Image source, UK Parliament

The focus should be on getting palliative care right, argues Rachael Maskell, the Labour MP who is addressing the Commons now.

She says funding for palliative care has regressed and hospices are paring back services, which she argues needs to be fixed before we start discussing the proposed assisted dying law.

"We can't do both, there's simply not the capacity," she adds.

She is briefly interrupted by Conservative MP Roger Gale, who voices his agreement with Maskell, and adds that palliative care for children is also needed.

Maskell then goes on to talk about coercion, which she says is her biggest concern with the bill.

"In dying, where there is malign intent, this bill fails to safeguard," she says, adding that people not wanting to be a burden is one of the major drivers for people choosing assisted death.

She ends by arguing that public polling "overwhelmingly" shows the public expect their MPs to vote against the bill if they are in any doubt.

"We can focus on optimising palliative and end-of-life medicine to then bring consensus and discern what further steps need taking. For death, as with life, is too precious to get this wrong," she concludes.

Today's debate shows the Commons at its bestpublished at 11:31 Greenwich Mean Time 29 November 2024

11:31 GMT 29 November 2024

Chris Mason
Political editor

Hello from the Press Gallery of the House of Commons.

This is Parliament at its expansive, thoughtful, and passionate best.

The nature of parliamentary party politics is most debates here are looked at directly through the prism of party politics.

Loyalty, ideology, the spectrum of left and right, etc etc.

That isn’t something to be overtly jaded about, if you can manage it – it is a necessary organising tool for governments and opposition parties to bind themselves together and attempt to deliver a promised programme for government.

But for those with a cynicism or tiredness for the inevitably partisan nature of Westminster, today is a day to take another look.

A "visceral and direct" conversation about life and death, as one MP put it.

The testimony about the most horrible deaths, told in respectful silence, demanding a change in the law.

The power of the case that the state must not become a "suicide service" as one MP described.

There are those of total conviction on each side of the argument.

And others deeply conflicted about what to do.

Image source, UK Parliament

Conservative MP Kit Malthouse, a co-sponsor of the Terminally Ill Adults (End of Life) Bill, says he sees "no compassion or beauty" in difficult deaths.

He goes on to talk about other countries which have some form of legalised assisted dying, including Canada, a country that's often cited by opponents as an example of the so-called "slippery slope".

Malthouse says he's married to a Canadian and makes the point that "they love their children just as much as we do". He adds that MPs are more than capable of creating legislation that works.

On the issue of the impact on the NHS he points out that these people are already dying and entitled to care.

He asks: "Are are you seriously telling me my death, my agony, is too much for the NHS to have time for, is too much hassle?"

Malthouse also dismisses the claim that judges would be overloaded.

He says a vote against bill is not a passive act stating that there are two states of being on offer today.

"People with terminal illness will still take their lives. If the bill falls today, we are consigning those people to take their lives in brutal, violent ways."

Emily Doughty
Live reporter

One of the concerns that's been raised this morning by MPs is the issue of safeguards and coercion. That's something we've also been hearing from some of our readers on the proposed law for England and Wales, as part of Your Voice, Your BBC News.

Mark Bonnington does not support the legislation in any form. He is concerned that people who are vulnerable will be pressured into assisted dying if the bill passed.

The 62-year-old thinks that more money should instead be put into palliative care within the NHS. He thinks assisted dying will have a profound impact on the service: “It won’t be the national health, service it will be the national death service.”

Even though there will be safeguards in the bill, Durham based Mr Bonnington believes this won't be enough saying: “Economic pressure will pressure some elderly patients. We need to protect the vulnerable”.

However Pete from Nottingham does not believe that the new bill goes far enough and should be a stepping stone.

The 65 year old believes that anyone who is suffering and in the right state of mind should be allowed to access assisted dying.

Aiding in the care of his mother-in-law, he says that she “is in constant pain and just wants to die. We can’t help her though because it is illegal, even though she is asking her doctors to help her end it.”

However, he does believe safeguards are needed: “There has to be safeguards to stop unscrupulous relatives.”

Image source, Parliament TV

Conservative former cabinet minister Andrew Mitchell says he has changed his mind on this issue since he first entered the Commons.

He says the reason for that is he has sat with constituents and had tears pouring down his face as they described how a loved one has died in great pain and indignity.

He says he strongly supports the bill, and that he believes MPs should give people "this choice", saying he wants it for his own loved ones, and "perhaps, one day, for myself".

The current law forces people to "plan their deaths in secret", he says, arguing the bill is about extending choice in a "very narrow" set of circumstances, and describing the status quo as cruel and dangerous.

Image source, UK Parliament

Labour MP Diane Abbott is next and she begins by saying she is not against legalising assisted dying in any circumstance, but that she has reservations about the bill, and that she does not believe the safeguards in it are sufficient.

She goes on to say that the safeguards are supposed to be the strongest in the world because of the involvement of a High Court judge, but continues to say that divisional courts have said the intervention of a court would "simply interpose an expensive and time consuming forensic procedure".

She goes on to talk about the role of a judge proposed in the bill.

