Danny Kruger MP: speeches

Speeches

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  I think so. The hon. Lady is absolutely right that there is this difficult loophole that somebody may have capacity and be refusing food and drink and would therefore potentially be eligible. In the Bill as it stands, we have an expedited process for people whose prognosis is only a month. There, the 14-day waiting period could be reduced to just 48 hours. If a person stopped eating and drinking, their death would almost certainly happen within a month. In other words, a person who is not terminally ill could make themselves eligible for an assisted death within 48 hours simply by refusing sustenance. It is very important that we recognise that and explicitly exclude it. I will refer quickly to other jurisdictions where this specific situation occurs and the voluntary stopping of eating and drinking is used to qualify for legal drugs. A peer-reviewed article in the Journal of the American Geriatrics Society discusses this case—it may be the one referred to earlier. The authors noted that if anyone can access VSED—voluntary stopping of eating and drinking—then anyone can qualify for medical assistance in dying. In Colorado, 12 people qualified for assisted suicide based on a diagnosis of severe malnutrition. The American Clinicians Academy on Medical Aid in Dying, an organisation of doctors who provide assisted suicide, acknowledges this loophole. Its guidance states that “there is nothing in the letter of the law” to prevent voluntary stopping of eating and drinking from being used in this way. It adds that that would “essentially eliminate the criteria of terminal illness,” because a person could always qualify as having terminal illness if they stopped eating and drinking. That is obviously not what the Bill’s sponsor and drafters wish. I hope they will consider accepting the amendment to close that loophole. I will not repeat points made very eloquently by my hon. Friend the Member for Reigate, but I echo the need to ensure that the Bill is not for conditions that, although they cannot be reversed by treatment, can nevertheless be controlled or substantially slowed. I will therefore support the amendments in the name of my hon. Friend the Member for South Northamptonshire. I pay tribute to the hon. Member for Harrogate and Knaresborough and to the people he speaks for in tabling amendment 234. I recognise absolutely that the MND Association has pointed out that the six-month rule would not work for all MND sufferers. It successfully persuaded the last Government to change the rules on benefits in recognition of that point, and its evidence to us, it has requested a clear and workable definition for assisted suicide. It was not very clear on what that would be, and there are practical problems with extending to 12 months, specifically the one we have with six months—the difficulty of prognosis, which would be twice as bad. I also refer to the evidence from Professor Sleeman, who made the point that a non-neurologist would find it particularly difficult to make an accurate 12-month prognosis for MND. The main reason to object to the principle of the amendment—I appreciate that the hon. Gentleman is not moving it, but it is an important principle to discuss—is that it makes no sense at all to have two different prognosis periods. Of course, we can see where it will go. The fact that the amendment has been tabled and selected, that it is in scope, and that people will support it in this Committee or beyond, or outside Parliament, is evidence of where things go. We saw it very clearly in the evidence we heard from witnesses from Australia, who pointed out that there is no logical reason to have two prognoses—one for cancer and one for neuro-degenerative disorders. Their response was, “Well, let’s make it 12 months for everyone,” and of course that is the way things would go. I finish with a tribute to the great quixotic effort of my hon. Friend the Member for Runnymede and Weybridge, who is not on the Committee. Runnymede is the home of Magna Carta; the spirit of liberalism lives on in my hon. Friend, a genuine liberal who wants to scrap the period of prognosis altogether, because he genuinely believes in absolute autonomy. I have been trying to make the Bill live up to its claim to be a Bill for safeguarding; he wants it to live up to its claim to be a Bill for autonomy. In principle—in logic—he is absolutely right. If we think that some people should have access to suicide assisted by the state, then why should person A get it and not person B? Needless to say, I disagree with him.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  The hon. Gentleman is making a very important point, and he picks up the observation by the hon. Member for Bradford West that there is a link, through the Equality Act, with disability. It is absolutely right that we address that. Does he agree that the way to do so is not to accept amendment 181 tabled by the hon. Member for Spen Valley, which would retain the dangerous words “only” and “for the avoidance of doubt”, but to accept amendment 11, which would exclude those words and ensure that someone could not get an assisted death by reason of disability or mental illness? Because of that concern, perhaps we need to table a further amendment to exclude the Equality Act from the operation of this clause, and I await the Chair’s ruling on whether that is possible at this stage. Amendment 181 does not refer to the Equality Act, although the Bill does, so we should follow that point. Rather than accepting that amendment, which would not move us forward, we should accept amendment 11. I hope that that is clear and that it might satisfy the hon. Gentleman’s concern.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  I beg to move amendment 12, in clause 2, page 2, line 2, at end insert— “(c) their illness, disease or medical condition is found on a list that the Secretary of State may by regulations specify.” This amendment would require an illness, disease or medical condition to be specified in regulations that may be made by the Secretary of State to be considered a terminal illness under the Act.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  I was going to remind the Minister that he is, in his strange Jekyll and Hyde personality, speaking as a Minister but voting as a Member of Parliament, so if he has given the Government’s view that my amendment is not acceptable, but he personally thinks that it is, I hope that he will vote for it.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  The hon. Member invites me to suggest that I think it would be possible to draw a safe safeguard. I do not. I think that one month is better than six months, because with one month we can have more accuracy and doctors are more genuinely right when they say that someone is close to death at that point, while six months is much more inaccurate and 12 months is notoriously inaccurate. If we restrict the Bill by using a time limit, that limit should be as close to death as possible in my view.

