Did 59% fear being a burden?published at 13:41 Greenwich Mean Time 29 November 2024

13:41 GMT 29 November 2024

By Anthony Reuben

Labour MP Melanie Ward cited the example of Washington state, where she said: “last year 59% of those who went through with an assisted death did so because they feared being a burden to family, friends or caregivers”.

Those figures come from the state’s latest annual report, which actually covers 2022, external.

People who had an assisted death were asked what their end-of-life concerns were, but were allowed to give more than one answer.

So while 59% said they were concerned about being a burden, it was not the top answer.

There were 83% saying they feared loss of autonomy, 83% were concerned about being less able to engage in activities making life enjoyable and 69% worried about loss of dignity.

Only 10% were concerned about the financial implications of their treatment.

Labour MP Florence Eshalomi says she will oppose the bill because of persistent issues with health inequality.

She says she believes everybody in the House shares the same goal of achieving a more compassionate society - but says "true compassion should have equality at its heart".

And, she adds, MPs "must recognise … that health inequalities are wide and persistent".

"We know that black and minority ethnic disabled people have far worse health outcomes than the national average."

Eshalomi describes her the situation faced by her mother, who suffered from sickle cell anaemia and was not listened to when she told doctors she needed life-saving medication.

"We should be helping people to live comfortable pain-free lives on their own terms, before making it easier for them to die," she says."Freedom in death is only possible if you have had freedom in life."

Mollie Perella
BBC Newsbeat

Image source, Phoebe Mooney / Handout

Phoebe Mooney helps people at their end of life as well as those with learning disabilities.

She’s been telling BBC Newsbeat that she’d “fully support” a patient or family member who wanted assisted dying, but has questions over making it law.

“I support a very vulnerable group in society and I worry about proper safeguards for them,” Phoebe, 28, says.

“We support people that might have a lot of communication issues. I worry that there might be a possibility of people forcing them into something they don’t quite understand.”

“I wouldn’t want anyone to be forced into anything.”

Phoebe thinks there should be a focus on more funding for end of life care, saying it’s in “crisis”.

“In the last two weeks I’ve had three people with learning disabilities die and they all died at home.”

“It was a real privilege to help with that and support their families as well.”

Image source, UK Parliament

Jess Asato - the Labour MP for Lowestoft - says her concern is about the "potential for abuse and coercion" if assisted dying were to be legalised.

She says she finds it hard to reconcile her desire to "safeguard the most vulnerable" with putting that into practice - even though choosing an assisted death could be something she wants for herself.

Asato says she is worried that people could be "coerced by an abuser, or societal expectation" to end their own life.

It is hard for some victims to notice the signs of coercive and controlling behaviour, she says - adding she fears judges and medical professionals do not currently have the training to be able to spot warning signs.

The MP says she has come to the conclusion that no bill can "adequately sift" those with a genuine desire to end their own lives, with those doing it for all the wrong reason.

Hannah Karpel
Reporting from Westminster

Julie, a retired specialist palliative care nurse of 32 years is against the proposed bill.

“My reason to exist in my work was to make sure I did everything I possibly could to alleviate pain and suffering," she says.

She believes the government need to do more to invest in palliative care services instead.

“If someone who is terminally ill says to me, I’m tired, I don’t want to be here anymore, my main concern is what can we do to help not let’s give you an opportunity to end your life”.

Image source, UK Parliament

Conservative MP Sir Julian Lewis says that in the past he has voted against this type of measure for one overriding reason: "the impracticability of effective safeguarding".

He says that although practical safeguards could be erected for external coercion, there was "no prospect whatsoever of having effective safeguards against internal pressures on someone to request assisted dying or even euthanasia".

Lewis gives the example of someone dying in a care home, knowing that the legacy they would leave behind to their children would be reduced by tens of thousands of pounds every few weeks.

He says this person would be "highly likely to feel obliged to ask to die" and that he can't conceive of safeguards against self sacrifices of this sort.

He then brings up the ability of health workers to administer effective pain relief, even of the kind that shortens a patient's life - which he believes they should be able to do.

Lewis concludes by saying MPs should consider three things: whether safeguards can be effective, if pain can be alleviated sufficiently by palliative care, and if doctors are able to give patients effective pain relief. He adds they need to know the answer to this last question.

Rajdeep Sandhu
BBC Scotland

Image source, Getty Images

The SNP have said they won't take part in the vote because the bill doesn't directly impact Scotland.

Although that has been criticised by a former SNP MP Steward McDonald - who pointed out the party did vote on the issue back in 2015. He said "you can’t credibly claim that another part of the UK legalising assisted dying wouldn’t have an impact on Scotland - how on earth could it not?"

Scottish Conservatives, Labour and Liberal Democrat MPs are expected to vote and Scottish Lib Dem MP Christine Jardine is even a co-sponsor of the bill.

Out of 57 Scottish MPs, 22 are against, 11 are for, 10 will abstain and 14 are unknown. Three MPs told me they'd be deciding today after listening to fellow MPs in the debate.

