper forum to discuss the matter but that Parliament is rightly responsible for deciding on issues of such fundamental importance. I have been struck by Phil’s considered and measured case, and it sits with us to make a decision.

The crux of the matter is to recognise the terror and the agony there must be in having your body turn on you, with it racking you with pain or torturing you. Those suffering debilitating terminal diseases are being robbed not just of life but of death. To come to terms with one’s own death and to depart this life in peace and dignity is a privilege that we as a society should endeavour to extend, not to limit. What is more, those facing such daunting circumstances may wish to take the decision into their own hands. I support a change in the law, but it must be the right change with the right safeguards.

Many doctors hold that assisting in death is a violation of their professional oaths and a desecration of their ethical responsibilities. For that reason, any legislation must protect the conscience rights of healthcare professionals and ensure adequate protections for them.

While I support a change in the law, it must be limited, be done after widespread governmental and non-governmental consultation, and balance the rights of those seeking dignity in dying with our obligations to protect the most vulnerable and the rights of healthcare practitioners. As many have said, we must also improve palliative care. I do not believe we face a binary choice. We can and must balance empathy and science not just for our sake but for Phil and everyone in this country.

Photo of Aaron Bell Aaron Bell Conservative, Newcastle-under-Lyme 3:49 pm, 23rd January 2020

It is a pleasure to serve under your chairmanship, Sir Graham. I congratulate Christine Jardine on securing the debate.

The status quo is not sustainable. It puts the Director of Public Prosecutions in a difficult position, and that is no way for such an important matter to be handled in law. It is for us to make the law. Whatever we do, we must do something, because the current situation is not sustainable. It is not fair on family members who are investigated and left on bail. The evidence is that the public are willing to look again, and are willing us to look again, for the reasons already given, including compassion and dignity. I do not think there is much dignity in what people have to go through to obtain an assisted death. Another reason, perhaps, is our changing attitudes to faith. There are more people without faith or whose faith is less orthodox than it was in the past.

Like Daisy Cooper and my hon. Friend Elliot Colburn, I am new here. Hon. Members who have taken part in previous debates have told me that those debates changed their minds. I recognise that exact safeguards will be difficult to agree and that if a Bill is introduced, we would have to consider them all carefully.

To conclude, although I am instinctively predisposed towards a possible change in the law, I remain open-minded. Therefore I welcome a Government-backed inquiry as an important first step.

Photo of Andrew Mitchell Andrew Mitchell Conservative, Sutton Coldfield 3:50 pm, 23rd January 2020

I congratulate Christine Jardine on what she said and the way in which she has framed the debate.

There is no doubt that opinion is moving. I myself have changed my mind completely since I arrived in this place 33 years ago. My wife is a senior an NHS GP of some 40 years standing and, after many years of opposition, she has also changed her mind. Public opinion is moving. We should put at least some of that down to the work that has been done in the House of Lords, in particular by Lord Falconer. He has deftly aired the legal, moral and emotional issues, which has led to a majority of the House of Lords being in favour of changing the law. This place has been 75% against changing the law, but there are signs of things moving, which is a good thing.

Photo of Katherine Fletcher Katherine Fletcher Conservative, South Ribble

Like my hon. Friend Aaron Bell, I am new here. I paid my way through university by working in a care home for old people. Those people were my friends and I witnessed them screaming in pain and agony, asking for a death that nobody was able to give them. Unfortunately I have also witnessed family members trying, if I can put it in northern tones, to bump them off for the money. Does my right hon. Friend agree that any proposed legislation has to protect against that absolutely? That would be key to my decision.

Photo of Andrew Mitchell Andrew Mitchell Conservative, Sutton Coldfield

I thank my hon. Friend and I hope we will hear much more from her. She expresses the dilemma on both sides of the argument extremely well. For the first time in 33 years I have drawn a place in the private Members’ ballot, although somewhat low down, so I am unlikely to trouble the scorers much. I am considering, and am talking to constituents about, the possibility of promoting a Bill for assisted dying, but the balance of the argument is as the hon. Member for Edinburgh West set out and an inquiry would be the right approach.

