Thank you to everyone who has contacted me with their views and experiences regarding the Terminally Ill Adults (End of Life) Bill and assisted dying more generally. I know that this Bill brings up difficult emotions for many people and you have all been in my thoughts.

Throughout the passage of the previous and current Bills, I have met with and read evidence from a range of experts, organisations and people with lived experience: from terminally ill people and their loved ones, to doctors and clinicians, legal experts, disabled people’s organisations, and hospices and care providers.

I have continued to consider not only the benefits that the Bill would bring in alleviating suffering to those terminally ill people who want to access an assisted death, but also the context in which it occurs, the need to protect the most vulnerable and the unintended consequences it could have.

I have previously voted in favour of the Bill but that does not mean that I do not continue to hold  reservations about it. With a new Bill in front of us, I have been continuing to weigh up all the arguments and evidence in its favour and against it.

Today I voted in favour of the Bill at second reading. The primary motivation behind my vote was to enable further discussion on the issue, the specifics of the Bill and amendments which may strengthen it. I wanted to continue to engage with the Bill with an open mind, reserving my right to vote against the Bill at third reading if I came to the conclusion that this would be the right course of action.

The Bill did not pass second reading. This means that it will not progress any further. I recognise that this will be of significant disappointment to some, and relief to others. 

What is vital now is that the focus on terminal illness and end of life care does not stop because this Bill has fallen. The debate surrounding this Bill has shone a light on the harrowing circumstances that many terminally ill people face. I have always been clear that regardless of what happens with this Bill, drastic improvements and substantial funding must be provided to palliative care. The government must act on this area.

Below is a summary of my thinking about key aspects of the Bill and the context surrounding it in the run up to this vote:

The current situation for terminally ill people

Terminally ill people who would prefer to opt for an assisted death are often dying in painful and drawn out ways. Some are also ending their own lives behind closed doors, in a way that is unsafe and unregulated. This is leaving long-lasting trauma and emotional scarring for their families. Families who help loved ones to die also face the risk of criminal sanctions.

While many palliative care services are high quality, many also remain underfunded and require improvement. It may be the case that with better palliative care, which must happen urgently regardless of whether this Bill becomes law, some people with terminal illness who would currently opt for an assisted death may reconsider.

However, it is clear that even with the best palliative care, not all suffering can be eliminated, as has been confirmed by the Office of Health Economics, Hospice UK and the Association for Palliative Care of Great Britain and Ireland. Some people would still want to choose an assisted death alongside this care.

In principle, I believe that this is a choice that people should be allowed to make, under the right circumstances. 

Safeguarding vulnerable people

It is important to consider the impact of this legislation within the context of a highly unequal society, where so many people live in extreme poverty, face huge amounts of discrimination, abuse and violence, and cannot access the healthcare and social care they deserve after years of cuts and underfunding. It must be recognised that this will have an impact on the choices that people make and their vulnerability to coercion and pressure.

This does not mean that they should be denied the ability to exercise the agency they have in these situations, but that the law, and those making it, must consider how to safeguard those who are vulnerable and whether it is possible to truly do so. 

The Bill attempts to address this, and I believe that the version voted on today is stronger than that which was introduced in the previous session. Multidisciplinary review panels, consisting of a senior legal figure, a consultant psychiatrist, and a social worker, would make the final determination which must be reached unanimously, a process that I consider to be a stronger safeguard than a High Court judge as was in the previous Bill before it was amended.

However, I remain concerned about how mental capacity is assessed in the context of a decision of such gravity. I believe that the Mental Capacity Act alone is not sufficient and would want to see the Bill amended to strengthen this assessment. Similarly, I want to see additional safeguards that would categorically rule out any possibility that a person with an eating disorder (and no terminal illness otherwise) could be considered eligible under this Bill. 

Ultimately, I have reservations about whether this Bill is able to truly safeguard the most vulnerable from pressure and coercion and this is something that remains at the forefront of my mind.

Impact on palliative care

I have also had reservations about the effect that the Bill could have on the palliative care sector and the way it might be used by governments in the future. 

Evidence from other jurisdictions suggests that reductions in funding for palliative care have not occurred elsewhere. A report commissioned by Palliative Care Australia which examined what had happened in a number of countries that have introduced assisted dying found that there was “no evidence to suggest that palliative care sectors were adversely impacted by the introduction of legislation. If anything, in jurisdictions where assisted dying is available, the palliative care sector has further advanced.”

Assisted dying and palliative care are not binary choices, with those who opt for assisted dying also making use of palliative care services.

I am reassured by the evidence from other countries. However, it stands to reason that with assisted dying being a cheaper option than well-funded, high quality palliative care, there could be a risk that future governments deprioritise palliative care funding and, whether explicitly or implicitly, push people towards assisted dying. This is something that must be considered.

The potential widening of eligibility under the Bill

I appreciate concerns about the potential widening of the eligibility criteria within the Bill, something I would not wish to happen. This Bill is tightly limited to terminally ill adults who have an inevitably progressive illness or disease which cannot be reversed by treatment, and whose death in consequence of that illness or disease is reasonably expected to be within six months. 

Even if the narrowness of the eligibility criteria was challenged in the courts, the European Court of Human Rights has taken the approach that it is for Member States’ legislatures to decide policy on assisted dying, and it has not expanded the laws on assisted dying in any country to date.