Today Parliament voted on the Terminally Ill Adults (End of Life) Bill which would give people aged 18 and over the right to be prescribed medication to end their life in circumstances where they have been given a prognosis of six months or less to live, two doctors and a judge have agreed their decision and they are able to administer the medication themselves.

In my nine and a half years in Parliament, few decisions have weighed more heavily on my mind or caused me more sleepless nights. 

Although death is an inevitability we all must face, we are as a society, very poor at talking about it. Many people come to the debate about assisted dying informed by distressing and traumatising experiences.  In my experience, no matter their view, everyone comes to it with deeply and sincerely held beliefs, compassion and a desire to alleviate suffering.

I want to commend my friend and colleague Kim Leadbeater MP who has ensured that the debate on her bill has been respectful and inclusive and who has led with immense compassion.

Over the past few months, to inform my decision on this important vote, I have taken the time to meet with a very wide range of people with differing views and perspectives, including bereaved relatives, people living with a terminal diagnosis, disabled people, clinicians including some working in palliative care and staff at both St Christopher’s Hospice and King’s College Hospital, lawyers and constituents with a wide range of views including people with a faith and those with none.  I have sought views proactively, including by holding two meetings in Parliament for local residents who have recently contacted me about this important issue. I am grateful to everyone who has shared their views and experiences and I know that for many of my constituents this has not been easy to do.

The striking thing about the debate on assisted dying is that people with almost identical experiences and backgrounds often reach opposite conclusions.  I have spoken with bereaved relatives, clinicians, lawyers, people of faith and those with none, people with a terminal diagnosis and disabled people who are both opposed to assisted dying and in favour of it. People who I hold in the highest esteem and whose judgment I respect fall into both camps and many are undecided.  Exactly the same proportion of psychiatrists support the proposals as oppose them. A constituent who is a palliative care nurse with 30 years of experience told me that they didn’t know how they would vote in my position.

Public views on assisted dying are complex.  Behind the headline that a significant majority of the UK population are in favour of assisted dying, there are some significant caveats. A majority of people say that they would change their mind if there was a case of coercion, and when people are asked detailed questions about policy on assisted dying, their views (on both sides of the argument) tend to change during the process.

I have found myself completely torn on this issue. In 2015 when draft legislation on assisted dying was last in Parliament, after much deliberation I finally voted against it.  But I have always said that I do not consider this a closed question. I believe in personal choice and autonomy and I have listened to constituents whose loved ones have experienced unbearable pain and suffering at the end of life. My instinct, as the vast majority of people’s would be, is to want to prevent anyone from having to endure such horror.

Members of Parliament were not, however, being asked to vote on the general principle, but on a specific version of assisted dying proposed by Kim Leadbeater’s bill. While amendments can be made to a bill during its passage through Parliament, this is such a significant change in the law, with such enormous and wide-reaching implications, that I believe it is important to have been satisfied with the basis on which the current bill has been drafted and its core substance in order to vote for it. Over the last 18 days that we have had to consider the detail, I have had a number of concerns, as follows:

Lack of a formal national conversation on the end of life: I am concerned about the process that has underpinned this bill.  While assisted dying has been debated by some people over many years, there has been no formal, structured national conversation, like a Royal Commission, that has allowed everyone to feed in their views, and no risk assessment, impact assessment or equalities assessment has been prepared in relation to this bill. There are differing models of assisted dying and accompanying safeguarding processes across the world and we have not been given the opportunity to consider them.

The postcode lottery of palliative care and crisis in social care: This is the same issue which led me to vote against assisted dying in 2015, namely that while some terminally ill patients have access to a gold standard of palliative care, this is not available everywhere.  Last year alone, 100,000 people died wanting palliative care but unable to access it.  Social care is under immense strain and all too often does not deliver the dignity, independence and quality of life that should be available to everyone. Far too many people face catastrophic care costs which drain down their savings. I fear that this could lead some people to make the decision to choose an assisted death for reasons that most of us would regard as tragic and regrettable. If assisted dying is introduced it should be in addition to good palliative care and social care, not instead of it.

The risks relating to safeguarding and coercion (both direct and indirect):  There are many examples of processes that were designed to keep vulnerable people safe that have catastrophically failed. We have seen this locally in the historic scandal of abuse at Lambeth children’s homes. This does not mean that effective safeguards are impossible, but it does mean that the detail of both the principle and the process for safeguarding really matters. The bill specifies that two doctors and a judge should sign off the decision, but it is not clear what expertise in mental capacity or coercion they must have, or how well they would know the patient. Nor is it known whether and how the person seeking an assisted death would be represented in the court and whether it would be possible for anyone to object to their decision.

I can imagine situations in which a terminally ill person might decide to have an assisted death in order to avoid their savings being eaten up by care costs, or because they want to spare their family the responsibility of caring for them.  I think most people would agree that these are not reasons for an assisted death that are intended by the legislation and they should be avoided.  But I don’t see how such views would meet a legal definition of coercion.

The scope of the bill:  The bill applies to people with a prognosis of six months of life (an inexact clinical judgment) who are able to administer medication themselves.  There will be many people who are in favour of this legislation who are unable to access assisted dying, sometimes because they have a terminal diagnosis with a more uncertain timescale, sometimes because they would not be able to administer medication themselves and also because while they may be in intolerable uncontrolled pain, they are not terminally ill.  I understand why attempts have been made to make this bill tight and narrow, but this bill proposes unequal access to assisted dying in ways which expose the ethical dilemma at the heart of this debate but does not resolve it. We have not had the opportunity to consider alternative criteria, for example, as is the case in some states in Australia, where the dual criteria of a terminal diagnosis plus ‘pain which cannot be reasonably controlled’ is included.

The deep fears of some frail and disabled people about this legislation:  The stories of people whose loved ones have died an agonising death are heartbreaking. So are the fears of people who have often had to fight discrimination, hatred and low expectations their whole lives and who fear that whether they are eligible for an assisted death or not, introducing this bill will devalue their lives and put them at risk of coercion.  Not all disabled people are opposed to assisted dying, but I have listened to the views of disabled constituents some of whom are genuinely terrified about this legislation and their voices have not always been sufficiently represented in the debate.  Some of their concerns may be possible to allay, but their views should not be dismissed.

As a consequence of these concerns, and with some regret, because I know how much this decision means to my constituents who are strongly in favour of the principle, I could not reconcile myself to vote in favour of the current bill and I voted against it.

I understand that this decision will disappoint constituents who are strongly in favour of assisted dying.  Please know that I have thought deeply about the heartbreaking stories you have shared with me.  If I believed that this bill was the way to stop people from suffering in the way your loved ones did without opening up the concerns I have described above, I would have voted for it. I hope you will be able to understand that I have taken your views extremely seriously and I have never believed that this vote should be the end of the conversation.