Perhaps it is a factor of age, Sir Graham, that over recent years you and I have seen more of our friends, families and constituents facing the dilemmas that this debate is examining. It seems to me that it is not for lawyers and judges to make these decisions, which is a point that has been eloquently made this afternoon. It is for us to wrestle to with our consciences, as a number of colleagues have said. We should do that. I can think of constituents, friends and family who, at the end of their lives, I have watched with the deepest concern and misery, and have reflected that we would not allow a family dog or a wild animal to be treated in the way in which they inadvertently ended up being treated. With all the protections that must, of course, be required, we need to wrestle with this issue.

When I feel that it is the time to go, I want to be able to choose the manner in my own way. I want that decision to be available to my constituents as well and, above all, I want it to be their decision and not the decision of the state.

Photo of Kevin Hollinrake Kevin Hollinrake Conservative, Thirsk and Malton 3:54 pm, 23rd January 2020

I congratulate Christine Jardine on securing this important debate and on her excellent contribution, which eloquently summed up the issues on both sides of the argument.

When Parliament voted on this issue in 2015, I was a new MP and was invited to various debates on the subject. A local bishop invited me to a parish church to talk to the congregation about assisted dying. He knew I was in favour of it, as I still am today. We debated the issues and were asked questions about what we proposed. I was surprised, as was the bishop, that the vote at the end showed that 80% of the people there were in favour of assisted dying. There were only about 20 people present, so it is not a representative sample.

That concurs with the public view. According to the Dignity in Dying survey, 84% of the public are in favour of assisted dying. Therefore, it is perhaps surprising that in 2015 some 75% of parliamentarians were against it. We have to be careful when we are that far out of step with the general public, as we have seen before with the Brexit debate. I was one of 22 Members on the Conservative side of the fence who voted in favour of assisted dying, and I think the Minister also voted for it. It is great to see so many new Members speaking today and sitting in the Chamber. I have a feeling that may mean that the balance of opinion may have changed in recent months.

During the election campaign I lost my mother. Her final hours were difficult, particularly when she was having some fluid taken off her lungs. It was difficult for us as relatives and for other people on the ward, as she was on an open ward and she had to have a number of surgical treatments to clear the fluid off her lungs. It was very distressing. I simply do not see why someone should have to go through that in the final hours of their life. I contrast this to the way we treat family dogs, as my right hon. Friend Mr Mitchell said in his excellent speech. Our dog, Ben, was put down. He was perfectly healthy apart from a hip problem, but that meant we had to put him down. My wife, four children and I gathered around him as a family, and he had a very peaceful end to his life.

Photo of Ian Paisley Jnr Ian Paisley Jnr Shadow DUP Spokesperson (Communities and Local Government), Shadow DUP Spokesperson (Culture, Media and Sport)

Would what the hon. Gentleman is describing take place if more resources were put into palliative care? If that happened, precedence would be given to the care, expectation, love and compassion that Members so desperately want to see, not just for themselves but for their loved ones and their families.

Photo of Kevin Hollinrake Kevin Hollinrake Conservative, Thirsk and Malton

That is a good point. I am not against more resources for palliative care, but I am in favour of choice. I think people should have the choice. My hon. Friend Kit Malthouse, who is doing much work in this area, made a brilliant speech in the 2015 debate on assisted dying. In his phrase, we should have “the dominion over” our bodies.

Photo of Alicia Kearns Alicia Kearns Conservative, Rutland and Melton

My father was a brave and strong man who built double-decker buses all his life. I lost him when I was 18 and I remember from my youngest years that his gravest fear was being trapped in his strong body and not being able to communicate. The father of one of my best friends in the world was the first person to be diagnosed with locked-in syndrome. It is about choice and being able to have some sense of control over the body, and about deserving to have that choice.

Photo of Kevin Hollinrake Kevin Hollinrake Conservative, Thirsk and Malton

I absolutely agree. I do not wish to impose my views on any citizens as to how they choose to end their lives, but I do not want anyone else imposing their perspective on the way I might choose to end my life in difficult circumstances.

Of course we have to have checks and balances. In my professional life, outside this place, I have dealt with a number of cases where there have been rapacious relatives. Where there is a will, there is a relative. We know what these things can be like, so we have to have checks and balances. Given that so many other jurisdictions have dealt with this issue and introduced legislation to allow assisted dying, an inquiry must be able to learn from the best of other jurisdictions, develop best practice and ensure that we get this absolutely right. We should do what the public expects us to do and bring forward an appropriate law on assisted dying that is fit for purpose.

