Terminally Ill Adults (End of Life) Bill

I remind Members that it is not customary to impose a speech limit on private Members’ Bills, but I hope that after the Member in charge of the Bill and the speaker after that, Members will restrict themselves to about seven to eight minutes in the first instance; that includes taking interventions. I may need to ask for further shorter speeches to enable more Members to contribute. I should make it clear that the Chair retains the right to impose a formal speech limit, but I would rather colleagues helped each other, especially on a day like today.

I beg to move, That the Bill be now read a Second time. It is a privilege to open this debate on the Terminally Ill Adults (End of Life) Bill—a Bill that will give dying adults, under very stringent criteria, choice, autonomy and dignity at the end of their lives. What is being asked of MPs today? It is a fair question, given that this House already voted to send the near identical Bill introduced by my hon. Friend the Member for Spen Valley (Kim Leadbeater) back to the House of Lords in June last year. On Second Reading, we vote on the principle of a Bill, but we did that in November 2024. It is a broader principle that the House must consider today: who ultimately decides the laws that govern our nation? Many Members would no doubt prefer to be working in their constituencies today. They are not because a small number of peers in the other place chose to prevent any votes from taking place on the substance of the Bill in the last Session.

Will my hon. Friend give way?

I will once I have concluded my opening remarks. That decision by those peers means that one of the most significant national conversations that we have been having as legislators was brought to an abrupt halt. Who suffers detriment as a result? Clearly, the terminally ill and their families, who had a fair assumption that the will of the people they elected to represent them in this Chamber would be respected, but also those who must navigate our current, unclear laws. They are laws that do not protect or guide those who work in our health system, laws that do not contain safeguards against the risks of coercion, laws that criminalise and traumatise families who simply want to be with their loved one at the moment of their death, and laws that four Directors of Public Prosecutions have urged need to change. If we do not vote today to allow this Bill to continue its passage through Parliament, we accept those outcomes as the cost of maintaining the status quo, and who knows how long it will be before we get the opportunity to consider the introduction of assisted dying laws again, despite consistent polling showing that it receives majority public support?

The hon. Lady is setting the scene for what the Bill hopes to achieve, but she cannot ignore the overwhelming 68% of the public who believe that it must be paused, or the 73% of people who say that it should be rejected outright. The public see the danger. This House must halt the process, pause the Bill and instead focus on properly funding world-class palliative care.

I think we need to be very careful when we are quoting polling. For instance, we know that Whitestone Insight has been criticised heavily by the British Polling Council in recent weeks for failing to meet its standards in terms of disclosing who has been funding its research. The reference I am making in my speech is to those very robust, independent polls, such as the British attitudes survey, which in 2024 found that 73% of the British public supported assisted dying and have done so over the last 20 years.

I will give way to my hon. Friend the Member for Hackney South and Shoreditch (Dame Meg Hillier).

My hon. Friend talks about who makes our laws, and she has talked in articles that she has written about the primacy of this place. If the Bill goes forward, is she willing to accept amendments? She has brought forward a Bill that is exactly the same as the previous Bill, despite its sponsor in the House of Lords himself saying that there needed to be 77 amendments to make it safer.

It is not quite the exact same Bill; it incorporates two amendments that were agreed without a vote in the House of Lords last time. We have had our conversation in this Chamber about this Bill in 2025, and we have had an interrupted conversation as a nation. I am asking Members of this House to send the Bill back to the House of Lords so that they can continue their important work of amending and scrutinising legislation.

Does my hon. Friend agree that unless this House makes it absolutely clear that it is outrageous and unacceptable for a very small number of unelected peers to block legislation, supported by the elected Chamber, then the same tactic could be used again with any private Member’s Bill that comes forward in this House?

Absolutely—it would set a dangerous precedent. Those Members who want to come in on the specifics of the Parliament Acts will have ample opportunity to do so later in my speech, and I will be willing to take interventions on that matter. I pay tribute to my hon. Friend the Member for Spen Valley for the courage, courtesy and openness she showed during the passage of her Bill. Her engagement with those from all sides of the debate, particularly in Committee, delivered a stronger Bill that this House voted for on Report and Third Reading. One strengthening factor was the introduction of a requirement for the Health Secretary to report regularly on the availability, quality and distribution of palliative care. In asking parliamentarians to consider assisted dying, my hon. Friend also prompted a national conversation about how we improve and fund palliative care. We saw more funding for hospices, as well as Government action to develop a new framework to improve palliative care and end-of-life care.

I chair the all-party parliamentary group on hospice and end-of-life care, and I wonder whether my hon. Friend shares my concern. Given that an estimated 170,000 people die in this country each year without access to palliative and end-of-life care, there can be no choice until hospice and end-of-life care are properly funded.

It is absolutely right that, for instance, the Prime Minister and the Government have said that improving palliative care must be a priority—I think that is something we can all support. Everybody should have access to good-quality palliative, hospice and end-of-life care in their final moments.

I will make some progress. As acknowledged by organisations that provide that care, though, their services cannot address pain and suffering in all circumstances. During the passage of the Bill in the last parliamentary Session, we heard examples of the limits of palliative care from Members with medical expertise themselves.

Will my hon. Friend give way on that point?

No, I will make some progress. We heard difficult stories about patients with bile duct cancer facing the prospect of faecal vomiting as their illness progressed. We listened as Members recounted memories of watching patients bleed to death while conscious, cancer having eaten away at their carotid artery. We felt their frustration when the maximum dose of sedatives could not alleviate the choking and suffocation of someone with peritoneal cancer. Those people deserved choice and a dignified end, too.

