‘MPs would be right to vote against the assisted dying bill in light of the unfolding care crisis’

As parliament resumes after recess, the highly-controversial “Terminally Ill Adults (End of Life) Bill” will once again demand our attention. If passed, the bill would allow adults with a prognosis of less than six months to opt to have their lives ended early on the NHS. It is due to be debated and voted on at Second Reading on 11 September, having been brought back as a Private Members Bill by Lauren Edwards MP.

For some MPs, the vote will present an interesting question: if they supported Kim Leadbeater’s (near-identical) “assisted dying” Bill in the previous Parliament, should they not support this one too? I believe the answer is no. As MPs, we have a responsibility to reconsider previous decisions when new evidence comes to light. Parliamentary scrutiny has inarguably exposed unresolved problems in the Bill since the last time we were called upon to vote. This should be of significant concern to members across the House, irrespective of our party affiliation or position on the principle of assisted dying.

The Royal College of Psychiatrists, for example, has raised unanswered questions about mental illness, suicide risk and whether the Mental Capacity Act is an appropriate framework for a decision to end someone’s life. The British Association of Social Workers called for stronger and more comprehensive safeguarding, which has not adequately materialised. At the same time, the Royal College of Physicians highlighted troubling questions around equity, coercion and access to palliative care. 

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Before entering Parliament, I spent 18 years working in social care and safeguarding, including with children and families. That experience taught me that safeguarding people at risk can very rarely be reduced to the neat, box-ticking exercise that legislation can sometimes lend itself to. Pressure can be overt, but it can also be subtle. Dependence on another person, financial insecurity, domestic abuse and isolation can all shape an apparent “choice”. So too can the fear of becoming a burden to those we love, or even to the NHS. If even one person is pressured into an early death they wouldn’t have otherwise chosen, then not only will this Bill have been proven tragically flawed, but we will have failed in our duty as legislators to serve and protect our constituents – particularly those who are most vulnerable.

That pressure can also materialise from the fact that end-of-life care resources are currently very limited. Indeed, it is the ongoing care crisis that has brought Andy Burnham to take a stand against continuing the debate on this Bill, despite having supported the principle of assisted dying in the past. During his first few weeks in office, while speaking at an elderly care home, the Prime Minister rightly raised significant concerns as to whether it was appropriate to introduce assisted dying while the country’s care provision remains inadequate. After all, it is difficult to talk meaningfully about “choice” at the end of life when the alternatives to an assisted death are not reliably available.

This concern is validated by new research from over the past 12 months. In August, Hospice UK warned that at least 33 hospices in England have already made significant cuts to services, with almost 60% of hospices either making changes or considering reductions as they struggle to balance their budgets. Offering an assisted death when high quality end-of-life care is not reliably available is not a meaningful choice.

The problem is not going away. A House of Commons research briefing has noted that demand for palliative care in England and Wales is expected to increase by between 25% and 47% by 2040, as an ageing population means more people live longer with serious, life-limiting conditions. Earlier, expedited death cannot be the solution to mounting pressures.

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A lack of end-of-life care resources will impact those who suffer from structural inequalities more than others. The government’s own newly-released equality impact assessment of the bill warns that structural pressures could result in “disproportionate numbers of ethnic minority people choosing to have an assisted death” to avoid financial hardship or escape abuse. How can that be justified?

The public supports the Prime Minister’s analysis. A poll commissioned in May, surveying more than 10,000 Britons, found that 60% of the general public agreed that Parliament should prioritise fixing the NHS and improving palliative, social and end-of-life care before considering assisted dying. Only 19% disagreed. A majority supported that order of priorities in every constituency modelled.

The very purpose of parliamentary scrutiny is to bring issues to light in order for MPs to make an informed decision based on the best evidence available. Fellow MPs who supported the bill in the past should then be confident in knowing that voting for a Bill once does not mean that every subsequent version must also be supported, nor does it signal abandonment of compassion or principle to adjust your position. Rather, it simply recognises that emerging evidence is being listened to, that limitations of current contexts are acknowledged, and that new conclusions may be reached.

As we approach 11 September, we should ask ourselves this: what do we know now, in the light of months of expert scrutiny, that we didn’t before? Are we more confident, after months of expert scrutiny, that its safeguards will work? And can we really call this a free choice when good palliative and social care is still not available to everyone who needs it? 

As we weigh up the evidence before us, it surely leads us to where the Prime Minister has gone: the answer to the “assisted dying” question, is, at the very least, “not now”.

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