Terminal Illness (Relief of Pain)

I beg to move,

That leave be given to bring in a Bill to require the Secretary of State to issue guidance about the application of the criminal law in respect of the administration of pain relief by healthcare professionals to people who are terminally ill; and for connected purposes.

As we know, a ten-minute rule Bill is a delicate flower; it is almost certainly doomed to oblivion because there is no time for a Second Reading debate, but it can serve a purpose in allowing us to demonstrate a truth or a problem, or even just ask a question. I am deliberately proposing this Bill 10 days before the debate on the Terminally Ill Adults (End of Life) Bill—the “assisted suicide” Bill—because I want to highlight a real problem. There is simply not enough time to consider the immense complexities of this issue before we will be required to make our decision. That point will be the subject of a joint letter from me and the Mother of the House, the right hon. Member for Hackney North and Stoke Newington (Ms Abbott), to be published in The Guardian tomorrow.

A private Member’s Bill may be an appropriate vehicle for an issue that is narrow in scope, or involves a decision that is relatively clearcut, but that is not the case for the assisted suicide Bill. Were it a Government Bill—which it should be—there would be an impact assessment, but there is none. The Bill is much longer than almost any other private Member’s Bill, but it was published only very recently. What will be the impact on the NHS? Do we not need to know? At least one retired judge has questioned the role of judges. Should we not know more?

My Bill seeks to gain, and give the public, extra knowledge on one key aspect of this debate. What is the state of palliative care in this country? What are the options available to assist people in their dying? I use that phrase advisedly. All hospices currently assist people in dying as peacefully and painlessly as possible, but they do not do that by administering lethal drugs. So much of the impetus in favour of assisted suicide comes from an understandable fear of dying in pain. Talking to palliative care nurses and doctors, I am told that in nearly every case experienced practitioners can make our passing bearable, but I would like to know more, and I think that the public would. We would like to know more about the passing of people with degenerative diseases.

Demand for palliative care is increasing, and will continue to do so. It is estimated that by 2050, one in every four people in England and Wales will be over 65. The charity Marie Curie estimates that by 2048, over 646,000 more people will need palliative care—and, of course, just as individuals and families are feeling the cost of living crisis, our hospices are facing higher expenses. Hospice UK estimates that hospices faced £100 million more in costs in 2023 than in the year before. Research from King’s College London suggests that more than 100,000 people in the UK die each year without receiving the palliative care that they need and deserve.

My Bill asks the Secretaries of State for Justice, and for Health and Social Care, to publish a detailed analysis and advice on the law and procedures. For instance, palliative care nurses tell me that if your only motive is to relieve pain, you can give as much morphine as you like to a patient, and you will not kill him or her. However, I also hear that sometimes the pain doubles but the nurse—probably not in a hospice, but in a hospital—is unwilling to double the dose for fear of legal consequences. I hope that if I am dying of terminal cancer, a nurse will not hesitate to give me as much as necessary. I was at the deathbed of a dear friend and former colleague in the House; we were together in a hospice. I could hear the morphine pass, gurgling, into his wrists. He was knocked out, and his death was peaceful. It was clearly good practice. We, the public, need to be told what the situation is, in respect of ensuring a peaceful death in all conditions. My Bill would be a small step forward in taking up the debate and informing it. The debate in 10 days’ time could be seen as a useful airing of the issues, and then, in a year or two, we could make a measured and well-informed decision.

This is an immeasurably complex issue. First, there are deeply held moral and religious concerns about the ethics of assisted suicide; but even if those are of no concern to some people, there are practical issues as well. The hospice movement is one of our most loving and admired services, but we all know that sometimes there is not sufficient experience in some NHS hospitals to match the care given in hospices, so we need to know more. Should we not start by building up our hospice movement before we are given a binary choice in 10 days’ time? All this is before we even start to consider other issues, such as extending the law to other countries, or pressure being put on old people who feel themselves to be a burden.

There is something else that we that must consider. We know that we must provide more funding for the hospice and care home sector, but how can we afford it from general taxation? We need a national debate on a new social contract for a ballooning frail and elderly population with multiple health needs, and I have long argued that we can only do so with social insurance. We have to pay more for our care in old age. What we do not want, however, is pressure for assisted suicide for old people because there are not the resources to pay for them. Again, we need much more information about this whole area. I hope that my intervention today, in which I am seeking more knowledge, not just loudly stating my own position, is helpful, and that my Bill is useful.

Today I received the following letter from a doctor:

“Only recently, I was giving my condolences to a grieving woman who had lost her husband in the early hours. He had been given a few small doses of pain relief and mild sedatives over the last few nights for symptom control and had passed away peacefully at her side. She asked me in all seriousness, ‘Doctor, did the nurses give him something to make him die quicker last night?’ This was an awful lingering doubt that she had. I was able to firmly reassure her that, no, the medication would not have sped up his passing.

For her, and the vast majority of other patients, doctors are there to prolong life and palliate symptoms. Were this to change, then we should not be doctors in the eyes of many but bringers of death, agents of a state which counts the weakest members as expendable and worthy of nothing but an early grave.”

In conclusion, I hope that my Bill and this very short debate will inform discussion on this unbelievably moving and delicate matter. I have a dream, as we all have, that in years to come, when our time comes, we will be given the care that we need, but there is so much doubt and uncertainty about that. Many people, quite understandably, take a position from a point of principle. They may believe fundamentally, from a religious point of view, in the right to life; or they may have a libertarian point of view that states that everybody has a right to control their destiny. But when making this decision, probably one of the most important in this Parliament, it is surely important that we do so from a state of knowledge, and that we have a hospice movement and an NHS that are fully funded to care for our old people, so that we can assure all people that in this country—this civilised nation—we will ensure that everyone’s passing is as painless and peaceful as possible. In that spirit, I commend the Bill to the House.

That Sir Edward Leigh, Rachael Maskell, Sir John Hayes, Danny Kruger, Sir Christopher Chope, Sir Julian Lewis, Lincoln Jopp, Martin Vickers, Dame Meg Hillier, Saqib Bhatti, Helen Grant and Sir Roger Gale present the Bill.

Sir Edward Leigh accordingly presented the Bill.