As a practising surgeon who deals with bile duct cancer, I can reassure my hon. Friend that there is almost never a reason that someone should be in that state, with feculent vomiting, if they were treated appropriately and all the relevant palliative care measures were in place.

The position that I take is that we can, and must, both improve palliative care and support assisted dying. We must grasp the opportunity that is in front of us to create a holistic end-of-life care system that will deliver choice and dignity for every single one of our constituents.

On the specific point of hospices, I absolutely understand what the hon. Lady is saying; I have visited our local hospices, and I have sat beside my father when he was dying, but not in a hospice. The point about palliative care absolutely matters, but the Government do not recognise the funding that the sector needs. There is a postcode lottery, and the Ministers are not even answering written parliamentary questions, so does the hon. Lady agree that until this is fixed, we should not be having this debate?

I point out that if this Bill received Royal Assent, the four-year implementation period provided for at the end of the Bill would give us the opportunity to work together to improve palliative care and assisted dying, creating the holistic end-of-life care system to which I have referred.

I am going to make a little bit of progress. The four-year implementation period means that nobody would be receiving assisted dying until 2031 at the earliest. That would be too late for many people, but it would be plenty of time to make improvements to palliative care, which would go hand in hand with providing the choice of an assisted death for those who still need it. We can, and should, do both.

The hon. Lady is making a principled argument that the House must listen to and respect, but she has spoken about choice and dignity, and the one thing I have never understood about this Bill is the importance of the specific time period—that it would apply to adults who have six months or fewer to live. If there is to be choice and dignity, and if people are in pain and the condition is terminal, what is the sanctity of six months? If the principles of choice and dignity underpin the Bill, surely six months is way too narrow.

I thank the hon. Gentleman for his intervention. Obviously, Members have previously raised concerns about doctors getting their prognosis wrong when it comes to how long someone is able to live. My understanding is that, given the international evidence, six months was seen a reasonable line to draw, because as the time of death gets closer, the accuracy of the diagnosis is increased.

Will the hon. Lady give way?

I am sorry, but I will not give way. I thank all those who took part in the debate on the Bill in this Chamber during the last parliamentary Session. We showed politics at its best through our robust but courteous debates. We did our job, and we did it well; now it is time for us to send this assisted dying Bill back to the House of Lords, so that it can finish what it started. Whatever our respective views on the form and composition of the second Chamber, I hope we can agree that peers play an important role in scrutinising, refining and strengthening the legislation that we send there.

I am extremely grateful to the hon. Lady for giving way. She has outlined the will of this House, but she may remember that, during the passage of the last Bill, I asked the then Prime Minister at Prime Minister’s questions to do what has happened with similar Bills in the past—on homosexuality, on abortion and on the death penalty—which was to give time on the Floor of the House for Committee of the whole House. That would massively strengthen amendments that are made by using the whole House to approve them. That is a choice for Government Front Benchers, so is the hon. Lady going to lobby her own Government to give everybody in this House the opportunity to properly scrutinise the Bill in Committee?

The Government have been clear, as the Government of the previous Prime Minister were, that they remain neutral on assisted dying, but that they have responsibilities to make sure that the legislation we bring forward is workable. We received those assurances on Third Reading of the previous Bill, when we voted in favour of it as a Chamber.

I will not give way. I am asking Members today to start the process of sending this Bill back to the House of Lords, so that they can continue their important function of fulfilling their constitutional role.

I thank my hon. Friend for giving way, and for making an incredibly strong speech. I was part of the Bill Committee, and we gave about 200 hours of assessment to this Bill, which is much more than most Government Bills get. Indeed, the Lords had an enormous amount of time to consider it, too. Saying that there has not been enough scrutiny is simply wrong.

Members should be in no doubt that the Bill we sent the Lords last year was robust.

Will the hon. Lady give way?

No. The Bill was expertly drafted by the Office of the Parliamentary Counsel and developed with comprehensive technical advice from officials in both the Department of Health and Social Care and the Ministry of Justice.

Will the hon. Lady give way?

No, I will make a little bit more progress, please. Although the Government are neutral on the issue of assisted dying—then, as now—they have a duty to ensure that any legislation that Parliament passes is effective, legally robust and workable. I am confident in saying to this House that the Bill before us today is a well-designed, safe piece of legislation.

My hon. Friend is making a good case for this Bill, but she will know that when the Bill was introduced in 2024, no equality impact assessment was carried out. Recently, the Government have published the assessment, and it highlights the disproportionate impact that the Bill will have on black and ethnic minority communities and on disabled people. There is nothing in the Bill to address that point.

I would start by saying that the Bill is explicit that it does not apply to people with a disability.

What we are considering today is not the general principle, “Do we or do we not agree with assisted dying?”; it is this Bill. We are not a debating society; we are a Parliament. I therefore ask my hon. Friend why it is the case that virtually no disabled people’s organisation in this country supports the Bill. Disabled people often feel voiceless, and I think it is important that their voices are heard today. They are outside Parliament, so I would like her to address that point in her speech.

I would be happy to address that point. There is not a uniform view among disabled people on assisted dying. Like with anything, within organisations there are people who arrive at different views. It is important that we are giving disabled people the same rights as other people. It is very clear in the Bill that it is for adults aged over 18 who have a terminal illness and who only have six months to live. It specifically makes clear that it does not apply to people who have a disability.

No, I will not give way. I will make some progress—[Interruption.]

Order. The Member has made clear that she is not taking interventions at this point.

As has been mentioned, the Bill has been subject to hundreds of hours of scrutiny, and amendments have been made to strengthen its safeguards, but that does not mean it cannot be strengthened further. As with any Bill, it will benefit from additional scrutiny. The Bill before us today already includes an important clarification on eating disorders that was agreed without a vote in the House of Lords last time. Together with the co-sponsor of the Bill in the House of Lords, Lord Falconer, who is in the Gallery today, I have recently met representatives from medical bodies and hospice organisations to discuss further amendments that could be made in the other place.