The Scottish Secretary Ian Murray won't be voting today as he is on a trip to Malaysia and Singapore to promote trade and Scottish products. So despite other cabinet colleagues making their views known publicly, he is not expected to. A source close to him said was not a "particular advocate" for assisted dying, he would probably be in favour but it depended on the strength of the safeguards.

There is similar legislation in the Scottish Parliament put forward by Liberal Democrat MSP Liam McArthur. He's urging MPs to vote in favour today. MSPs aren't expected to vote on his bill until next year.

Would they be influenced if MPs had already said yes?

Interestingly, a few Scottish Labour MPs told me that while they were pro-devolution they felt this was an issue that should be decided on a UK-wide basis.

Labour MP Rachel Hopkins says she supports the bill, seeing it as an opportunity to "change the status quo once and for all".

The public has "overwhelming" support for the measure, Hopkins says, citing a poll that she says 75% were in favour of a change in the law.

At the moment, she adds, some choose to go abroad to do so, but the high costs of doing so highlights "systemic inequality" in the system.

Hopkins says she believes individuals should have the "agency" to die a safe and painless death. And believes this bill has "stringent safeguards" to prevent it being used inappropriately.

She adds that her grandfather had a terminal illness and "suffered greatly". The "haunted look" on her father's face after looking after him in his final days, she says, made a "lasting impression".

In a modern society, "if we're able to live a good life, we must be able to have a good death", she says.

Millions of people now live in countries which have legalised assisted dyingpublished at 12:51 Greenwich Mean Time 29 November 2024

12:51 GMT 29 November 2024

By Anthony Reuben

There have been many references from MPs to rules on assisted dying in other countries.

It is illegal in most of the world, but several countries have legalised it since it was last debated in the UK, with more than 300 million people now living in places where it is allowed.

But there is considerable variation between the laws and the take-up around the world.

In the Netherlands, about one death in 20 is assisted, whereas at the other end of the spectrum, in Spain, it is less than one in 1,000.

• How assisted dying has spread across the world and how laws differ

Image source, UK Parliament

Carla Lockhart, the Democratic Unionist Party (DUP) MP for Upper Bann, starts by saying that she - like many others - is coming to the debate with a personal experience.

She tells the story of her father who was terminally ill, with a "painful, aggressive cancer", and of a health service system that sought to support and care for him and medical staff who "went over and above" to make sure he could see his family and grandchildren grow up.

Although she did not want to see her father in pain, she says those difficult times "gave us the opportunity to care for and express love for a person whose life we valued".

"The route of my conviction is that life in all its forms is of inherent worth and value," she says.

She adds that she has come to this conclusion partly because of her faith, but also because of "the danger this bill represents".

She argues that Parliament is having the wrong debate today, and that they should be discussing how to improve someone’s end-of-life experience.

“This is not the answer to end-of-life care," she says, adding that’s why she and her DUP colleagues will be voting against the bill.

Dr Marie Tidball says deciding how to vote today was "one of the hardest" decisions she's had to make.

After much wrestling, she's now found herself voting in a way she "never" thought she would: in favour of the bill.

The Labour MP - a disability rights campaigner who was born with a congenital disability - recalls a time she underwent major surgery as a child, and while recovering she was in severe pain in a body plaster from her chest to her ankles.

She says she remembers telling her parents: "I want to die, please let me die."

That moment, she says, made it clear to her she would not vote for the bill if it was about those in intolerable suffering, but it gave her a glimpse of how she would want to die.

"Just as I've lived my life...empowered...with dignity and respect."

Paul Burnell
Reporter

Chris Webb, the Blackpool South MP, has said he will be viewing constituents' feedback on his smartphone during the debate after an “amazing” response to a detailed online questionnaire in this “once in a generation vote”.

The Labour MP, who was mugged for his phone recently, said he has received more than 350 responses to the question.

“I never expected such a response,” he said, adding, ”I’m still getting feedback today”.

Webb added: “I have held surgeries, meetings with faith groups and even conversations with family members about this very important issue which is going to affect millions of people."

He said he wanted to get as wide ranges of views and experiences as possible.

Webb said he will be contacting everyone who has participated in his questionnaire, explaining why he voted the way he did - which will be happening at around 14:30 GMT.

He added: "Even if the bill passes this reading I want to engage with my constituents in the rest of its progress."

Image source, UK Parliament

Liberal Democrat Tim Farron is now speaking in the Commons and says while he's against the bill, he recognises that the motives of those in favour are "grounded in compassion".

"Neither side has a monopoly on compassion," he says, but insists his opposition to the bill is also "grounded in compassion".

He says to legalise assisted dying is to create the space for coercion and goes on to argue that there are no safeguards that will prevent it.

He addresses the issues of "self coercion", and says many people will have heard relatives describe not wanting to be a burden.

He also speaks about domestic violence, and says all MPs have come across victims of coercive control who have gone years without realising that is what was happening to them – he says those coerced into assisted dying will never have the chance to make that realisation.

• For context: The bill would make it illegal for someone to pressure, coerce or use dishonesty to get someone to make a declaration that they wish to end their life or to induce someone to self-administer an approved substance. If someone is found guilty of either of these actions, they could face a jail sentence of up to 14 years.

