Today, the House of Commons is debating draft legislation to introduce assisted dying for people who are terminally ill with less than six months to live, who have mental capacity.  Many constituents have got in touch about this Bill, expressing strong views – in relatively even numbers, both for and against.

This is an issue which I have thought long and hard about and which arouses very strong emotions.  I recognise that there are very strong arguments on both sides of the assisted dying debate, and I have carefully read every letter and email that I have received on this issue.  These include extremely harrowing accounts from people who have witnessed their relatives die in agonising pain, as well as heartrending letters from constituents who fear that if assisted dying is made legal, they would feel under obligation to make that choice themselves.

I have decided that I will vote against the Bill today.  This is not a decision that I have reached lightly, and it is not a clear cut choice, but I have tried to explain my reasons below.

The arguments in favour of assisted dying focus on compassion and choice. I believe strongly that all of us should be treated with compassion and should have real choices in the last stages of life.  In the UK we have a gold standard of palliative care in the hospice movement, both in hospices and increasingly in people’s homes, under the care of hospice teams.  I have seen first hand how the burden of grief and pain can be eased by the best possible, whole-person care, in a pleasant non-clinical environment, by doctors, nurses and other health professionals whose sole aim is to ease suffering and help people's last months, weeks, days and hours to be as peaceful as possible. However this quality of care is not available to everyone across the UK.

Later in the autumn, NHS England will publish a new palliative care strategy, and this will be a welcome step in further embedding good quality palliative care across all areas of health and social care. I will campaign to ensure that the government provides the resources to implement this strategy fully.  Currently there are still people whose pain relief is not as well managed as it could be, whose housing, social care or financial situation means that they are not living with dignity or choice at the end of their life.

Wherever you live in the UK, you should receive good quality social care, appropriate housing and support at the end of your life. On too many occasions however public services don’t respond quickly enough to someone’s terminal diagnosis, in order to enable the adjustments and support that they need to live the best possible quality of life in their time remaining to happen quickly and without burdensome administration. All of these issues can lead people to feel that they can no longer go on and the failure to tackle these issues quickly and efficiently is completely unacceptable.  I am concerned that in a context of severe cuts to our public services, it will become even harder for services to join up in the way that is necessary to support terminally ill people, and in that context, the pressure to take the option of an assisted death may grow.

There is more that can be done to encourage good practice in the preparation of 'living wills' which enable people to be explicit about their wishes for their death including where they wish to die, the approach to resuscitation and other areas. Where this practice is encouraged and implemented well, taken full account of by all of the professionals involved in caring for a terminally ill person, it makes a big difference.

Assisted dying, if it were to be introduced, should be a choice that is available in cases when no more can be done to relieve pain, not for when access to the best possible pain relief is limited, or there are other circumstances making someone’s life intolerable, which could be addressed. No-one should choose death because they fear the quality of health or social care that they will receive. Until the best possible palliative care is available to everyone, there is a significant risk that assisted dying would simply become another treatment option in a menu of imperfect choices.  

I am concerned, most of all, about the compassion we offer, as a society to those with a terminal condition – a situation that any one of us could find ourselves in at any time.  I feel most strongly, that until everyone has meaningful choices about their care, and access to the best possible palliative care, and until further work is undertaken on the safeguards, this is a major change in the law which would have unintended consequences.