I am very grateful to the hon. Lady for allowing me to intervene. She mentions that the Government have a responsibility to ensure this legislation is lawful and workable, yet she is the Bill’s sponsor—that responsibility rests on her, too. Yet despite knowing that the Bill’s sponsor in the previous Session brought forward over 30 amendments and eight new clauses of her own and the Bill’s sponsor in the Lords brought forward 77—a recognition that the Bill is manifestly unworkable—she has chosen not to amend her Bill. What is before us today is for a political—

Order. Interventions must be short.

I disagree with the position that any time we amend a Bill in this place, it is ultimately deficient and unworkable. That is not how it works. All I am asking the Chamber to do today is to send the Bill back to the House of Lords so it can continue its work, which was interrupted, of scrutinising the Bill.

I thank my hon. Friend for giving way; she is being very generous with interventions. Is she willing to share with the House what, if any, amendments the Lords made, besides the two she has mentioned, that she thinks should have been added to the Bill, and, if so, why they were not?

There were a number of amendments around points of clarification—some external organisations wanted some words made a little clearer, although they seem robust to me—that I certainly believe could be made in the House of Lords.

No, I will make some progress. Taking the approach I have outlined respects both the will of this House, as expressed in June 2025, and allows the usual parliamentary processes to continue.

“Erskine May” gives this House a way to send what are called “suggested amendments” to the Lords as a separate motion alongside the Bill, when it goes to the other place. It has not been used since 2004, but does she recognise that if some Members of this House think certain amendments are crucial to the Bill, they can do so?

That is a part of our usual parliamentary process and the hon. Lady is right to raise that point. By sending the Bill back to the Lords as it stands, we will prevent that same small group of peers who talked it out last time from doing the same thing again. It is my fervent wish that all the peers—

Will the hon. Lady give way?

No, I am sorry; I will make some progress. It is my fervent wish that all the peers in the House of Lords will accept that important distinction between their Chamber and ours, and fulfil their role in the usual way. In doing so, they can consider and send an amended Bill back to us for a final vote before Royal Assent.

No, I will make some progress. If, at that point, Members of this House decide to vote the Bill down, I and many others, in this Chamber and outside, would be upset and disappointed, but I would accept that as a result of the proper democratic processes being followed. What I cannot accept, and what many people both inside and outside the Chamber cannot accept, is the current situation, where a small number of unelected peers filibustered legislation that was supported by this Chamber. That is not how our democracy is supposed to function.

I am very grateful to the hon. Lady, whose speech is a series of oxymorons: she does not like polling that is against the Bill, but likes it when it is in favour; she feels the Bill should be amended in the House of Lords, but not with amendments that would improve safeguards. On that subject of safeguards, will she explain to the House why the previous legal safeguards to assuage doubts about efficacy were entirely dropped from the Bill?

They were dropped in favour of a stronger safeguard, which was a multidisciplinary panel of people with different perspectives who were trained in spotting coercion—a psychiatrist, a legal expert and a social worker, bringing other people in with different perspectives—to ensure that the person taking the assisted death decision was doing so in an informed and settled way, free from coercion. That was a strengthening of the Bill, not a weakening.

I will make some progress. Members took the best part of a year to grapple with this issue: spoke to constituents; engaged with the organisations that would be affected; read the materials; thought deeply; consulted their conscience. They arrived at a decision—whatever that decision was and however they voted or, indeed, did not vote at all—but it was a difficult process. It is not acceptable that the outcome of those deliberations has not been respected. We owe it to the people we represent to find a resolution on this issue one way or another within this Parliament.

I am grateful to the hon. Lady for giving way a second time. This is the democratically accountable House; I think we would all agree on that point. On that basis, is she prepared to accept in Committee and on Report, if this Bill secures its Second Reading this afternoon, amendments authored, debated and voted upon by Members of Parliament?

We have been through that process. There was a Committee that had hundreds of hours of scrutiny and properly kicked the tyres on the robustness of this legislation. What we need to do as a House is send the Bill back to the House of Lords so that they can finish their job. We did ours.

I will make some progress. As important as a democratic point of principle is to the argument I am making, we must not lose sight of the people who are relying on us most: the terminally ill and their families. The Gallery today is filled with inspirational people campaigning for this much-needed change in the law—people who are themselves terminally ill and who, due to the passage of time, may never get the opportunity to choose a dignified death surrounded by their loved ones, but who nevertheless spend the time that they have left campaigning so that others in future may have that choice.

Will the hon. Member give way?

I am sorry; I will not. Those people include Christie Arntsen, who has lived for more than a decade with incurable metastatic breast cancer, which has sadly returned for the fifth time. She is undergoing what may be her final treatment of chemotherapy. Christie speaks eloquently about how her fear of a difficult death has weighed on her mind since her diagnosis and affected her life: “For me the scariest part of having the diagnosis was that I had no control over the last few weeks of my life…If I had known that assisted dying was an option, a weight would have been lifted from my mind for the last 10 years.”

I will make a little more progress. This is the cost of accepting the status quo: the fear and worry for those who know that palliative care may not be enough to avoid a difficult and painful death. It snatches away their final moments, which, as I know from speaking to friends and family in Australia, can be much better spent when there is a safe voluntary assisted dying system in place.

I thank the hon. Lady for being so generous with her time. Is she aware of the sheer number of palliative care consultants who are not prepared to take part in assisted dying, and the impact that that will have on the palliative care system? In my constituency, all three palliative care doctors who work in Plymouth’s Derriford hospital are against assisted dying and are saying that they would leave the profession. How can we offer palliative care at the same time as assisted dying?