"Is a judge supposed to second guess doctors? Will a judge make decisions on the basis of paperwork, or will there be a hearing in an open court? Where will be the capacity in the criminal justice system to deal with all this," she asks.

"Far from being a genuine safeguard, the involvement of a judge could just be a rubber stamp," she says.

Abbott continues by saying robust safeguards for the sick and dying are absolutely vital to protect them from predatory relatives, or the state, or themselves.

An unusually packed Commons reflects importance of issuepublished at 11:00 Greenwich Mean Time 29 November 2024

11:00 GMT 29 November 2024

Henry Zeffman
Chief political correspondent

Image source, UK Parliament/PA

One thing that’s striking, more than an hour into this debate, is that the House of Commons is still rammed full. That’s rare.

Often, even in very big debates, the chamber will start to empty after the first significant speech or two.

That underscores that lots of MPs want to speak. It shows that lots of MPs are still are undecided – I spoke to a few yesterday who said they would make up their mind finally after listening to the debate.

Above all, though, the packed chamber is a visual reminder of what a big deal this is, not just for Parliament but for British society too.

Kruger is now outlining his concerns that there are not enough safeguards around the issue of coercion, saying the biggest danger is not other people but the pressure people may put on themselves.

He adds that the bill assumes judges will take on an inquisitive role as investigators, but Kruger is critical of this saying there is no requirement for a judge to meet the patient. He goes on to say that decision could be reached through a phone call or by an email from a medical practitioner.

Kruger also criticises the lack of a requirement to tell the patient's next of kin, wider family or GP that a person is seeking assisted dying.

"I am very aware of the terrible plight of people begging us for this new law - I think we can do better for them," he adds.

"Let today not be a vote for despair, but the start of a proper debate around dying well... true dignity consists of being cared for to the end."

Kruger says that if there are concerns about how the NHS addresses concerns about coercion "then let's deal with that".

But he adds: "Let's not license suicide. Which by the way, again evidence from around the world shows increases suicide in the general population. So suicide is contagious."

Kruger continues to make his case, using the phrase "assisted suicide" before he is interrupted by an MP in the Commons who says: "it's not suicide, that's offensive." The MP goes on to ask him to "correct" his language.

Kruger says he is sorry if offence is given, but argues the bill would amend the Suicide Act 1961 and "allow people to assist with a suicide for the first time".

As we mentioned a little while ago, there are many terms that have been used to describe assisted dying legislation throughout the world.

Assisted dying, the term the BBC uses, is how the practice is most commonly referred to in the UK.

Some MPs have spoken about the issue previously using assisted suicide, as Kruger has just done. And, as we reported earlier, some disabled people against the bill also use this term.

Nick Triggle
Health Correspondent

We've just been hearing from Tory MP Danny Kruger, who has been discussing the issue of palliative care in the NHS.

Three quarters of people are estimated to require palliative care at the end of their lives – that is around 450,000 people a year across the UK.

But significant numbers are unable to access it. One estimate suggests around 100,000 go without.

Marie Curie says around half of families are unhappy with the care their loved ones receive when they die, reporting they are left in pain and with too little support.

The NHS employs palliative care specialists, but hospices also play a crucial role – providing care to around 300,000 people a year.

Only around a third of their funding comes from the NHS, with the sector having to raise the rest themselves. A parliamentary report, external has described this funding system as “not fit for purpose”.

This week the Office for Health Economics, external said an increase in palliative care funding was crucial regardless of the outcome of the vote in Parliament today - which as a reminder, will be happening at around 14:30 GMT.

Many are asking what impact would assisted dying have on palliative care? A report by the Health and Care Committee, external found in places where the law had been changed it did not lead to a deterioration in services – in fact, in some, it had been linked to an improvement.

Image source, UK Parliament

We're now hearing from Conservative MP Danny Kruger, who has been prominent in his opposition to the assisted dying bill.

He argues that if the country's palliative care system is improved, and hospices funded, it would be possible to do "so much more" for people.

He says it will then be possible "to help people die with minimum suffering". He argues that this won't be possible if the bill were to go through, and people would be "exposed to harm".

Kruger says the proposed bill is "simply too big for the time it has been given".

"Members who vote for the bill must be prepared to see it become law largely unamended," he says.

He lists what he says are several issues too comprehensive to be dealt with in the committee stage - where the bill would go next if it were vote passes today.

(In the committee stage, a smaller group of MPs will consider the bill line by line.)

Kruger also argues that the safeguards that have been introduced in the bill will in practice be a "barrier of discrimination against a new human right that has been awarded to one group and should be awarded to all".

Hannah Karpel
Reporting from Westminster

While MPs continue to debate the assisted dying bill inside the House of Commons, campaigners for and against the issue are also continuing to gather outside.

Mick is here today on behalf of his friends, husband and wife Ann and Bob, who both travelled to Switzerland consecutively in 2014 for Ann and 2015 for Bob to end their life where assisted dying is legal.

“They were forced to go abroad because they were beyond end-of-life and palliative care and in terrible pain," he says.

Ann was expected to die of not being able to move her tongue and would have choked to death. Bob had mesothelioma, a type of cancer, “his lungs were on fire and he decided he couldn’t take the pain anymore".