Photo of John Hayes John Hayes Conservative, South Holland and The Deepings 3:59 pm, 23rd January 2020

It is a great pleasure to follow my hon. Friend Kevin Hollinrake, for whom I have great regard, but whom I disagree with fundamentally. I shall explain why in a few moments.

One of the most difficult things to come to terms with in life is the fact that it is temporary—one might say, in the great span of human existence, almost momentary. It is also difficult to come to terms with the fact that each and every life is punctuated by despair, pain, loss and disappointment. All our lives will have a share of that, and some lives have more of it than others. That is a sad fact.

In our age, it seems very unpalatable to people that that should be so. We have been encouraged, perhaps by the world we live in, by media, popular culture or the exchange of ideas, to think that lives can be made ideal, perfect, cushioned and so forever comfortable, but it is just not like that. I say to everyone in this room that if they live long enough, unless they are taken in some dramatic or sudden way, they will become weak and wizened, frail and faltering, because that is what ageing does.

Although life, as I have described it, is momentary, each moment is precious. The life of profoundly disabled people is precious, and the life of those weak, wizened, sick and infirm people is precious. Every life has value and every life ultimately ends. If that is unpalatable, then so be it, because that is the contextual reality that this debate is considering.

Of course, it is true that people on both sides of this argument want to do right by people in difficult circumstances; they are motivated by compassion. Several people have said that they are conflicted because of that. But in the end, the truth is that it is compassionate most of all to care, to protect and to prevent where we possibly can. That is the ultimate compassion: coming to terms with the temporary nature of life and the pain that I have described, and then exercising that kind of care.

It is easier to end lives. I would not for a moment accuse anyone in this Chamber of this, but there are those who, perhaps because of their bourgeois sensibilities, find it difficult to accept what my hon. Friend Katherine Fletcher says: that there are people who would take advantage and who would see this as a route to do very cruel and unkind things—not to exercise compassion, but the opposite. She described it more graphically as bumping people off; I will put it slightly differently. Some of those people would say, “You are a burden, Mother.” Mother would reply, “Do you think I really am? Am I causing you difficulty? Am I causing you disturbance and distress? Wouldn’t it be better, now that I have reached this great age, to go?”

If there is any prospect of one vulnerable person dying as a result of this change who would not otherwise do so, it is not a chance that, as a legislator and a parliamentarian, I am prepared to take. Indeed, it is not a chance that any other Member of this House should be prepared to take. The current law may not be perfect—what law is?—but I say that we should stay where we are, for anything else could be considerably more dangerous, damaging and, in the end, frightening.

Photo of Graham Brady Graham Brady Chair, Conservative Party 1922 Committee

We move on now to the Front-Bench winding-up speeches, and there should then be a little time for the hon. Lady to wind up at the end.

Photo of Imran Hussain Imran Hussain Shadow Minister (Justice) 4:03 pm, 23rd January 2020

It is, of course, a pleasure to serve under your chairmanship, Sir Graham. I thank Christine Jardine for securing this very important debate. Although I may not personally agree with her conclusion, as many of us across the House do not, I must credit her with having set out a passionate and robust case, both this afternoon and in her recent article.

I thank other hon. Members for attending—certainly, for a Thursday afternoon, this is probably one of the largest attendances I have seen in this Chamber—and for their own moving and thought-provoking contributions. We have heard many moving and personal accounts. Many of our thoughts and beliefs, and much of what drives our opinions, on this important topic come from our own personal experiences and stories. In this debate and the debate last year, hon. Members spoke powerfully of friends and family members at the end of their lives, or of constituents at the end of theirs. Bound together with our mortality and the fact that some day each of us here will pass on, hoping to do so as peacefully as possible, those experiences are what make this such a personal and hard-hitting issue.

Across the Opposition, across the Chamber and indeed across the country, as we have heard, we are split on the issue of assisted dying, with clear arguments advocated on either side of the divide. For those advocating a change in the law on assisted dying, important and pertinent points have been made by hon. Members on both sides of the House.