I would point out that there is a range of views among those in the palliative care community. It is specifically for that reason that the Bill allows them not to be involved in the process if they do not wish to be.

Will my hon. Friend be generous enough to give way on that point?

No, I am sorry. I end with the words of Elise Burns, who, like me, called Kent home, and who sadly died in July with secondary cancer of the lungs, liver and bones. She said she would love peers “to look me in the eye and tell me why me and my friends, and anyone with terminal illness, don’t deserve to die with dignity and to have the choice to die…without pain.” We owe it to terminally ill people like Elise, who are relying on us and who were so filled with hope when we voted in favour last time. Quite rightly, they cannot understand how, having secured the support of the people they elected to represent them, the issue that is so important to them has been frustrated by a small group of people with no democratic mandate. The important conversation that we have been having on assisted dying, as legislators and as a society, has been interrupted. To leave it so would have a profoundly negative impact on people’s trust in our political system. If we fail to support the Bill’s Second Reading, are we not saying that it is fine for a minority of unelected peers to defy the will of the House of Commons? Are we really prepared to cede that point and accept the consequences not only for this vital legislation but for future legislation too? I ask hon. Members to join me in sending a clear message that the will of this Chamber should be respected, on behalf of all the people that we represent, and to support this Bill on Second Reading.

This is a very difficult day. No one could fail to be moved by the grief of campaigners and by the deeply personal stories, whether born of their own experience or of those they have lost. Those voices deserve to be heard, and it is important in this place that we respect all views, whether we agree or disagree; but as we deliberate today, I go back to the words of the hon. Member for Bradford West (Naz Shah) in a past debate, asking us to remember “the quiet ones, those who may be less organised or not as powerful but who are none the less equally, if not more, important—the voiceless”. —[Official Report, 13 May 2026; Vol. 786, c. 11.] Those words resonated particularly strongly with me, because I had the privilege of serving 10 years ago as the Minister for Preventing Abuse, Exploitation and Crime—the first time that safeguarding brief had been brought under one Minister. It was so often the quiet voices that needed to be heard. It was the time I spent with victims that persuaded me that modern slavery was something we needed to legislate for. It was the time I spent with the victims of domestic violence, some of whom did not even want to admit that they were victims, that persuaded me we needed to do more and that we needed to legislate in this area. When I took the coercive control offence through Parliament, it was incredibly important. That is a very difficult offence; coercive control is not easy to prove or to find the evidence for, but it was so important that we did that. I remember speaking at an event not long after the legislation had gone through, where I explained that coercive control offence and what we were trying to do in Parliament. Afterwards, a woman came up to me privately, in tears, and told me that what I described had been her life some 30 years earlier. She had recognised eventually that she was a victim; so often victims do not recognise that they are victims, but she did recognise it. She had gone to the police, but because the offences were not violent or physical, they said that there was nothing they could do. They even said, “Lock the door and hope that he beats the door down, because then we could arrest him on criminal violence.” That was all they had. There was nothing they could do to help this woman. That encounter stayed with me, and it reminds me time and again that abuse is not always a single act. It can be the gradual erosion of somebody’s confidence, independence and sense of what choices are really theirs. Coercion to end one’s life may not come as an explicit threat. It may be the repeated suggestion that someone is becoming a burden.

Will the right hon. Lady give way?

I will not be giving way much, Madam Deputy Speaker, but I will give way to the hon. Lady.

I thank the right hon. Lady very much for giving way and for sharing that really difficult story. Does she not agree that the current system has no safeguards at all against coercion, and that is exactly why we need this Bill?

Coercion is something that we absolutely need to tackle and understand as a society, but I do not think that this Bill has the safeguards that are needed.

I will give way to the hon. Member for Strangford (Jim Shannon), and then to the previous sponsor of the Bill, the hon. Member for Spen Valley (Kim Leadbeater), and then I will make progress.

I quote the story of one of my constituents, a motor neurone disease sufferer. He said that, if he had had the option of assisted dying two years ago, he probably would have taken it. But, in his words, “I would have missed out on the most fulfilled two years of my life and the knowledge that I can have more moments like this ahead of me.” His words are, “Please don’t do this, life is worth living.” Does the right hon. Lady agree?

The hon. Gentleman makes a very important point.

The right hon. Lady is making a very important point, which I have considered at length during the last two years. Many amendments relating to coercive control were made to the Bill to ensure that all professionals involved have training, and there are multiple checks for coercion throughout the process, which do not currently exist. At present we check for coercion only when someone is dead.

I accept what the hon. Lady says, and I know she speaks with great sincerity, but it is still the case that under this Bill, somebody could be seen remotely—without a face-to-face appointment—where they are not alone and the coercive perpetrator may be forcing them.

Suicide currently outstrips homicide as the main reason for the deaths of women in cases of domestic abuse and coercive control, so what the right hon. Gentleman outlines is currently happening. Arguing for the status quo is not something I feel comfortable with. I feel considerably stronger about the safeguards that I worked with my hon. Friend the Member for Spen Valley (Kim Leadbeater) to ensure that the Bill had.

I have enormous respect for the previous Minister, who I have worked closely with, but the point she is making about suicide of women who were victims of domestic abuse is a separate matter. For women to feel that they have nowhere else to go other than to commit suicide, is the most outrageous and horrendous situation, and we absolutely have to tackle and work on that. But this Bill is not the solution to that problem.

