RE: My vote on the Second Reading of the Terminally Ill Adults (End of Life) Bill

Dear constituent,

Many thanks for writing to me on the difficult issue of assisted dying.

The Private Members Bill, titled the ‘Terminally Ill Adults (End of Life) Bill’, is scheduled for a second reading debate this coming Friday on 29th November.

This is the most challenging of issues and I have received a very significant amount of correspondence on the issue from constituents making the arguments, both in favour and against, with considerable commitment and sincerity. I do respect the views expressed; I am grateful to all who have reached out to share their views and deeply moving lived experiences.

The intent of the bill is borne of compassion with the purpose of responding to those who are terminally ill with limited time left to live and who would wish to be in control of their own death.

Many constituents express their support for the principle that an individual should be at liberty to have the means to end their own lives and for some to avoid the anticipated suffering.

The issue of autonomy, of being in control of one’s body, is a hugely important consideration and consequently any legislative framework that would seek to inhibit that freedom presents very great difficulties, as do the consequences of giving legitimacy to the assisted exercise of that choice.

Of course, in recent times the issue has come to fore again with the current profile given to it by Dame Esther Rantzen who is terminally ill with stage 4 lung cancer. She has chosen to join Dignitas and has expressed a wish to travel to Switzerland to end her life at a moment of her choosing. No such facility exists here, and the point is often made that such a choice is beyond people of modest means. That is countered by saying that wealthy people do have the ability to exercise all manner of choices that others do not, but the point of being denied a choice that is available to others is not lost on me.

I wholeheartedly agree with those who say to me that, whether there should be such a facility or not, it is wholly unconscionable that it should ever be extended to non-terminally ill adults, disabled people, those with mental health problems and children.

The Bill does not make any such proposal, but the possibility of potential further extension of any such legislation is often raised.

This is contentiously described as the “slippery slope” argument by opponents, whereas proponents of the Bill say with great force that the Bill does not open up that future possibility and they vehemently reject the slippery slope argument.

I note and understand the thinking but there is nevertheless a real fear amongst opponents that is sincerely expressed in that regard.

Indeed, some proponents argue that the Bill is too tightly drawn.

I met with the actor Liz Carr, when this matter last came before parliament, and I found myself then persuaded by her.

I met her again on this occasion with Dame Tani Grey Thompson a few short weeks ago and whilst, in my view, the Bill does not present a threat to disabled people as such, it is a genuinely held fear by many which cannot be ignored.

I also note that both sides of the argument cite other jurisdictions in support of their view, with the Bills’ supporters reciting the tight restrictions laid out in the draft legislation as being sufficient by way of safeguards and on the contrary, opponents looking to other jurisdictions to describe how the safety rails have been loosed and widened. I am as satisfied as I can be that the Bill has, quite rightly, been tightly drawn.

I do however have remaining concerns about the very real impact on disabled and vulnerable people. Many express real fears and again, I am obliged to accept the sincerity of that view.

Indeed, as it is for many disabled people, living a dignified and fulfilled life can be extremely difficult. Gordon Brown has said in recent days that it is incumbent on a civilised society to deliver assisted living and he has also raised the notion of a commission of end-of-life care which in my view has considerable merit.

I think of the services and support that people need and deserve that are on too many occasions sadly lacking. It is incumbent upon every government to address those needs, but I have seen over many years just how the state can often fail in its duties to disabled people.

There is a powerful argument made to me that someone in those circumstances may well conclude that their lives are beyond difficult, and that death is, as a result, seriously considered as a preferred alternative. That worries me.

Over and above the physical and psychological difficulties that people face, I also have to have regard to the financial pressures that people with life limiting conditions may feel subjected to.

This is not a party-political point but, as a society, I am firmly of the view that we have not served people in such circumstances as well as we might, and there remains a great deal more to do to improve their lives and alleviate their suffering.

I turn my attention to Palliative Care:

I recently visited the wonderful Teesside Hospice to discuss its services with the Chief Executive. I recognise the high quality of care that is provided by our hospices, but it is a concern that such services sit in the charity sector, and they are not fully funded within the mainstream NHS.

In recent years, I have advocated for our NHS, through our Integrated Care Boards, to properly fund our Hospice services as they are statutorily obliged to do so, and I will continue to press on the issue.

I do think that by focussing on palliative care, much of the anxiety can be alleviated.

We sat and held our 16-year-old son’s hand as he gently passed away free from pain, as I did with my Father, my Mother and my beloved Aunt. Those doctors successfully ensured that their deaths were peaceful, dignified and without terror and pain.

Whilst I was sadly not present at the time of my sister’s death, I know she was beautifully cared for by the magnificent staff at Teesside Hospice and I will be forever grateful for the kindness and amazing gentleness and compassion shown to her.

Whilst none of their deaths are analogous to assisted dying as we are discussing it, I regret to say that I hear of so many instances where families are not blessed with the grace of the moment and, sadly, they and their loved ones have not experienced “good” deaths.

That, in so many cases, can be avoided and I commit myself to ensuring that the best possible end of life care is available for all. People deserve dignity in dying, and each person nearing the end of their life should feel reassured and safe in the knowledge they will receive the very best care.

I know that the terrible condition of Motor Neurone Disease is raised regularly. A friend of mine, a truly compassionate and thoughtful man, expressed a wish to return to his native Scotland and be allowed to die on his own terms but in the absence of that option was prepared to travel to Switzerland.

As it transpired, other illnesses befell him, and he died.

So, I bear all of these considerations in mind, and I repeat that this is the most challenging of decisions and I have agonised over it.

In considering how I will vote, I have approached this with an open mind to consider the evidence presented. The strength of feeling across the range of viewpoints shared with me has not gone unheard or unfelt, and I have sought to inform myself with as much information as possible, from a wide range of perspectives.

I have considered the variety of views expressed by medical professionals, those for and those against, and also note the framing of the Bill whereby it will be for a High Court Judge to adjudicate as to whether the evidence presented to her or him is persuasive, and an order thereby given to facilitate assisted dying. It is certainly not a rubber-stamping exercise. Concerns have been expressed about how such a Judge and the Justice system more broadly will deal with these matters.

In the final analysis, I am not sufficiently certain that we are currently in a position to sanction and approve this proposed law.

I recognise and accept that, whichever way this vote goes, vast numbers of citizens are going to be enormously unhappy with the outcome but having carefully weighed all the evidence I conclude that I am not able to vote for the Bill.

Thank you once again for taking the time to write to me on this important matter.

Yours,

Andy McDonald

MP for Middlesbrough & Thornaby East