Time does not permit me to go through contributions from each hon. Member, but one of the first arguments put forward is that of personal liberty—that relaxing the law would grant an individual control over their own death when it would otherwise be cruelly taken away from them by a terminal illness; and that it would allow them to end what is often incredible suffering, which leaves them with little to no quality of life and forces others to watch helplessly, witnessing the decline of their friend or relative right in front of them. We have heard some very personal experiences of that here today.

The argument that to legalise assisted dying would also spare loved ones the fear of conviction for their compassion, as we have seen with a number of cases such as those of Zoë Marley and Mavis Eccleston, has also been put forward. It will continue to be, for I doubt whether anyone here, regardless of what our views may be, really wants to see an elderly grandmother or others prosecuted for honest acts of compassion. That is joined by an argument that adequate safeguards could be applied to prevent abuses of the process and protect vulnerable people, with several examples of countries and states that have legalised assisted dying put forward as a model for the UK to copy.

However, for every argument made in favour of relaxing the law on assisted dying, a counter-argument is advanced, as it has been by hon. Members in this and previous debates. Those who oppose change point out that legalising assisted dying could lead to an abuse of the system and to pressure being applied, even unintentionally, to those suffering from terminal illness. They may feel that they are, or will become, a burden on their friends, family and carers, leaving them, in their eyes, with no real choice but to end their own life in a selfless act to spare others. That point was made by a number of hon. Members.

Hon. Members also raised the point that to relax the law on assisted dying now would slowly allow an escalation in what is allowed, creating a slippery slope whereby the eventual outcomes are far beyond the reality originally imagined by those who advocate for change. They argued that assisted dying would put immense pressure and stress on doctors and families, and even on individuals themselves.

Photo of Karin Smyth Karin Smyth Labour, Bristol South

Some of the phrases that my hon. Friend has used are used across the world, although there is no evidence for many of those things—for example, that there is a “slippery slope”. Does that not reinforce the idea that, whatever people think, if we can persuade the Government to look at the call for evidence, we can air these issues publicly and get the real evidence in a process that the public, and all who participate in such care, can recognise as rigorous? That call for evidence is the real thing we should be focusing on.

Photo of Imran Hussain Imran Hussain Shadow Minister (Justice)

I thank my hon. Friend for being a strong and passionate advocate in this area. I think the whole House will acknowledge her work on this subject. A call for further evidence or an independent inquiry can only be of assistance to the broader debate. We cannot forget that the ethical and practical issues, and the threat of a slippery slope, have left even medical professionals reluctant to back any changes to the existing legislation on assisted dying.

Despite the clearly differing views in the House and in society, we are united on the principle that everyone should be able to pass on in peace, surrounded by family, friends and fond memories. That brings me to palliative and end-of-life care for those with terminal conditions, for at the heart of this debate is the matter of dignity. Indeed, much of the argument in favour of assisted dying is about the real fear faced by those approaching the end of their lives that they will lose control, that they will have their dignity taken away from them and that they will suffer in pain in their final days, weeks and months.

Sadly, for too many, that fear becomes a reality as insufficient palliative and end-of-life care, too much variation in practice and poor management of symptoms leave those who are at the end of their lives, and their friends and families, suffering unnecessarily. As I pointed out last year, the Institute for Public Policy Research found that there was considerable scope to improve the way that care is designed and delivered for those reaching the end of their lives, and that the experience faced by such people can still be poor, with medical and care staff sometimes failing to recognise that people are dying and failing to respond to their needs appropriately.

The IPPR also found that too few people were offered the opportunity to end their lives in the comfort of their own home, surrounded by their friends and family, and not in a hospital, surrounded by strangers fighting for every last breath. While talking about the pros and cons of relaxing the law on assisted dying—the arguments for and against—we must talk more about how palliative and end-of-life care is not nearly as good as it should be, and how that drives so many people to consider taking their own lives.

Time not permitting, I will sum up. I firmly agree—this is probably not a statement I will make often—with the Minister for Health, Edward Argar, who stated in response to questions in a previous debate on this issue that this is a matter of conscience and must be decided by Parliament. Of course, as my hon. Friend Karin Smyth indicated, for a matter to be considered properly, we must be properly informed and have as much information as possible.