I speak as a survivor of domestic violence and as a survivor of an attempted suicide many years ago, while campaigning about domestic violence. Does the right hon. Lady agree that coercion is not always external? Coercion can also be internal—“Am I a burden on my family?”, “Can they afford to look after me?” That coercion is not picked up on in training, because it comes from deep inside when a person is vulnerable and at their lowest ebb.

The hon. Lady makes the case so powerfully. I am going to disappoint Members now, because I will not take any further interventions for some time. Like the hon. Lady, my fear is not principally for those who are confident, articulate and able to insist on what they want; it is for the person who does not want to make a fuss—the person accustomed to putting everybody else’s needs before their own, who internalises that coercion and feels guilty about the care they require, or has simply been deprived of it. Recognising abuse is really difficult. Those who have the misfortune of watching daytime TV may notice that there are currently adverts for “no frills” cremation services. I am particularly struck by one, which features a woman of late middle age, who is slightly small and says in a quivering voice that she does not want to be a burden or cause any fuss and does not want her family to have an awful time at the point of her death. Therefore, she is investing in a “no frills” cremation to make things better for her family. That person exists. The advertising agency would not bother making that advertisement if that person did not exist. We have to think about the most vulnerable. These are the people who Parliament—this House—has a particular duty to remember when we legislate and, today, when we decide whether this Bill, without further changes, is safe to become law. The question before us is, what decision will this House make. I recognise that the sponsor, the hon. Member for Rochester and Strood (Lauren Edwards), is keen to focus on the other place. There is an appealing simplicity in saying, “Send it back there and let them do their work”, but this is not really about the other place anymore. That House has made itself irrelevant. It is about this House and this House alone. If we seek to engage the Parliament Act, we are, in effect, taking a unicameral decision, and we should understand what that means. We would be declaring that the Bill before us is in a fit state to become law whether or not the other place completes its work. There is no separate process by which this House later authorises the Parliament Act. Our approval of the Bill is the decision.

Will the right hon. Lady give way?

I will not; I really need to make progress. The hon. Member for Rochester and Strood and co-sponsors of the Bill have been clear, including in the debate now, that there will not be amendments made in this place. A deliberate decision has been taken to introduce a near-identical Bill and not to incorporate the 77 amendments from the Lords sponsor, including changes that addressed issues that he himself accepted required attention.

Will my right hon. Friend give way?

I really cannot; I am so sorry to my hon. Friend. We could have dealt with this over the summer; we had time to work on it. We could have included, for example, a clause that would have given an equal right to palliative care or a simple assessment of unmet need—something, anything, to allow there to be a genuine choice. But that opportunity is now gone. Let me be absolutely clear about what today’s vote is and what it is not. It is not another vote on the principle of assisted dying as on an ordinary Second Reading debate, and the hon. Member for Rochester and Strood said that herself. It is not a vote to allow this House to improve the Bill. It is not even a vote to allow the other place to improve it, because that is not in this House’s hands. If this Bill is sent to the other place and falls for whatever reason—even if that is because Parliament prorogues early and it receives not a single further hour of debate—it could be forced into law as it is. The Hansard Society put it plainly in saying “bills proceeding under the Parliament Act have been subject to only minimal amendment.” The House needs to understand that the proposed approach requires “preserving an unchanged bill with…defects”. That is a very different decision. I know that there will be Members in the House saying to themselves, “Nothing has changed since I voted for this before—why should I change my vote now?” My answer is simple. A great deal has changed, though not, unfortunately, in the Bill itself. We know more now than we did then, and changing one’s conclusion when the evidence changes is what Parliament is supposed to do. We now have revised estimates from the Government showing that many more people may seek an assisted death than Members previously understood: up to 4,610 may apply in the first year, and up to 10,428 in year 10. That is more than 1,000 times the number going to Dignitas each year. That is not a slow run-up during which we can watch the system develop, identify mistakes and quietly correct them.

Will the right hon. Member give way?

I am sorry; I really must make progress. We could have thousands of people entering the system immediately. If the safeguards are not right on day one, vulnerable people will be exposed on day one. We also have the updated equality impact assessment, to which the hon. Member for Bradford West referred, and its conclusions should give every Member pause. It recognises that “disabled people may feel subtle pressure due to attitudinal barriers or a lack of alternative appropriate services and support…This could also include structural pressures such as neglect, poverty and difficult living conditions”. It also recognises that we may see “disproportionate numbers of ethnic minority people choosing to have an assisted death to avoid financial hardship or escape abuse.” I believe that the Bill is not finished, but we are effectively voting today for a completed and finished Bill. That worries me enormously. Much has been said previously in the debate—I will not repeat the point—but we are giving powers to a future Government to implement this Bill. We are not giving those powers to the Ministers sitting on the Front Bench today, and we are not necessarily giving them to those on the Opposition Front Bench; we are giving them to a future Government of any political persuasion. When I was a Government Minister, I remember always asking myself, “Would I be happy if another Government took this forward—if they had the power to do this?” I ask Members to apply a test that we too rarely apply when legislating: do not ask whether you trust the people who will administer these powers today; ask whether you would be content with the political party you trust least possessing them tomorrow. There is simply not enough detail in the Bill to constrain how many of these decisions would be made. The National Down Syndrome Policy Group put it best: this Bill hopes for the best rather than prepares for the worst.

Will the right hon. Member give way?

