I would like to thank constituents who have contacted me regarding this issue and have shared their personal testimony from all perspectives. I have been truly moved by the stories that have so generously been shared with me. There is great intensity of feeling from people of all positions in this debate, and I am thinking of everyone for whom this is a particularly difficult and personal matter. 

In developing my views on this issue, I have tried to be conscious of my own biases, and I recognise that the law is not just about the rights of the individual; the law must protect everyone. My decision is based on extremely careful consideration of the evidence, including the Health and Social Care Select Committee inquiry, legal opinion, and the views of clinicians, those who are terminally ill and their loved ones, and disabled people’s organisations, which have legitimate concerns about potential unintended consequences.

A dignified death looks different for everyone and is deeply personal. For some, this will mean the choice of palliative care and end of life care alone, and for others, it would be a combination of this and assisted dying. 

The current law produces inhumane consequences for terminally ill people who wish to end their suffering through assisted dying. Those who can afford to, can access assisted dying in Switzerland, but they may have to die earlier than necessary because they need to be well enough to make the journey. They often have to go alone as otherwise, their loved ones face lengthy and distressing police investigations. 

Those who cannot afford it are left with the choice of suffering painful deaths or dying by suicide, which is dangerous and extremely traumatic for both the dying person and their loved ones.

In all scenarios under the current situation, there are no safeguards, including from coercion. As Professor Aneez Esmail, a doctor previously opposed to assisted dying who now campaigns to legalise it has stated, “By forcing people to plan these deaths in secret and in the absence of a clear legal framework, we cannot be reassured that the individuals involved are making decisions voluntarily, free from pressure or coercion, and fully informed of their alternative care options.”

I understand that there are serious concerns about the legalisation of assisted dying, some of which I share. I will address these thematically below.

Palliative and end of life care

Despite the UK’s palliative care system often being rated among the best in the world, underfunding creates huge inequalities in the care that people receive. Without urgent government funding, this is set to worsen with increased demands due to an ageing population. Hospices should not have to rely on charitable donations because state funding only meets 37% of costs. I support calls from the hospice sector for this to rise to at least 70%. 

However, The Office of Health Economics, Hospice UK and the Association for Palliative Care of Great Britain and Ireland, all confirmed that even universal access to the highest quality palliative care could not eliminate people’s pain and suffering. Some would still want to end their lives sooner. 

I also understand that there are concerns that palliative care would be deprioritised if assisted dying was legalised. However, this is not borne out by the evidence: in countries and US states where assisted dying is legalised, it was found that there is “no evidence to suggest that the palliative care sectors were adversely impacted by the introduction of the legislation… If anything… in jurisdictions where assisted dying is available, the palliative care sector has further advanced.”

But I wish to be absolutely clear: our government must not wait until assisted dying is potentially legalised; it must properly fund palliative and end of life care now. 

Safeguards

I am pleased that this Bill explicitly limits eligibility to terminally ill people, with mental capacity, if they are expected to die within 6 months, and that it specifically excludes people with disabilities or mental illness alone.

This Bill can still be strengthened. For example, I would urge Parliament to consider a different threshold and process to assess capacity than the assumption of capacity in the Mental Capacity Act and to review the provision for the use of proxies.

It may be that after the committee stage, I decide that even the most substantial safeguards are not sufficient because of the material reality of our society. That is, a society that discriminates against and devalues the lives of disabled people. It is utterly shameful that the UN found that previous UK governments have been responsible for grave or systematic violations of disabled persons’ rights since 2010. These are matters of vital and urgent importance which the government must fix, regardless of whether or not this Bill passes.

Potential widening of the law

I do not want the eligibility criteria for assisted dying to be widened. This Bill is entirely different to assisted dying laws in Canada or the Netherlands, where eligibility is based on ‘intolerable suffering’. In Australia, New Zealand and states in the USA where the criteria is based on terminal illness, there has been no expansion of the law. 

I also understand concerns that the law could be challenged in the courts on discrimination grounds because the eligibility is too narrow, which could lead to a widening of the criteria. However, 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. While Parliament should give consideration to the rulings of the courts, Parliament is sovereign and has the ultimate power to legislate.

Today’s vote does not change the law; it is a vote on whether to progress the Bill to a process of rigorous scrutiny. I voted in favour of this, and I reserve the right to vote against the Bill at third reading should I consider its provisions to inadequately safeguard the most vulnerable.

The current law is not working. It is cruel, lacks any safeguards for dying people, and the testimony I have heard has been truly harrowing. I believe in the right of the individual to choose, in the principles of autonomy and power in respect of your life, your body and your healthcare. 

The government must create the conditions in which the right for terminally ill people to die in dignity, is possible, while protecting everyone. That means urgently funding welfare and good quality palliative and end of life care, healthcare and social care – and making it our mission to end poverty, so everyone can make a free choice. This is what I will continue to fight for, regardless of whether this Bill eventually becomes law.