• 25 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Thirteenth sitting) · Hansard source

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  I am delighted to hear it. I am grateful to the hon. Lady and to other hon. Members who have indicated their sympathy for the amendment. I look forward to the Division and to the Minister’s decision. May I follow up on a point made by the hon. Member for Bradford West? I do not know whether the hon. Member for Spen Valley would like to intervene to help me understand the point. Amendment 181 would redraft clause 3(2) to make it clear that a person does not qualify as terminally ill “only because they are a person with a disability or mental disorder”. It would add to clause 3(2) the following additional sentence: “Nothing in this subsection results in a person not being regarded as terminally ill for the purposes of this Act if…the person meets the conditions in paragraphs (a) and (b)”. Does the hon. Member for Spen Valley agree that that will essentially mean that the clause does nothing? It confirms the terms of eligibility set out earlier in the Bill, and confirms that a person would still be eligible to receive an assisted death if they had conditions that were a consequence of a mental disorder or a disability. If she feels like intervening on me, I would like her to help me understand what that additional sentence adds. To my mind, it negates the purpose of the clause.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I emphasise that the basis of the Bill, despite what many campaigners might want, is not one of total autonomy. The Bill requires us to have some responsibility towards the applicant, and not simply to say “Do you want it? You can have it.” There are already provisions in the Bill that put an obligation on the assessing doctors and then the judge not so much to conclude that it is in the person’s best interests—I am afraid it does not have that stipulation—but it does seek to insist that they make their own decision. As the hon. Lady said, many people make a decision and might not even be fully aware themselves that they are the subject of undue influence. They may be being deceived by their loved ones. Their loved ones might be deceiving themselves about the pressure they are putting on them, but let us just talk about a genuine intent to persuade, which does happen. In answer to the question, “Have you been coerced or pressured?”, the patient may say, “No, of course not.” But if they are asked, “Have you been encouraged?”, they might say, “Actually, yes, I have.” That should raise a very significant red flag, and it is absolutely appropriate and sufficient at that point to say, “I’m sorry, but I don’t conclude that this is an autonomous decision.” To conclude, I refer back to the debate we have been having since the news broke two days ago that there will be an amendment to scrap the judicial stage that is currently in the Bill. If there were a High Court judge sitting at the end of this process, as we were promised and as was understood by the House when it voted on Second Reading—if there were a judge sitting over each individual case, rather than sitting at the head of a national assisted dying commission, and if there were a judge sitting in court reviewing the case properly—there might arguably be no need for the amendment on undue influence. It is possible, as the Minister explained, that coercion would sufficiently capture the more insidious undue influence and encouragement we are concerned about. It is possible that we could strengthen the definition of coercion through guidance, or through further definition in the Bill. But if we are going to have a panel, and not a court or a judicial process at all, it is even more necessary that we insist on added protection.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I remember the hon. Lady’s very powerful speech on Second Reading and I fully recognise that, which is why I said that I recognise that including suffering would be problematic. I understand her point about pain as well. I think we need belt and braces. If we are going to do this, we should have strict restrictions on prognosis, because I want to restrict the time limit. I could go further than six months; we keep hearing about people in the very last stages of their life, and I think it should be restricted to them, but I also think the purpose of seeking an assisted death should be consistent with all the arguments that we keep hearing about people suffering terribly at the end from an agonising death, and we need to restrict it to those cases as well. It should be for people at the very end of their life, for the avoidance of suffering terrible pain. Those are the reasons that the public, in so far as they do support the Bill, support it—they support it for those reasons only.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  This is my last intervention, I promise. I want to hear the hon. Lady confirm that under the Bill as currently drafted, after all these conversations have taken place, as long as the doctor cannot find evidence of coercion, they would be obliged to approve the assisted death, as would the judge and the judicial panel. If that is the case, and they conclude that a person has capacity and there is no evidence of coercion, no matter what conversations go on—if the person wants to do it in order to save their family money—the doctors and the judges would have to say yes.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I am very conscious that people feel like a burden at the end of their life. It is quite right that at the moment the system says, “No, you are not. You have value. You might feel a burden, but we want to sustain your life until its natural end. If you want to withdraw or decline treatment, that is your autonomous choice, but we do not recognise you as a burden.” It is very important that the British state does not tell people or confirm to people that they are a burden, which is what we would do in the Bill. To the point that the British people are very self-effacing, I should say that I suspect we would be at extreme risk from this law. I think many people would indeed feel like a burden. If we pass this law, we are explicitly saying, “Yes, you may well be a burden and it might well be right for you to seek an assisted death.” My right hon. Friend the Member for Braintree, who tabled the amendment, makes the powerful point that a right to die should not become a duty to die. Nobody wants that. Nevertheless, the implication of a law that confirms that people may seek to get the state’s help to kill themselves—not for their own sake but because they feel a burden to others—is incredibly dangerous for our society and for our culture. I would be very concerned if we proceeded with it. I will now conclude on the amendment before quickly talking about pain. It addresses the motivation of doing things for one’s own sake. I do not underestimate the difficulties. My right hon. Friend the Member for North West Hampshire has stated a number of them at least, as have other Members. Implementing this safeguard will be difficult, but the fact is that the Bill’s sponsors have already put enormous faith in doctors and judges, or other experts, to detect external coercion and make all sorts of judgments—to ferret around in people’s minds and in their lives to understand what they are doing. We have to consider how best to implement this safeguard, but at the moment the Bill does not even say that asking for an assisted death for other people is something that should be protected against. That is wrong, and it is right that we make the amendment. I will proceed quickly to a few points about the amendments in the name of my hon. Friend the Member for Sleaford and North Hykeham (Dr Johnson), which specify that the purpose of seeking an assisted death must be the avoidance of pain. They would make the Bill honest. The point has been made repeatedly by advocates in the media and in Parliament, including in our evidence sessions, that the reason why we need an assisted dying law is that so many people die terribly. My right hon. Friend the Member for North West Hampshire has referred to some of that today, and he did so very powerfully on Second Reading too. Sir Nicholas Mostyn made a fairly unarguable case that if we are honest about what we are trying to do here, it is unclear why we have a period of prognosis as a qualifying factor: why should people have to be within six months of their death in order to qualify if we are concerned about the avoidance of suffering? If the logic of the Bill’s proponents and the argument for it is followed through, of course it should be only about the avoidance of pain. I recognise that “suffering” is a more complicated word, but I do not agree with my right hon. Friend that pain is too difficult to determine. The motivation of avoiding pain is straightforward. It should be simply about pain, and unless someone is a full-blown ethical egoist who believes there should be no restrictions on someone seeking the assistance of others to take their life—