I feel sorry for my hon. Friend from the Home Affairs Committee, but I really must make progress, because Madam Deputy Speaker has been clear to me that I must. I say to colleagues who supported the Bill before and have wrestled sincerely with the issue since: you do not have to repudiate the vote you cast last time to vote differently today. You do not have to decide that assisted dying can never be right. You do not have to abandon the compassion that led you to support the principle. You need only ask whether this Bill, in this form, on the evidence before us today, is safe enough for Parliament to force it into law. That is today’s test. There is no shame whatsoever in concluding that the answer to a different question is different. Indeed, there would be something profoundly wrong with a Parliament in which Members felt bound by an earlier vote, regardless of everything they had learned since. Success is rare for private Members’ Bills. It is an amazing route when legislation is simple and consensus is easily achieved, and the whole House came together last Friday to do something quite remarkable for babies, but it is a terrible route when the risks of getting it wrong are great and there is great complexity and such emotion. Before a Government Bill is introduced, Departments will normally spend months or years developing the policy—sometimes that is too slow, but that is what they do. They consult experts and those affected, test the legal and practical implications, produce impact assessments, secure cross-Government agreement and have the legislation professionally drafted and scrutinised by parliamentary counsel. Finally, the legislation goes through the Parliamentary Business and Legislation Committee, where Ministers have to prove to the rest of Government that the Bill is fit for purpose. That is what we needed here, when dealing with one of the most profound changes that Parliament could make to the relationship between the citizen, medicine and the state. Some say they want to amend the Bill. Have there been any reassurances that those amendments will be supported? The promoter controls the make-up of the Public Bill Committee and will have a majority. On Report, if we are fortunate Members may have the opportunity to vote on only a handful of issues, and those who support the Bill will be asked to reject each one. We are being asked to support the Bill as it stands, alongside a commitment to force it into law regardless of what safeguards are forgone or what gaps, through which vulnerable people may fall, remain. There is no one else to whom we can pass responsibility. We cannot say that the other place will sort it out, or that we will fix it later. If the Bill becomes law, Parliament may not get another opportunity to reopen it and put right what we discover we got wrong. The consequences will instead be worked out in practice—in hospitals, homes and, ultimately, the courts, where judges will make decisions based on the law before us today. For the people affected by a mistake, “We will sort it out later,” is no safeguard at all. My appeal today, particularly to those who voted for the Bill before, is this. Look at what we know now. Look at the people who will depend on our having got every safeguard right. Remember the quiet ones. Are you prepared today to say that this Bill, in this form, is safe to be forced into law?

More than 90 Members are trying to catch my eye. I can maximise contributions only if colleagues keep their speeches to around six or seven minutes.

Today I am going to share the most personal of stories publicly for the first time, and I ask for the kindness of colleagues in not intervening so that I can. Last October, my mum, Ruth Hazelgrove, chose to bring her late-stage terminal illness to an end, on her terms, at home, with dignity and with a strength that I can only try to imagine. Mum had just turned 61. She had endured significant health challenges for almost half her life. When mum was 32, she was diagnosed with a rare blood cancer, polycythaemia vera. Thankfully, she was able to see us grow up and meet her grandchildren. Mum loved life and laughter, and our family will remember her this way. In early 2024, mum was told that her condition had taken a significant turn. That autumn, while we debated the initial version of this Bill, her pain was excruciating. She had access to good palliative care, but what we learned the hardest of ways is that not all pain can be palliated. I will never forget seeing her writhing and screaming in pain, at points for weeks. None of us will. I know of no deity that would want that. Eventually, some medication helped her leave hospital, but it then became less effective over time. For mum, it was not a choice of life or death; it was a question of what kind of death she would have. She was clear that she did not want a painful or undignified death. She wanted peace. For us, it will always be a tremendous personal sadness that the current law meant that she could not tell us her plan, and we could not say goodbye to her—but more importantly than that, that she could not say goodbye at the end of her life, or be surrounded by her loved ones, which is what she would have wanted for her death. Instead, the harmful status quo meant that mum died alone, with photos of us around her. This was 11 months ago either today or tomorrow—we will never know whether she died late one evening or early the next morning, or whether we are ever marking the anniversary on the right day. This is the status quo. This needs to change. That is why our vote today and our work on this issue is so important now. People with terminal illnesses, and those who will be diagnosed with them soon, matter greatly. If we were again to leave this issue to another Parliament, it would be too late for other people with terminal illnesses who want this provision, but instead face the same impossible bind as my mum; they would continue to face it well into the 2030s, at best. An excruciating death or dying alone is simply not an acceptable bind for a human being. To allow choice does not impose an outcome, but to continue to restrict it does. In part of mum’s last note to us, which is why I am speaking today, she wrote, “I wish the Assisted Dying Bill would have come into force in my lifetime…Maybe there will be hope for others in the future.” Ultimately, is it not what Parliament is for to provide safeguards and freedom? I believe that we are here not to dictate how people live their lives and their deaths, but to enable safe individual choice. Today’s vote is on whether we should continue to work on this, or not at all. I ask right hon. and hon. Members to ask themselves if they feel that this impact of the status quo is right, is just. My hope, and I know my mum’s hope, is that her story can help us choose to end this harmful status quo and see terminally ill adults finally have true choice over their lives and their deaths.

I call the Father of the House.

The hon. Member for Filton and Bradley Stoke (Claire Hazelgrove) has spoken most movingly, and we know that many of us are very conflicted on this issue. We have to respect each other and show compassion—we know what this debate is all about. No one side has a monopoly on compassion. I will say in a moment why I believe in being assisted to die in a dignified way, but will the House forgive me if I start with an essential legal point? We know that what this is all about is ensuring that the Bill we are debating today leaves the House unamended so that the Parliament Act can be imposed. The Isle of Man had an assisted dying Bill, which, like this Bill, left a lot to delegated powers. The Ministry of Justice concluded that this meant that that Bill was not compatible with the European convention on human rights. When the result of the private Member’s Bill ballot was published, three former Attorneys General of both parties—Baroness Scotland, Dominic Grieve and Baroness Prentis—wrote to the promoter to urge her not to present the same Bill, as it would run into the same legal and constitutional difficulties. It is unfortunate that that offer has not been taken up, and we have to ask why. Let me give my own personal views as briefly as possible. I will surprise the House by saying that I am in favour of assisted dying. I am in favour of the idea that when I, or when any of us, approach our last moments, we go into a hospice and are assisted to die. That is what doctors and nurses do all the time. I have been very impressed by what our Prime Minister has said on this issue—he has not been mentioned yet. It is about ensuring that everybody receives excellent palliative care, as we see in our hospices like St Barnabas hospice in Lincoln. So we are agreed on that.

