Dr David Montgomery is a former Parliamentary Candidate for East Renfrewshire and former Association Chairman and President of Reigate Constituency. He is also a medical doctor with almost 25 years experience considering end of life care.
“They seek it here, they seek it there, those Parliamentarians seek it everywhere. Is it in Heaven? Is it in Hell? That damned elusive assisted dying Bill”.
Look, I shouldn’t make light of this. It’s an incredibly serious issue. But it’s more than two weeks since Kim Leadbetter introduced her ‘Terminal adults (end of life)’ private members Bill in Parliament and it still hasn’t been published. Where on earth is this Bill?
The delay adds to the general sense that Labour have been rushing things.
VAT on school fees, winter fuel allowance. Political own goals; decisions taken too quickly without proper consideration of the consequences. But rushing the discussion on assisted dying will be the biggest mistake of this Parliament. MPs are increasingly beginning to realise this.
This bill is hugely important, not in a binary ‘yes or no’ sense. No. Because the current situation is heartbreaking. Something needs to change.
Assisted dying is currently illegal in the UK, but it is possible to access such support if you can afford to travel overseas to countries where it is permitted. Yet making that decision under the current framework presents you with impossible, heart-rending choices.
Anyone assisting you, even close family members, can be prosecuted.
While such prosecutions are rare, they carry a maximum prison sentence of 14 years and are likely to preclude those convicted from inheriting your estate under the 1982 Forfeiture Act (although section 2 of the act allows judges some discretion; in a recent ruling a judge did permit a man who had assisted his wife to end her life in Switzerland to inherit).
People seeking assisted dying abroad must either risk the liberty of friends or family or travel on their own, robbing them of the chance to say goodbye to loved ones and sacrificing weeks, months, maybe even years of life to ensure they don’t become too frail to make that final journey on their own. Blur drummer Dave Rowntree was the most recent to recount the heartbreak of a loved one dying alone in a foreign country in a article last week.
This is something we need to talk about.
But into this emotionally complex issue wades a relatively inexperienced Parliament. Over half of MPs are brand new, coming to terms with the complexities of the role. Many still don’t have offices or full staff. And they will now take the single most consequential decision of their lives; whether to allow one human being to end the life of another.
The vehicle they will use to explore this issue is the Private Members Bill, a vehicle wholly unsuited to this question. Private members Bills typically get less time for debate than government bills, often being talked out by opponents. Supporters can attempt to move the ‘closure’, ending the debate and forcing a decision, but again this mechanism stifles the debate. I fear this immensely complicated issue will not get the discussion it needs.
And let me be really clear, this Bill needs a proper discussion.
I’m going to leave aside the moral, ethical and religious aspects of the argument. They’re important, but they will be well aired during even the most cursory debate.
Let me instead focus on the practicalities. Practicalities we know nothing about despite the second reading rapidly advancing upon us, scheduled for 29th November.
But let me speculate based on the discussions I’ve had.
I understand this bill will propose that people with less than 6-12 months to live can be considered for support to end their lives. Life expectancy in terminal illness is a notoriously difficult thing to judge. In another recently published Bill by the Labour Peer Lord Falconer, two doctors and a judge will be required to agree. This level of oversight in an already stretched health and legal system will lead to delays and challenges, adding additional stress at end of life. This isn’t a practical solution. But we await the detail of Kim Leadbetter’s proposal still.
And why an arbitrary cut off at 6-12 months anyway? People at this stage of life are often very well supported by our existing services and look to spend time with loved ones. Whether or not we allow assisted dying, it is critical that we offer outstanding palliative care and excellent mental health support at end of life.
Yet our mental health services are on their knees. And our palliative care services are incredibly stretched, as Wes Streeting recently acknowledged, with hospice care remaining highly dependent on the charity sector.
Will desperation and depression cause people to turn to assisted dying, robbing them of time with their family, for want of better support?
Will permitting assisted dying allow us to duck the responsibility of improving these services?
I understand that one of the reasons the Bill is being held up is that Kim is under pressure by some to remove the cut off, while others say removing it will reduce the chance of their supporting the bill. A hugely difficult dilemma for Kim, with the days before the second reading passing rapidly.
But this is one of the key reasons we need time for debate. It is often people with much longer life expectancy but devastating ill health or chronic conditions who are often most desperate. People with conditions such as multiple sclerosis, motor neuron disease and many others can live for years, many with awful quality of life. Some become so desperate they ultimately refuse food and water, effectively starving themselves to death. Yes, you read that right. People so desperate they starve themselves to death. And some may vote the bill down if we include these people within its provisions.
So here we are.
Putting before a brand new Parliament a private members Bill dealing with issues so complex that the author hasn’t finalised the text more than two weeks after the Bill was initially presented to Parliament.
And on an issue that we actually need decisions made one way or another; the status quo isn’t acceptable.
Sure, if the bill passes then some of the issues can be addressed as the Bill proceeds through subsequent stages. But the basic premise (if the bill passes) is that assisted dying becomes law. We won’t be able to reverse that just because we discover major unintended consequences in some of the services I mention above.
And if the bill doesn’t pass we may have missed the opportunity to clear up some of the current legal uncertainties for at least another decade.
Let me be clear, I truly don’t know the answer. After 30 years in medicine and having given deep and long consideration to this question, I really don’t know. But I do know that it’s an issue that needs very careful consideration.
There are growing calls for a Royal Commission. Those calls are correct. What a shame that MPs, whatever their ultimate view, must vote this down to get that outcome.