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  Would the hon. Lady be content if somebody who had capacity chose an assisted death for the purpose of saving their family money?

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  On a point of order, Mrs Harris. The Minister gave a brilliant speech in support of the Bill as it stands, so I simply do not understand how, having explained so clearly why she believes that the amendment is inappropriate, she can claim to have a neutral position on it. This is not in any way personal; she made a very good speech and she ended it with—

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  Okay. I am sorry to hear that.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  My right hon. Friend says that the primary purpose is control, and that is certainly the argument made by some of the most passionate advocates of this sort of legislation. However, does he recognise that, in the majority of cases, in jurisdictions where this is legal, being a burden is a primary cause for people to seek an assisted death? People request an assisted death explicitly for the purpose of not being a burden on others. If my right hon. Friend is content with that because he respects their autonomy, and he thinks that that is an acceptable reason for people to want to die, that is fine, and let us say so. However, I do not think it is acceptable to hide behind the idea that we are talking about people who simply want to control their own passing. In fact, many want to do this because they are concerned about being a burden on others.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  Will my right hon. Friend explain what the doctor would do if he or she did not think that there was an appropriate reason to approve the death? The Bill simply requires there to be a settled and informed view. As the hon. Member for Richmond Park says, the motivation might be that the person wanted to save their children the care costs—at which point the doctor, if they could not find evidence of coercion, would say, “Go for it. That is a perfectly good reason.” Is that not the case?