I outlined my personal view at the beginning of this speech, and I believe that this is a matter of conscience that must be decided by the whole of Parliament. However, I hope that we can address some of the real issues at the heart of the debate—insufficient palliative and end-of-life care, and allowing those who are reaching the end of their lives to die peacefully and painlessly.

Photo of Chris Philp Chris Philp The Parliamentary Under-Secretary of State for Justice, Minister of State (London) 4:13 pm, 23rd January 2020

It is, as always, a great pleasure to serve under your chairmanship, Sir Graham. I congratulate Christine Jardine on securing the debate on such an important and profound topic so early in the new Parliament, and on the sincerity and compassion of her speech, which I know everybody here will have listened to very carefully indeed.

Whatever one’s personal view on this issue, there is no question but that Members on both sides of the argument hold strong and powerful views, which we heard expressed today with great sincerity and compassion. I thank everybody who took part in the debate. I particularly thank the new Members, who spoke with such thoughtfulness and conviction, as well as the more experienced Members, who offered their views as well, which are equally important. The debate has been an example of Parliament at its best, as we weighed up these deep and profound questions—weighing up, on one side of the argument, the sanctity of life, against, on the other side, the principle of personal choice. Few topics are deeper or more profound than those.

It may be worth my laying out the legal background to the question before us, which has not really been touched on; it is probably worth reminding ourselves of the current legal landscape. The current law on assisted suicide in England and Wales is governed by section 2 of the Suicide Act 1961, which gives a blanket criminalisation of the offence, including by “encouraging or assisting” suicide. There are no exemptions from that in statute. In Northern Ireland, there are similar statutory provisions. In Scotland, there is no statutory criminalisation of assisted suicide, but it is prosecuted as a culpable homicide, so the effect in Scottish law is, broadly speaking, the same. The law as it currently stands across all parts of the United Kingdom is that assisting or even encouraging somebody to commit suicide is a criminal offence.

The application of the law, and prosecutions for anyone suspected of assisting or encouraging suicide, is subject to prosecution policy—whether the Crown Prosecution Service in England and Wales, or the Procurator Fiscal Service in Scotland, decide to prosecute. In making a prosecution decision, with this offence as with any other, the Crown Prosecution Service and the Director of Public Prosecutions apply two tests. One is an evidential test: is there evidence that the offence has been committed? Secondly, there is a public interest test: does it serve the public interest to pursue a prosecution?

Photo of Ian Paisley Jnr Ian Paisley Jnr Shadow DUP Spokesperson (Communities and Local Government), Shadow DUP Spokesperson (Culture, Media and Sport)

Is it not the case that there are about 150 of those type of cases, but that only three are actually being prosecuted for the sinister motive that could lie behind some of them?

Photo of Chris Philp Chris Philp The Parliamentary Under-Secretary of State for Justice, Minister of State (London)

I was about to come on to precisely the figures that the hon. Gentleman refers to. Before I do, it is worth reminding the House of the current prosecution policy. It was set out substantively in February 2010 and revised somewhat in 2014. Clause 43 of those Crown Prosecution Service guidelines sets out a number of conditions that will make it more likely that a prosecution serves the public interest.

However, clause 45 lays out six conditions that will make a prosecution less likely, including: first, that the person who has died reached a voluntary, clear and settled decision; secondly, that the accused was motivated by compassion; thirdly, that the nature of the assistance or encouragement was minor; fourthly, that the accused had tried to dissuade the person dying from pursuing that course of action; and fifthly, that the matter had been properly reported to the police. If those conditions are met, the Director of Public Prosecutions would be less likely to bring a prosecution—not completely unlikely, but less likely. The judgment as to whether a prosecution serves the public interest is an independent question for the Crown Prosecution Service, or the Procurator Fiscal Service in Scotland.

Photo of John Hayes John Hayes Conservative, South Holland and The Deepings

The Minister is actually setting out—I was going to deal with this in my speech had I had longer to contribute—that the existing circumstances, far from being rigid, are very flexible. The guidance exercised and the discretion used allow a good deal of latitude in the circumstances he describes. That is a good case for not changing the law.

Photo of Chris Philp Chris Philp The Parliamentary Under-Secretary of State for Justice, Minister of State (London)

I will come on to the Government’s position of neutrality in a moment.

