Hansard

Amendments in this group get to the heart of some of my concerns about the bill as drafted. Without support to ensure the equality and human rights of all, we could end up legislating to make it easier to die than to live and to deepen some already entrenched inequalities.

Some amendments in the group highlight the societal factors that could lead to someone believing that it is easier to die than to go on living: a lack of care, poverty or financial hardship, social isolation or loneliness, feelings of being a burden, breakdown or loss of significant personal relationships, inadequate or unsafe and insecure housing, pain that is untreated, palliative support that is not there, or inequalities denying access to that support.

I recognise that members have lodged amendments in the group with the intention of tightening the criteria and clarifying them in an effort to strengthen safeguards in the legislation. I will address those amendments in turn.

First, I will talk briefly about the amendments in the name of Daniel Johnson and Bob Doris that would introduce a six-month timeframe until death. I would also like to associate myself with some of the comments that Bob Doris has just made on the record about what is in the policy memorandum for the bill, and I would note that, as the bill stands, it does not deliver on that.

I know that the amendments in this space are well intentioned. However, throughout committee scrutiny of the bill, we heard from a number of experts—whose evidence has been repeated in the chamber this afternoon—about the difficulty and indeed, the near impossibility, of accurately predicting how long someone has left to live. In evidence to the Health, Social Care and Sport Committee, Dr Sarah Mills said:

“Any doctor who feels that they are able to adequately predict somebody’s prognosis in months and years is usually mistaken. . . . Until we improve on the precision and accuracy with which we can identify somebody’s prognosis, it is meaningless to include a timescale in the bill”.—[Official Report, Health, Social Care and Sport Committee,19 November 2024; c 44.]

Similar concerns have been raised more widely, including ones that are supported by research from the Association for Palliative Medicine, which says that

“across thousands of prognosis assessments . . . doctors’ assessments of which patients are likely to die in six or 12 months are correct less than 50% of the time.”

Therefore, although we attempt to narrow eligibility—I take on board the points that my colleague Daniel Johnson has made about the need to have something in the bill that does narrow eligibility—it is very difficult to make that happen, so I am left worried that people could still end their lives prematurely.

I move to amendments in the group that seek to address the wider societal pressures that could drive someone to choose to die.

The amendments in the group that make provision available are important. They do not just compel a discussion or a recording of the discussion—as the bill currently provides for and as later amendments, particularly in group 7, suggest—but specifically require the delivery of support or that inequalities be addressed. A discussion or a signpost is not sufficient, and a plan that is not costed or funded—this speaks to some of the debate that we have had earlier about the bill—is not delivery of support.

In a bill such as this, we need a high bar, because it is a matter of life and death. If we do not require those issues to be addressed, we risk making it easier to choose to die than to choose to live. The question facing us is whether we believe that such support—crucial healthcare, social care and psychological support—is likely to be available, and available to all equally.

Amendments 138 and 143, in Douglas Ross’s name, seek to ensure that terminally ill adults are eligible for assisted dying only if they have been

“offered, and have access to, a fully costed palliative care pathway”.

That is really important, given what we know about the significant unmet need that exists and the impact that that can have on quality of life.

The point about the pathway being costed is important, because we know that, often, people have identified what they think are their needs—or had their needs identified by other people in an assessment—but those things are not funded or provided. Support that is identified as needed but not provided is not support at all. That can be the difference between someone choosing to continue and not.

I listened carefully to the intervention from my colleague Liam Kerr about whether the decision should be based on support or illness. We are grappling with that very question throughout the discussion on the bill. Support is often what is needed and can be the difference between someone wanting to continue in a circumstance or not. Support is absolutely essential.

Even if amendments 138 and 143 are agreed to, however, I do not believe that they go far enough. We know that thousands of people have already been assessed as needing support yet are still waiting for care packages to be put in place. We know from all the excellent organisations, hospices, palliative care specialists and many more how unequal access to palliative care is. The “Dying in the Margins” report from Marie Curie gives examples of that.

Amendment 139 would make eligibility dependent on someone having been offered and having access to psychological counselling, and on whether they had previously been screened or treated for suicidal thoughts or ideation, or self-harm. That amendment is crucial. Illness and loss of function can lead to the experience of low mood and mental ill health. That is due to a variety of factors, including societal ones, but they are there nonetheless. We must recognise that there is a relationship between mental and physical health, and we have to support that. Amendment 139 tries to do that.

Particularly given the exchanges that we have heard this afternoon on amendment 139, it is important to remind ourselves of the statement on the issue by the Royal College of Psychiatrists, which has said:

“suicide prevention remains a duty when someone is terminally ill”.

That is incredibly important, and the amendment could help us to ensure that that is the case. The college went on to say:

“For someone given a terminal diagnosis, the inevitable loss and grief associated with the end of life should be acknowledged and supported”.

That is another reason why the amendment is important. However, I am still concerned that it would fall short of making the bill entirely safe.