Will the right hon. Member give way?

If the hon. Member will forgive me, I have been told to be brief. I am in favour of our being assisted to die as painlessly as possible, and every palliative care nurse and doctor I have ever talked to has made it clear that in the overwhelming majority of cases, that is possible. Of course, we can be anaesthetised, as we all are when we have operations. I hear the argument, but I believe that we need to improve palliative care. What worries me about the Bill—this is my point—is that I do not believe that it will be just an assisted dying Bill; I think that in time, it will become an assisted suicide Bill. I have mentioned the ECHR. What is the logic of the Bill? We all know it is terrible if you have a terminal cancer prognosis, but what if you are clinically depressed? What if you are quadriplegic? What if you are sentenced to a lifetime of being unable to move your arms or legs? What if you know, as a member of our family in Canada does, that you will get more and more dementia, so you take the assisted dying route? The truth is that we cannot differentiate between these conditions that make life unbearable for many people. I make this prediction: if this Bill goes through—if the Parliament Act ensures that it does—I believe that in 10 years’ time we will be in similar situation to Canada, and very large numbers of people will be choosing assisted dying. We hear a lot that this country is broken, and that the elite is ruining the country. I think that is rubbish. This country is not broken. The reason we are under pressure is that there are too many of us—too many old people; too many people with multiple health conditions. There is tremendous pressure on the NHS; we know that. We heard a lot from my right hon. Friend the Member for Staffordshire Moorlands (Dame Karen Bradley) about coercion. We have also heard that coercion is not necessarily external; it can be internal. I believe that if we move to a society in which assisted suicide is the norm, vast numbers of people will take it up. Is that really the sort of society that we want?

On that point, will the right hon. Gentleman give way?

No. I agree that we would have more prosperity and be a richer country, and would have more choice and freedom, but would it really be a happier country? What I stand for, and what I believe in passionately, is respect for all human life—the life of old people who are suffering so much from dementia that they cannot even recognise their own children, and the life of people who have appalling long-term conditions. I believe that there is a greater thing than choice or prosperity; it is love—love of life. All of us in every country in the last 100 years have said that whatever happens, we should respect life and not take it. Yes, this will be difficult for many people, and we have heard moving stories, but take the NHS; at the moment, when a person goes to hospital, they know that they will be dealt with compassionately by a doctor or nurse, and that the conversation will be all about relieving their symptoms and trying to save their life. Do they want the conversation to start with the fact that their life is unbearable? I know that there is passion on both sides of this debate, and we treat each other with respect, but before we vote for this Bill at 2.30 pm, remember what sort of society we would be creating—not a society that loves life.

I speak on this matter as an active medical practitioner, a transplant surgeon and a cancer surgeon. Much of my clinical practice for the last 20 years has revolved around caring for unwell complex patients, many of whose illnesses flicker between the labels of “terminal illness” and “life-limiting illness”. It is some of that experience that I wish to bring to bear on this debate. Let me start off by acknowledging the varied experiences people have at the end of their life, or their loved ones’ lives. I have cared for and operated on thousands of patients in that position, and I have helped many, but I have often fallen short, and some of those stories have played vividly in my mind over the last few days. When they have, I have reflected on the fact that more often, when things have not gone right, it is not because of a failure, but rather an absence of universally available good-quality palliative and psychological care. Today, as a Member of this place and as a surgeon, my job is to help move this discussion beyond the emotive and the case study to level-headed analysis that will serve our society well, not only today but for decades to come. Having read this Bill again, and with the hindsight of ministerial experience in the Department of Health and Social Care, I am more convinced than ever that our social care and palliative care systems simply are not ready to meet the demands of this Bill——at least not equitably. The Bill, when taken from the laboratory of legislative text and dispatched to the bedside and the clinical frontier, will not serve its laudable aims of bringing choice and control over a pre-emptive, quick death, which is what many desire and expect from this legislation. While it will not fulfil those aims, it will expose millions: the quietly vulnerable. I think of constituents and patients of mine in Glasgow South West, more often than not women, who quietly concede to me, usually in the sanctity of a clinic room, that they do not wish to be a burden, and who have on many occasions asked me to end their life because they have suffered multi-generational financial strains and do not want their illness to hold back their children and their grandchildren. When you visit places like Govan and Pollok as a parliamentarian, as well as a doctor, you understand that as a society, we are only scratching the surface of understanding the full extent of coercive control in this country.

It pierces my heart whenever cancer is mentioned in this conversation, and I am grateful to the hon. Member for West Lancashire (Ashley Dalton) for her advocacy. A person may have cancer, and a terminal diagnosis, and still want to live. We should support those people to live first, before we contemplate their death.

I commend the hon. Member for her powerful testimony. I know that she has personal experience of this matter. When you visit places like Govan and Pollok, you know what vulnerability looks like. Those people cannot send their voices down here via the mic, the TV studio or a billboard in Westminster tube station. We need to make sure that they do not feel the burden of making what some call an option, or a choice, their obligation or duty.