Photo of Chris Philp Chris Philp The Parliamentary Under-Secretary of State for Justice, Minister of State (London)

I will in a moment. I seek simply to set out, for the House’s benefit, a factual description of the current circumstances. I will first respond to the intervention of my right hon. Friend Sir John Hayes, before coming to my right hon. Friend Mr Mitchell.

As with any offence, there is a measure of CPS discretion as to whether the prosecution serves the public interest, but of course somebody who is in the unfortunate circumstances that we have been discussing today does not have any certainty, because they cannot be certain how the Director of Public Prosecutions will exercise their discretion.

Let me just go through the numbers, before I respond to the intervention by my right hon. Friend the Member for Sutton Coldfield; I think that it is worth my setting out some facts and some numbers for the House’s benefit. Between April 2009 and July 2019, the police referred 152 cases related to this issue to the Crown Prosecution Service in England and Wales; I regret that I do not have the figures for Scotland. Of those 152 cases, 104 cases were not proceeded with by the CPS; 29 cases were withdrawn by the police; three cases were prosecuted successfully; one case was prosecuted unsuccessfully, which is to say that it went to court but the jury acquitted; three cases remain outstanding; and eight cases led to prosecutions for a different criminal offence. So, just as a matter of fact—I am not expressing an opinion, but simply stating a fact—only three of those 252 cases, as Ian Paisley said earlier, resulted in a successful prosecution.

Now I will of course give way to my right hon. Friend the Member for Sutton Coldfield.

Photo of Andrew Mitchell Andrew Mitchell Conservative, Sutton Coldfield

What is so interesting about this issue is that I drew entirely the opposite conclusion to what my right hon. Friend Sir John Hayes said in his intervention. The conclusion that I drew was how uncertain this situation makes it for anyone put in this position, and how having to wait for a decision to be made at a time of great stress and misery in their life is so very wrong. That shows, I submit, that there are deeply felt views on both sides of this debate, and that it is for this House—this Parliament—to reach a conclusion.

Photo of Kevin Hollinrake Kevin Hollinrake Conservative, Thirsk and Malton

Will my hon. Friend the Minister give way again just before he resumes?

Photo of Kevin Hollinrake Kevin Hollinrake Conservative, Thirsk and Malton

I am very grateful. Does my hon. Friend the Minister agree that there is a difference between assisted dying and committing suicide? If I was faced with a terminal illness that I did not want to go through, I would happily choose for my life to be ended through the relevant medical procedures. However, I would not want to commit suicide, because I would not want my children to think that their father had committed suicide; I would not want them to live with that. So I think there is a complete difference between these two different ways of someone ending their life.

Photo of Chris Philp Chris Philp The Parliamentary Under-Secretary of State for Justice, Minister of State (London)

I thank both my right hon. Friend the Member for Sutton Coldfield and my hon. Friend Kevin Hollinrake for their very thoughtful interventions.

Perhaps I might just turn to the question of end-of-life care, hospice care and palliative care. Many Members on both sides of the argument, and indeed the shadow Minister, Imran Hussain, have referred to the importance of these types of care. I think that one thing we can all agree on is that, regardless of our position on the question of assisted dying or assisted suicide, proper provision of hospice and palliative care is essential; belief in the importance of palliative care is unaffected by and unrelated to one’s position on assisted dying. So it is very important that we ensure that those provisions are properly in place.

I am pleased to report that in 2015 the UK was ranked top out of 40 countries in terms of what is called a quality of death index, which is based on palliative service provision, access to opioids for pain relief and a national strategic approach. Very few countries have levels of integration of palliative care within wider health services similar to ours, so the UK leads the world in the quality of palliative care and end-of-life care.

In 2016 the Government brought forward the end-of-life care choice commitment. We have set out plans to improve patient choice significantly, by ensuring that more adults and children can die in the place of their choice, be it at home, in a hospice, or in hospital. End-of-life care is a key priority for the NHS, and in its long-term plan we have set out key actions to improve the care of people at the end of their life, including a £4.5 billion new investment to fund expanded community teams, which will provide rapid targeted support to those with the greatest need, including those at the end of life. Hospices are vital, and as recently as last August the Prime Minister announced £25 million of additional funding for hospices and palliative care. So Members should be in no doubt at all that, first, the United Kingdom leads the world in the quality of its palliative and end-of-life care, and, secondly, that the Government are completely committed to supporting those services.