Jacqueline Howard
Live reporter

Image source, .

We've been hearing a lot from MPs today about how different countries handle assisted dying where some form of it is legal. One of those countries that's come up frequently is Australia.

Australia and New Zealand are the only countries in Australasia to have legalised assisted dying.

In Australia, the practice is known as voluntary assisted dying, or VAD, and has gradually become legalised state-by-state over the past few years.

While the laws differ in small ways across the country, broadly speaking it is an option for anyone over the age of 18 suffering from an incurable disease, illness or medical condition that is advanced and progressive and due to cause death within six to twelve months.

Australia requires the sign-off of multiple doctors over time before the process can get under way.

The guidelines are similar in New Zealand, which calls it assisted dying, however a patient must be expected to die within six months to be eligible.

In both countries, a patient can choose to self-administer the lethal medication or have a doctor do it.

• How assisted dying has spread across the world and how laws differ

Labour MP Dr Peter Prinsley says that when he was a young doctor he thought of assisted dying as unconscionable, but "now I am an old doctor, I feel sure it is the right change".

"I have seen uncontrollable pain," he says, adding: "I'm speaking here of people who are dying, not of people living well with chronic or terminal diseases. We are talking about people at the end of their lives, wishing to choose the time and place to die."

Prinsley goes on to say that this is "not a slippery slope", saying "we are shortening death, not life for patients. This is not life or death, this is death or death."

Image source, UK Parliament

Labour MP and former minister Dame Meg Hillier says that if MPs "have a scintilla of doubt" about giving the state the power to assist people to die then "we should vote against this".

She speaks about when her daughter was "very ill a few years ago", she didn't know for many months whether she would live or die.

"I saw what good medicine can do, that palliated that pain, that got her to a place where although for two and half months she was unable to eat, she was saved," Hillier says, adding her daughter's pain was "managed".

Her voice cracks with emotion and she looks visibly upset as she says she hopes they will forgive her for raising a personal story in the Commons today.

She then goes on to say that the debate on palliative care must continue "but this bill must stop today".

Image source, UK Parliament

Conservative MP Dr Ben Spencer says many MPs support assisted dying in principle, but are concerned about the implementation of the bill and how safeguarding would work.

He says that as a private members' bill, there's limited ability for scrutiny of the proposed law's provisions, and that it has had no independent review, no pre-legislative scrutiny, and no impact assessments.

Spencer goes on to say the most substantive issues are the limits set on the bill. He asks why the bill is limited to those who are terminally ill, and not those who are suffering but not terminal.

He questions the definition of terminal illnesses, adding: "In this bill the most prominent problem is that in a legal context, if the availability of assisted dying is limited to only those who are terminally ill, it is discriminatory to either those with or without terminal illness".

Spencer also talks of issues around coercion and ends by saying: "We should and must vote bill down."

Image source, UK Parliament

Back in the Commons, the Labour MP for Gower gets emotional and her voice begins to crack as she describes how it's a privilege to be able to vote today but "it's not easy".

Tonia Antoniazzi goes on to say she'll support the bill, but respects the opposing views.

Antoniazzi discusses the complexities of devolved legislation and how the bill's implementation would work for the Welsh government.

She adds: "Everybody's lives matter and we have to get this legislation right."

Kate Whannel
Reporting from Westminster

We're continuing to follow the debate on the assisted dying bill from inside the Commons, but just outside those walls, campaigners for and against the bill are also sharing their opinion on the issue.

Amanda has travelled from Brighton to support the bill. She says she has been motivated by caring for friends and family at the final stages of their life, including her mother and one friend who had cancer.

“She was saying 'kill me now, kill me now'... that’s an awful thing for someone to hear their loved ones say.”

Meanwhile Jon, who is originally from New York but has lived in London for 40 years, says he would be “greatly disappointed” if the bill doesn’t pass - but thinks change is inevitable.

He argues that the pace of medicine and technology means “our ability to extend life is growing and growing.

“These debates will not go away," he says.

Image source, Parliament TV

Chair of the Health Select Committee, Liberal Democrat Layla Moran, says that as a nation we do not speak enough about death.

She says she will be voting in favour of the bill, because she wants "this conversation to continue".

She urges MPs to reconsider the question they are asking themselves today, saying she believes the question now is not whether to be for or against the bill as it looks today, but about asking if you want to continue the conversation.

Today, the bill is in its second reading and if it passes there are still many months of parliamentary activity and scrutiny ahead before it becomes a law.

Conservative former cabinet minister James Cleverly intervenes, saying she is "misrepresenting" the nature of what MPs are there to do.

She also says she is concerned about the debate on palliative care and addresses Health Secretary Wes Streeting, who has argued against the bill, telling him "the gauntlet has been thrown down".

She suggests to Streeting that if he wants people not to vote in favour of the bill, then he should put "firm commitments" about improving palliative care on the table, and commit to bringing a bill "like this" back to the Commons for reconsideration once those changes are in place.