Will the hon. Gentleman give way?

Not at the moment. It is on the foundational principles of the Bill that I primarily want to concentrate today. The first is the idea of a “six months to live” label. “Terminal illness” is a fast-changing medical diagnosis in the modern medical world, and it is becoming an increasingly meaningless term. Only yesterday evening, I was in the company of a professor of respiratory medicine who, with rightful satisfaction, told me that many of his stage 4 lung cancer patients who were designated with six months to live in 2023 are being managed as having a chronic disease in 2026. In my practice, if a patient comes to see me with stage 4 colon cancer that has spread to their liver, the advent of immunotherapy means that I have an equal chance of telling them they have six months to live or six years to live. Under this law, when I meet that kind of patient, it is unclear to me, with the Supreme Court precedents around consent, whether I should be offering them immunotherapy and an assisted death at the same sitting. A six-month prognosis will take a new and unhealthy salience in every clinical conversation. It will be a label some will desire, and others will want at all costs to avoid being placed on their clinical record. It will fundamentally change and undermine the candidness and sanctity of the patient-doctor conversation and relationship.

My hon. Friend is making a very informed speech on how the medical landscape has changed, but while the arguments we make today are the same, the political landscape has changed as well. Would he agree with the Father of the House that we now have a Prime Minister committed to solving the problems with social care and palliative care, and that in Scotland, where the hon. Gentleman comes from, we saw the political landscape change in front of our eyes? MSPs initially voted for similar legislation, but ultimately voted against it. People can change their minds, and I hope that they do.

I am grateful to my hon. Friend for mentioning the Scottish context. We voted down such legislation on Third Reading, when we understood the impacts and the wider societal ramifications. I have to be honest. When I am asked to prognosticate on whether someone has six months to live, I am as often wrong as I am right. It is no longer a good enough marker for the DWP to use in discharging benefits for life-limiting conditions, and I do not see why it should be a good enough marker for prescribing death. There is another paradox in this legislation: someone like me could write a prescription to induce death with less regulatory oversight than is on me when I have to remove a kidney to give life through transplantation. Of course, I sympathise with and endorse the desire of many colleagues who support this Bill to relieve suffering. To be clear, we have many tools to do this, and we must bust some myths today. Clinical discretion, for instance, means that there is no maximum dose of morphine, so I can give my patients whatever they need, in the setting in which they need it. But this Bill is less about relieving suffering and more about bypassing its possibility, and I understand that. The Bill is in many ways advocating for death as prophylaxis. Under the definition in this Bill, death must be induced by medical prescription. It will be the only medical prescription that I will be able to write as a doctor but not administer, because the burden of administration falls to the patient, and the weight of expectation falls on the patient. We must discuss the mechanisms by which death will occur: muscle paralysis, slowing of the heart rate, sedation, and the possibility that paralysis will take hold before sedation does. Death will not be an event; it will still be a process. In 15% of cases, it will be subject to some form of complication, such as vomiting or seizures, and it will not always achieve its goal. I wish I could give hon. Members more information about the complication profile, but despite this procedure being prevalent in other jurisdictions across the world, the data continues to be woefully lacking. Alongside that, the 14-day cooling off period means that the patient must remain lucid in that time. There have been cases elsewhere in the world where patients have denied themselves palliative care and pain relief to remain lucid in order to consent to their death. I am therefore of the opinion that the foundational elements of this Bill will create the allure of choice and control, but not the agency to pursue either. Turning to safeguards, much is made of the provision requiring two doctors to assess eligibility, but the trouble is that neither has to know the patient well, or go to any great lengths to exclude the likelihood of coercion. Doctors are trained to do many things, but assessing and picking up on coercion is not one of them. In fact, consultant psychiatrists with PhDs in coercion, like the hon. Member for Runnymede and Weybridge (Dr Spencer), whom I hope we will hear from soon, have said in written testimony presented in court that they would find it difficult to exclude coercive controlling behaviour. I came into medicine, and into Parliament, to act with compassion, and to provide dignity to those we serve. I believe that is why we are all here. Compassion and kindness is not the preserve of one those on one side of the argument or another, but for me, compassion and kindness also calls to courage—the courage to be honest with patient and constituent alike. We need the compassion and honesty to say that the Bill will not fulfil its aims; it will disappoint many who crave total agency and control, and it will expose and disenfranchise further the vulnerable in our society. We need the compassion and honesty to say that our NHS, while a great institution, is not, in its current form and state, ready. It is not safe for this conversation or for this Bill in this moment.

Looking around the Chamber, I see many Members wishing to contribute. In case I did not make myself clear, I urge colleagues to keep their contributions to five minutes or less; otherwise, I will be forced to put a speaking limit in place.

As co-sponsor of the Bill once again, I am acutely conscious that there is more at stake today than merely the fate of those who are facing their end, because the conduct of the other place means that our democracy is also on trial today. I sat in the Chamber at the other end of this building on a number of occasions when it was debating the Bill, and I saw more of the debate on television, and I watched with unfolding horror the game that was being played there—a game that was marked in homes across the country with dismay, misery and agony. I contemplated the Lords effectively putting up the pretence of scrutiny, but at the same time tabling 1,000 amendments—

On that point, will the right hon. Gentleman give way?

I will not. The Lords tabled 1,000 amendments, many of which were cruel or absurd; they were effectively designed to be sand in the engine, and to slow up what should have been proper parliamentary process—a process that the dying deserve to see operate correctly. We have to be aware in this House that expectations are high, and the people who send us here should be able to rely on decisions made in this House proceeding into law. I am afraid that what is at stake today is our democracy. If this Bill falls today, one of the biggest losers will be the standing of this House and this institution as a whole.