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I am not sure that we are going to satisfy each other on this point. A lot of the evidence that we have heard conclusively asserts that there is a widespread problem of families applying—and I do use these terms fairly interchangeably—undue influence, encouragement and manipulation. Pressure and coercion form a subset of those terms. They are at the sharp end—the more obvious forms of encouragement and manipulation. Those terms exist in law, and this certainly exists in society, as we have heard from Members and witnesses. It feels to me entirely appropriate and consistent with the principles of the Bill that we are trying to ensure that the new law will only be available to people who are acting entirely autonomously, without having been in any way—however subtly—the victims of any sort of undue influence. That is the purpose of these amendments.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  That is absolutely right. It is a very depressing fact that it seems to be the sentiment of the Committee that we should allow people to request and receive an assisted death for the purpose of saving their relatives money. That does seem to be what people are saying.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I am sorry to push my right hon. Friend further but to reiterate my point, we are not talking about external coercion. We are talking about the explicit motivation of somebody with a settled and informed wish that they want to die to save their family the cost of their care. My understanding is that the Bill would allow that. Does he agree and is he content with that?

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I will give way first to my hon. Friend and then to the hon. Gentleman.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  The purpose of the amendments, and the reason why I am supporting them, is that they make the Bill honest. They will make the Bill do what the public think it does and is the reason why so many people around the country and in Parliament have supported it: because they understand it to be for exactly the purpose specified in the amendments. In fact, the amendments add safeguards that at least two strong supporters of the Bill in the House of Commons—I will not mention them—thought were already there. Those people have gone on the record stating that these safeguards exist in the Bill, but they do not. We need to acknowledge motivation. As I said in my exchange with my right hon. Friend the Member for North West Hampshire, my concern is that the absence of recognition of motivation is a significant lacuna in the Bill. Earlier—or perhaps it was yesterday—my hon. Friend the Member for Solihull West and Shirley sought to draw a distinction between a depressed person who wants to die because of their terminal illness and someone who wants to die because of their depression. But in the Bill as it is written, there is no requirement for any causal link between the terminal illness and the desire to die. Under the Bill, someone’s reason for wanting to die does not need to be linked to the terminal illness; in fact, no reason is required. The Bill is totally neutral—in fact, it is silent—on the whole question of motivation. My hon. Friend also talked in an intervention about people who want to end their lives because of suffering and pain—again, that is not mentioned in the Bill. I will come to that shortly when I discuss amendment 235. There is no reason required to see a clear, settled and informed wish. As discussed earlier, I recognise that there are safeguards intended to detect coercion or pressure, but that does not include people putting pressure on themselves. It is important to consider people’s motivation in situations such as the example given of somebody who wants to spare their family the ordeal—the trauma—of witnessing a bad death. Those sorts of people do not write in to us, by the way. Evidence has been submitted by many people who have experienced the trauma of having watched their relative die badly, but there is also the experience of people whose relatives have been through an assisted death. I was talking earlier to the noble Baroness Finlay, the former chair of the National Council for Palliative Care, who cited evidence heard by the Commission on Palliative and End-of-Life Care. A man requested and received an assisted death in the Netherlands for the explicit purpose of sparing his son from seeing him degenerate and die badly. The son was desperate for his father to stay alive—he wanted to go with him through the ordeal—but the father refused. The impact on that young man has been significant, traumatic and destructive. Even if the patient wishes to do something for the sake of their children, it is not necessarily the case that that will happen or that it will be a good thing. Children can be traumatised by such decisions. Crucially, we should insist that the Bill does what it aspires to do and what many of its advocates have set out clearly over many months. Its purpose is to help people to die, specifically to avoid terrible pain and suffering—but crucially, for themselves and not because they fear that they will be a burden. The fact is that many people do feel that they would be a burden. I pay tribute to the hon. Member for Harrogate and Knaresborough, who has intervened a couple of times this afternoon and made a very coherent argument about the importance of autonomy. I think he was suggesting—my right hon. Friend the Member for North West Hampshire hinted at this, too—that it is an appropriate decision if a person seeks an assisted death because they do not want to be a burden on others. In fact, that point was made by people giving evidence to us from abroad. Some of the Australian witnesses—and, I think, the American witnesses—openly said, “Why not? This is consistent with people’s autonomous choice, and if they want to die to save their children’s inheritance or to prevent them from seeing them suffer, that is legitimate.” I would like more people to say openly, as a reason to legalise assisted death, that that is appropriate and that nobody should object—that the judges, doctors and everyone else should nod that through. I do not think that was the sense of the House on Second Reading and I do not personally think it is the view of the public, but if people think that is an acceptable reason to legislate for assisted dying, let us hear it. I want to emphasise the point about the number of people who genuinely seek an assisted death because they feel that they are a burden on others—not for their own sake, but to save their loved ones money or to avert their distress. A very large number of people—I said most, but I correct myself; I think it is getting on for half of the relevant people in Oregon, Canada and elsewhere—cite burden as the reason for seeking an assisted death. I note in passing—I hope the Committee will pay attention to this point—that I am concerned that we often feel we are legislating into a vacuum: we pass a law, it will apply, and that is that. As I said yesterday, the law is a teacher and has a direct cultural effect on society. It is very noteworthy that in countries where there is data on motivation, the number of people seeking an assisted death because they feel that they are a burden has risen significantly. It all started, naturally enough, with just the very desperate cases that we are all familiar with and we all understand the rationale for, but the number rose sharply. In the early years, between 12% and 34% across those four jurisdictions cited being a burden as a reason for seeking an assisted death. That has gone up to between 35% and 59% in the four jurisdictions—from around a quarter to around a half in terms of people who seek it. We could pass this law for the small number of people we think we want to help, but in due course many more people will avail themselves of an assisted death because they feel they are a burden.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  Will the Minister give way?