Dr David Montgomery is a former Parliamentary Candidate for East Renfrewshire and former Association Chairman and President of Reigate Constituency. He is also a medical doctor with almost 25 years experience considering end of life care.
“They seek it here, they seek it there, those Parliamentarians seek it everywhere. Is it in Heaven? Is it in Hell? That damned elusive assisted dying Bill”.
Look, I shouldn’t make light of this. It’s an incredibly serious issue. But it’s more than two weeks since Kim Leadbetter introduced her ‘Terminal adults (end of life)’ private members Bill in Parliament and it still hasn’t been published. Where on earth is this Bill?
The delay adds to the general sense that Labour have been rushing things.
VAT on school fees, winter fuel allowance. Political own goals; decisions taken too quickly without proper consideration of the consequences. But rushing the discussion on assisted dying will be the biggest mistake of this Parliament. MPs are increasingly beginning to realise this.
This bill is hugely important, not in a binary ‘yes or no’ sense. No. Because the current situation is heartbreaking. Something needs to change.
Assisted dying is currently illegal in the UK, but it is possible to access such support if you can afford to travel overseas to countries where it is permitted. Yet making that decision under the current framework presents you with impossible, heart-rending choices.
Anyone assisting you, even close family members, can be prosecuted.
While such prosecutions are rare, they carry a maximum prison sentence of 14 years and are likely to preclude those convicted from inheriting your estate under the 1982 Forfeiture Act (although section 2 of the act allows judges some discretion; in a recent ruling a judge did permit a man who had assisted his wife to end her life in Switzerland to inherit).
People seeking assisted dying abroad must either risk the liberty of friends or family or travel on their own, robbing them of the chance to say goodbye to loved ones and sacrificing weeks, months, maybe even years of life to ensure they don’t become too frail to make that final journey on their own. Blur drummer Dave Rowntree was the most recent to recount the heartbreak of a loved one dying alone in a foreign country in a article last week.
This is something we need to talk about.
But into this emotionally complex issue wades a relatively inexperienced Parliament. Over half of MPs are brand new, coming to terms with the complexities of the role. Many still don’t have offices or full staff. And they will now take the single most consequential decision of their lives; whether to allow one human being to end the life of another.
The vehicle they will use to explore this issue is the Private Members Bill, a vehicle wholly unsuited to this question. Private members Bills typically get less time for debate than government bills, often being talked out by opponents. Supporters can attempt to move the ‘closure’, ending the debate and forcing a decision, but again this mechanism stifles the debate. I fear this immensely complicated issue will not get the discussion it needs.
And let me be really clear, this Bill needs a proper discussion.
I’m going to leave aside the moral, ethical and religious aspects of the argument. They’re important, but they will be well aired during even the most cursory debate.
Let me instead focus on the practicalities. Practicalities we know nothing about despite the second reading rapidly advancing upon us, scheduled for 29th November.
But let me speculate based on the discussions I’ve had.
I understand this bill will propose that people with less than 6-12 months to live can be considered for support to end their lives. Life expectancy in terminal illness is a notoriously difficult thing to judge. In another recently published Bill by the Labour Peer Lord Falconer, two doctors and a judge will be required to agree. This level of oversight in an already stretched health and legal system will lead to delays and challenges, adding additional stress at end of life. This isn’t a practical solution. But we await the detail of Kim Leadbetter’s proposal still.
And why an arbitrary cut off at 6-12 months anyway? People at this stage of life are often very well supported by our existing services and look to spend time with loved ones. Whether or not we allow assisted dying, it is critical that we offer outstanding palliative care and excellent mental health support at end of life.
Yet our mental health services are on their knees. And our palliative care services are incredibly stretched, as Wes Streeting recently acknowledged, with hospice care remaining highly dependent on the charity sector.
Will desperation and depression cause people to turn to assisted dying, robbing them of time with their family, for want of better support?
Will permitting assisted dying allow us to duck the responsibility of improving these services?
I understand that one of the reasons the Bill is being held up is that Kim is under pressure by some to remove the cut off, while others say removing it will reduce the chance of their supporting the bill. A hugely difficult dilemma for Kim, with the days before the second reading passing rapidly.
But this is one of the key reasons we need time for debate. It is often people with much longer life expectancy but devastating ill health or chronic conditions who are often most desperate. People with conditions such as multiple sclerosis, motor neuron disease and many others can live for years, many with awful quality of life. Some become so desperate they ultimately refuse food and water, effectively starving themselves to death. Yes, you read that right. People so desperate they starve themselves to death. And some may vote the bill down if we include these people within its provisions.
So here we are.
Putting before a brand new Parliament a private members Bill dealing with issues so complex that the author hasn’t finalised the text more than two weeks after the Bill was initially presented to Parliament.
And on an issue that we actually need decisions made one way or another; the status quo isn’t acceptable.
Sure, if the bill passes then some of the issues can be addressed as the Bill proceeds through subsequent stages. But the basic premise (if the bill passes) is that assisted dying becomes law. We won’t be able to reverse that just because we discover major unintended consequences in some of the services I mention above.
And if the bill doesn’t pass we may have missed the opportunity to clear up some of the current legal uncertainties for at least another decade.
Let me be clear, I truly don’t know the answer. After 30 years in medicine and having given deep and long consideration to this question, I really don’t know. But I do know that it’s an issue that needs very careful consideration.
There are growing calls for a Royal Commission. Those calls are correct. What a shame that MPs, whatever their ultimate view, must vote this down to get that outcome.