I have tried to lay out in a factual way what the current legal, prosecutorial and palliative care landscape is. The reason that I have tried to do that in a factual way is that, as the shadow Minister has already said, it is quite right that in matters of profound personal conscience, such as this one, the Government do not take a view. The Government are neutral in the debate on this issue and have no policy position on it. Although all of us, including me, have our own personal views about this issue, the Government’s position is that it is for Parliament to decide great issues of conscience, including this one.

A number of Members have asked for a review or a call for evidence. The Government do not have any plans at the moment to initiate any review or call for evidence; our view is that it is for Parliament to act in this space. But of course it is open to Committees of the House, including Select Committees, to initiate reviews, calls for evidence and investigations, if they see fit to do so.

Of course, it is also for Parliament to initiate legislation, if it sees fit to do so. My right hon. Friend the Member for Sutton Coldfield mentioned the private Member’s Bill ballot. The last vote on this issue took place, as some Members have already said, in September 2015. The Bill proposed was defeated, but, of course, since then we have had two general elections and the composition of Parliament has changed. However, it is the Government’s position that it is for Parliament to decide on this great issue of conscience; it is not for the Government to lead in this area.

I reiterate how important and moving the speeches today have been, on both sides of the argument. I think this debate is an example of Parliament at its finest, dealing with these great issues of life and death, and weighing the sanctity of life against personal liberty and personal choice.

There are no easy answers to these questions, but I can think of no better way of resolving them than via a measured debate and a parliamentary decision. We have certainly seen a fine example of that in today’s debate, and I again thank and commend the hon. Member for Edinburgh West for her speech and for securing this debate.

Photo of Graham Brady Graham Brady Chair, Conservative Party 1922 Committee

I call the hon. Member for Edinburgh West to wind up the debate.

Photo of Christine Jardine Christine Jardine Liberal Democrat Spokesperson (Home Affairs), Liberal Democrat Spokesperson (Women and Equalities) 4:27 pm, 23rd January 2020

Thank you very much, Sir Graham, for calling me to sum up; it is a pleasure to do so.

I thank the many right hon. and hon. Members who have taken part in this debate, which, for me, showed exactly why this debate today needs to be the beginning of a debate throughout this Parliament, so that we can come to the sort of parliamentary decision that the Minister has just referred to. I hope that we can take it from his comments that we will now have a proper and meaningful debate on this issue.

I thank Mr Mitchell for clarifying, in the way that I would have done, the legal position on prosecutions, with 150 prosecutions being pursued, whereas more than 300 people have gone to Dignitas. There is a lack of clarity. The public deserve to have things made completely clear, so that they do not face having to make the most horrendous decision about their own future or a relative’s future without knowing whether prosecutions will follow. They deserve clarity.

I will just refer to two other specific points that were made. One was about medical organisations. The Royal College of Physicians has carried out the largest survey of medical opinion ever conducted. That survey showed that less than half of hospital doctors support the current law; the RCP’s elected council voted 36 votes to one in favour of moving to a position of neutrality. And both the Royal College of General Practitioners and the British Medical Association are looking again at their policies.

Ian Paisley mentioned religious beliefs, and I completely take that on board. I do not think that any of us in this place would want anyone to go against their religious beliefs or expect them to do so, but religious beliefs are a matter of personal choice. I say that because my own belief is very different to others’ beliefs, and I respect all manner of beliefs about the sanctity of life and whether we have a right to end life. And the humanist view is very different from some religious views.

I will make one final point about palliative care, and I thank the Minister for what he said about it. Perhaps the most important comment was made by both the hon. Members for Newcastle-under-Lyme (Aaron Bell), and my hon. Friend Daisy Cooper, who are two of the many new Members in this place. We have a duty to consider this issue, and to reflect on what the public might want and what the law might be. So, although all the opinions expressed here today are equally viable, we need to address the situation and come up with a fresh and accurate view about it. I hope that we can do so.

Motion lapsed, and sitting adjourned without Question put (Standing Order No.10(14)).