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I totally acknowledge that. I fully recognise that, as I said, morphine allergy does indeed exist, but I am told that it is very rare. I hope that the hon. Lady’s relative will confirm that there are other things that can be done for people who suffer from pain if morphine is not appropriate. I suppose that is the point that I want to make: no palliative care professional would ever say that they cannot help somebody in terrible pain. There is always something that they would like to do and always more that they can do to assist. The simple reality is that palliative care is improving so much that there is only an infinitesimally small number of people whom palliative care professionals would confirm they cannot help. I recognise that those people exist. I am not being naive or Panglossian and suggesting that palliative care can be perfect in all cases, but if we are serious about the purpose of the Bill, which is to help those whom palliative care cannot help, I suggest that that number will be very small. I pay tribute to the hon. Member for York Central (Rachael Maskell) and to the noble Baroness Finlay, whom I mentioned. They are leading a commission on palliative care at the moment, which is a helpful corollary to the debate we are having here. They will make a series of recommendations, which I will not go into. I want to conclude with this obvious point. I am repeating myself, in a sense, so I will be quick. If we are going to do this, let us be honest and straightforward about what we want to achieve. We want people who are dying in extreme agony at the very end of their life to avoid the pain of death and be able to avail themselves of this service. It is either that or we say, “No, we have no interest in people’s motivation for wanting it. We simply respect their autonomy. Unless we can detect external coercion,” which is the only thing that the Bill currently seeks to exclude, “and as long as a doctor can give confirmation that they have six months to live,” which is not difficult to get, “we don’t care why they’re doing it. We respect their wish, and whoever they are and whatever is going on behind the scenes, they can go for it.” We either have a Bill based on full autonomy—I think that is what some hon. Members genuinely believe we should do—or we try to restrict it to just those people who face an agonising death at the very end.

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  I am interested in what my hon. Friend said about not having had conversations with the Government or the promoter about the details of these amendments. I could understand that if this was purely a private Member’s Bill, but the fact is that the Government clearly are involved; we have heard it said today very clearly that the Minister supports the text of the Bill as it stands. Is my hon. Friend aware whether the Government have directly fed into the drafting of the Bill or discussed with the Bill’s promoter the appropriate response to these amendments? Does she agree that, if so, it would have been appropriate, as she suggests, to have had conversations with her or the other hon. Members who are moving these amendments, in order to do what normally happens in the course of a Bill’s process and convey the Government’s position ahead of the debate so that, if it is appropriate for amendments to be withdrawn or for concessions to be made by the Government or the promoter to amend the Bill in due course, that could have happened—rather than hearing today for the first time that the Government object to these amendments? Does she agree that that would have been an appropriate process?

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  But if the doctor concluded that they were doing it because they felt they were a burden, they would still be able to get the assisted death under the hon. Lady’s Bill. The only question is whether they have capacity. If they have been judged to have capacity, choosing to have the assisted death in order to save their family money would be acceptable under her Bill, would it not?

• 12 Feb 2025 · Terminally Ill Adults (End of Life) Bill (Eleventh sitting) · Hansard source

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  That is a fair point. I do not propose to push the amendment to a vote, but I hope that the point has landed sufficiently. There is a genuine concern that people will, as they do in other countries, with increasing regularity and in concerning numbers, seek to have an assisted death not with their own personal interests in mind but for the sake of others. That may be generous-spirited of them, but it is not the purpose of this Bill as far as I understand it.