Last week, Parliament debated the Assisted Dying Bill. The Bill was defeated, and I think that was the right decision.
The issue of assisted dying is of course one about which people hold incredibly strong views. In recent weeks I was contacted by a huge number of constituents and organisations, each with passionately held positions on both sides of the debate.
I voted against the Bill for a number of reasons.
First and foremost, the Bill which was defeated last week was a bad piece of legislation. In addition to the faults I explain in more detail below, it would not have helped those with locked-in syndrome, like Tony Nicklinson, who are the people my constituents are contacting me about.
Secondly, I could not accept the criterion set by the proposed Bill that a patient has to have been given a prognosis of 6 months to live in order to qualify. There are many people who hold the view that assisted dying should be made available to those suffering with terminal illnesses. However, whilst I respect that view and can understand, it is a fact that correctly predicting death to a number of months is extremely difficult if not impossible. Giving a prognosis of a length of time which a patient may have left is something that many doctors are very reluctant to do. As one GP in my constituency said to me: "We can usually predict death if it is imminent, and it's going to happen within a few days, but as for predicting an exact number of months, it can be very difficult to be precise even for the most experienced of doctors."
Doctors sometimes get it wrong. There are many examples of patients living much longer than doctors thought possible. Yet one of the criteria of the Bill depended upon the application of the very inexact science of giving a precise answer to the question, "How long have I got, Doctor?"
Thirdly, the Bill also provided a 'conscience clause' for physicians to opt out of the assisted suicide process and this itself brings with it the attendant problems that the two doctors assessing the patient and the medical notes may have little prior knowledge of that patient. The Bill was unclear on how much training and expertise these two doctors would need to have, indeed they could be fairly junior medical staff with little or no experience in palliative care.
A further concern I had with the Bill was that the two doctors, whoever they may be, would have been reassured that whatever decision they make would be reviewed by a judge. But I feel there is a real risk of the judge being similarly reassured and comforting him/herself with the thought 'This decision has been made by two doctors so who am I to override their professional judgement?'. It could just be a mere rubber-stamping exercise of an already made medical decision.
Fourthly, I do not believe this Bill would have helped to improve society's attitudes to people with disabilities. This was made clear to me in conversations I had with disability campaigners who expressed their concerns about the Bill and its potential for making value judgments about whether other people's lives are worth living or not. They worried that if the Bill had passed, it would send out a message that suicide is acceptable. As one campaigner said to me: "When a person commits suicide it's seen as a tragedy, but if a disabled person commits suicide it's seen as understandable."
Although suicide is not illegal, to pass a law allowing doctors to assist a suicide gives a message that it is an acceptable and reasonable response to the problems that life throws at us.
Lastly, and perhaps most importantly, I believe it would be a huge mistake in a time of stretched NHS budgets, and when we are putting the message 'Paid for by the British taxpayer' on medicines costing over £20, to add to the very common desire among our elderly, sick and vulnerable to not be a burden on the NHS, their families or society by presenting them with an option of assisted suicide.
If the Bill was to become law in the current climate I believe there is a very real risk that it could result in a subtle but dangerous culture change in which vulnerable terminally ill patients see assisted suicide as the preferred option, and indeed the best way to stop themselves becoming a 'burden'. Lord Winston has warned against this as well, saying: "There will be pressure on budgets and increasing pressure on patients who will feel under pressure to take a decision that is not entirely theirs."
So where do I think we should go from here?
A comment I heard recently which has had a deep effect on me is one by a fellow MP who reported their constituent saying: "Why can't I be given assistance to live?".
I go back to my constituent, the GP, who took the time to come and see me with her concerns about the Bill. She said that she had been asked on only a very few occasions by terminally ill patients if she could end their lives for them. She said to me that when she had explored their issues, she found common themes. These included the fear of being left alone without support, worry about suffering poorly controlled pain or other poorly controlled symptoms and thus the perceived poor quality of the remainder of their life, the need not to be a burden on the medical/nursing/social care staff, a profound sadness and despair at their predicament and spiritual pain, sometimes accompanied by a formal depressive illness.
However, the GP told me that once she had addressed these and many other concerns properly, the request to 'end my life' had not been made again and that in the majority it had been possible to achieve a dignified and peaceful death.
To achieve this outcome requires good quality palliative care and a multidisciplinary approach. It requires adequate time, and furthermore it does not come cheaply. While there is good practice in the care of the dying, the NHS has considerable room for improvement. This is the debate we must have, and this is the fight we must lead.
From those constituents who supported the Bill and who will be disappointed I voted against, I was often told it deserved support because "Nobody should be forced to live in unbearable pain". I completely agree, and that is exactly why we need to make sure patients receive better palliative care, and that better information and support is given to terminally ill patients and their families. What we do not need to do is normalise suicide, which is what I believe the Bill would have helped to do.
The Assisted Dying Bill forced us to ask ourselves some of the right questions about how we care for the sick and dying, and forced us to have this very worthwhile debate, but I do not believe it presented us with any of the right answers. For these reasons, I voted against.