"They both made their own independent decision to die at the Dignitas clinic. We went with friends and they had a very gentle death. He died to Beethoven Ode to Joy. I’m here today because they should have been able to do this at home.”

In her closing remarks in the Commons, Kim Leadbeater stresses that the vote today on the assisted dying bill marks the "beginning not the end" of the debate around the issue.

"We need to be clear - a vote to take this bill forward today is not a vote to implement the law tomorrow – it is a vote to continue the debate," the Labour MP says, emphasising that there is still much scrutiny work to be done.

Leadbeater insists this will be a "thorough process" that "people across the country clearly want us to address, no more so than the many families who are facing the brutal and cruel reality of the status quo".

Leadbeater says the bill is not about people choosing between life and death, arguing it's about "giving dying people, who have got six months or less to live, autonomy about how they die and the choice to shorten their death".

She also asks how many people will go through the difficult experiences she has described if another 10 years pass before Parliament examines this issue again.

She then turns to the so-called "slippery slope" argument against the bill, and says a parliamentary committee found that no jurisdiction which has passed similar laws on assisted dying on the basis of terminal illness have expanded their scope.

The comment is met by some rumblings in the chamber, which Leadbeater addresses, insisting that what she has said "is true".

She also addresses legal arguments against the bill, insisting that Parliament is sovereign and so can decide the matter.

• For context: The European Court of Human Rights has never decided that assisted dying laws violate ECHR rights. The court has repeatedly ruled that there is no clear consensus between member states and that it is a matter for individual parliaments to consider

Image source, PA Media/UK Parliament

Warning: This post contains distressing details

Kim Leadbeater now tells the story of one man who had bile duct cancer which obstructed his bowel, resulting in "an agonising death".

She says he vomited faecal matter for five hours, before he ultimately choked and died. She adds that he was vomiting so violently that he could not be sedated, so was conscious throughout.

Leadbeater says this man's family now tell her how they will never forget the look on his face when he died. His wife now has PTSD.

The Labour MP goes on to say that everyone has stories like this one from their own constituencies.

"I have been astonished by the number of people who have been in touch to tell me about their terminally ill loved ones who have starved themselves to deathout of desperation," Leadbeater says.

How can we allow this and not a compassionate death, she asks.

Fergus Walsh
Medical editor

We've just heard Kim Leadbeater reference the so-called Canada model, and she's stressed that the UK's assisted dying bill would not be modelled after this country.

As reminder, Canada is the country often cited by opponents of assisted dying as an example of the so-called "slippery slope" - a place where assisted dying has been extended and made available to more people since it was first brought in. Medical assistance in dying, external(Maid), external was introduced in 2016, initially just for the terminally ill.

This was amended in 2021 and extended to those experiencing "unbearable suffering" from an irreversible illness or disability.

Critics say the more the law is widened, the more disabled and vulnerable people will be put at risk.

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

Leadbeater says more must be done to support palliative care services and makes the point that assisted dying is "not a substitute for palliative care".

But she insists it's not an "either/or" issue, as she goes on to say the UK has some of the of the best palliative care in world but that shouldn't stop there being a choice of an assisted death.

She says it should be a component of a "holistic approach to end-of-life care".

An intervention by another MP suggests assisted dying is crossing a "red line" for doctors and could lead to to safeguards becoming obsolete.

Leadbeater disagrees, saying boundaries can be maintained.

Oliver Dowden asks if the judiciary will follow the bill's criteria and Leadbeater insists the criteria is strict.

Leadbeater says four former directors of public prosecutions – including Prime Minister Keir Starmer – and two former presidents of the Supreme Court, and many lawyers believe the law needs to change on this issue, adding "we have a duty to do something about it".

Intentionally helping another person to end their life is currently illegal, she says, but adds the law is "not clear" and it drives people to "desperate measures".

She then turns to the concern of the potential for people to be coerced when making such a decision on assisted dying.

Labour MP Kevin McKenna intervenes, saying he has been a nurse for more than 25 years and says it's "wrong to suggest clinicians cannot spot coercion".

Leadbeater agrees that spotting coercion is already part of a medical professional's job, and adds the bill would make coercion on this issue a criminal offence.

She argues that by providing a formal framework the bill will give an "extra level of safeguarding".

Kim Leadbeater continues her remarks by saying that vital stories are difficult to hear but are at the heart of this debate.

She recounts several stories, one of which is about a woman with terminal cancer who begged her husband to end her life.

Leadbeater is visibly emotional as she reads several other stories.

She also says that it is clear that public opinion is very much in favour of a change in the law.

Kim Leadbeater, Labour MP and bill co-sponsor, is the first to speak and she thanks MPs for attending.

She says it's a privilege to open the debate and says this proposed legislation would give dying people choice, autonomy and dignity at the end of their lives.

Leadbeater adds that she knows the issue is is not easy "but if any of us wanted an easy life, they're in the wrong place. After nearly a decade, many would say this is long overdue."

"This is particularly important as we have people in the gallery who have a very strong personal interest in this issue (people who hold a range of views) but some of whom have lost loved ones in very difficult and traumatic circumstances, and others who are themselves terminally ill."