Simon Opher MP: speeches

Speeches

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

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  I feel that the Committee has been through these points quite extensively. There is clearly a disagreement in our beliefs; I accept that, but it is very important to make the Bill as simple as possible, because that is the best safeguard. I believe that the Mental Capacity Act is the right test for whether people have capacity. I reiterate that if there is a doubt in the clinician’s mind, there should be an avenue to get an expert opinion on capacity.

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

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  I agree that the threshold is the same: does the patient have capacity or not? That is the single threshold. We often do mental capacity assessments for inheritance, control of bank accounts and that sort of thing; sometimes we do a very quick mental capacity assessment about the refusal of treatment. How long we take depends on how important the decision is. I suggest that a doctor assessing someone’s capacity to make a decision to end their life would have a serious, long discussion—up to 90 minutes, or possibly even two hours—to make sure that the doctor is convinced that the patient has capacity. The threshold is the same—it is about whether they have capacity—but that does not mean that the conversation is the same. In clinical terms, it is very clear that a conversation on those grounds would be much more involved than, for example, whether a person sees a dentist or not, or other conversations like that. I totally understand the concerns that the amendment has been tabled to cover; however, my main point is that if we accept the amendment, it will make the Bill less safe. The reason for that is that, as I have said before, if we change something that is well used, and repeatedly used, it will make the interpretation much more complicated. We will have to re-train all the doctors and, I think, it will not protect patients.

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

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  Well, that was disputed by other psychiatrists. We are asking questions about whether the Mental Capacity Act is safe and correct for the Bill. This whole Committee is about making the Bill safe. None of us would dispute that. However, I think that if we accept the amendment, the Bill will become less safe because the amendment would change a massive piece of legislation and therefore have a number of repercussions that we do not understand.

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

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  It is really important to understand that for the majority of people mental capacity can be assessed reasonably quickly because it is very clear whether they have it or do not have it. What we are talking about, I think, is a small proportion of patients in which it is unclear whether they have mental capacity. There is scope in the Bill for those circumstances, when the patient should be referred to an enhanced level of mental capacity assessment by a psychiatrist or a psychological nurse. In that way, it makes it much safer. We do not need to redesign the Act for that small number of patients because we already have a very safe route to assess capacity.

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

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  We are talking about a whole different area now, but I would say that, as a medical professional, if someone is gaining consent to a treatment it is in their code of practice under the General Medical Council that they explain all these things. We do not need to write it into the Act; that is already in existence. A more general point is that there is a lot of stuff already in the public domain on doctors’ behaviour that does not need to be restated in the Bill. The more we write, the more likely it is that it will be less safe for patients. I would keep it very simple.

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

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  As my hon. Friend the Member for Spen Valley said, there are eight different opportunities for assessing capacity in the process, the last of which is before the patient takes the medicine that will end their life. At all those stages, it is possible to stop the process, and the patient is in total control. I do not disagree with anything in amendment 50, but I believe that everything in it is already in the Bill, under other clauses. I do not think that the amendment would add anything to the Bill; it would actually make assessing capacity more confusing, from a legal perspective.

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

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  I understand what the amendment is trying to do; my argument is that it will not achieve that because it will muddy the waters of a mental capacity assessment, which will make how we do it less safe. I would also like to return to Professor Whitty’s comments and to say that in the majority of cases mental capacity is very clear. It does not actually take very long to assess whether someone has mental capacity.

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

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  There is a lot to talk about in this group and I thank you, Mr Efford, for calling me to speak. I would also like some confirmation about the term “medical condition”, and I agree with the hon. Member for East Wiltshire that we need to absolutely nail that. I am still to be convinced on the question of a condition that does not come under illness or disease but would come under “medical condition”, so I agree that we need to be very clear about what that means. Frailty is very often diagnosed in older people and I fear that “medical condition” could be equated with that, which would open up the Bill. We need to decide whether we want to do that. Personally, I would not support that in any way. If this is an opening for that, we need to close it, so I agree with the hon. Member in that respect. Some of the other amendments do not materially add anything to the Bill. On changing “an inevitably” to “a typically”, I do not think that would change the Bill—in fact, I think it would weaken it slightly, so I would not support amendment 123. Both amendment 11 and amendment 181 talk about how we can exclude mental health issues as a cause for seeking assisted dying. My personal feeling is that the Bill is strong enough as introduced to exclude that. I point people to clause 2(3): “For the avoidance of doubt, a person is not to be considered to be terminally ill by reason only of the person having one or both of— (a) a mental disorder, within the meaning of the Mental Health Act 1983; (b) a disability, within the meaning of section 6 of the Equality Act 2010.” I think that is pretty tight; I do not think that people with anorexia could be given an assisted death under this legislation. That is my personal view, and I am happy to be persuaded otherwise if the whole Committee thinks we need to tighten up the measure significantly. It is important to make that very clear so that the Bill cannot be amended away from what we wish it to be. I think all of us would say that we do not want patients with anorexia to be able to access assisted dying—I have not spoken to anyone who does not agree—so the question is how we nail it down in the Bill.

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

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  May I say that this is skewed statistics? There is no statistical evidence that suicide increases in jurisdictions that have assisted dying.

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

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  I thank my hon. Friend the Member for Bradford West and the hon. Member for East Wiltshire for their speeches. I also thank my hon. Friend the Member for York Central (Rachael Maskell), who is a fantastic campaigner for excellent palliative care, for tabling the amendment. I cannot disagree with almost everything that has been said: people need to be given real choice, and they certainly need to be given the choice of palliative care. As the hon. Member for East Wiltshire said, people need to be offered palliative care. That is absolutely crucial to the Bill. However, the amendment would make it a requirement that a patient has met someone in palliative care. What would happen to a patient’s autonomy if they did not wish to see a palliative care doctor? Would they be excluded from the process? It is incredibly important that people have real choices with respect to palliative care in this process. I note to the Committee the fact that clause 4(4) states: “If a registered medical practitioner conducts…a preliminary discussion” with a person, they have to also discuss with that person “any available palliative, hospice or other care, including symptom management and psychological support.” That is in the Bill. It needs to be offered. I have had patients who have not wished to see a palliative care consultant. It is their autonomy to make that choice. I do not think that it is a wise choice—I think almost every doctor would try to push them towards palliative care—but we must not exclude those patients from accessing an assisted death if that is what they want. That does not mean that people should face a fork in the road, as the hon. Member for East Wiltshire just mentioned. This is not an either/or: sometimes people can receive excellent palliative care and still request an assisted death, as my hon. Friend the Member for Spen Valley said. I absolutely agree with many of the things you have been saying. I totally agree that we need better palliative care—although, actually, we have pretty good palliative care. In 2017, palliative care in this country was the best in the world, and we need to rebuild back to that again. But having a requirement that someone has to have seen a palliative care consultant will weaken the Bill. I urge the Committee to reject the amendment.

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

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  I am not aware of that. I believe that this is always reversible until a person goes into the absolute terminal stage of multi-organ failure. Before that, we can reverse nutritional deprivation. I do not accept that point, and I think it is important that we look at the Bill in all its detail. I think it has enough safeguards to exclude someone with anorexia.

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

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  There is nothing inevitable about a diabetic getting worse; they just need to take the right treatment, so I would say that “inevitable” is a key word. I respect what the hon. Lady is saying about the amendments, and they do have some value, but I do think it is covered by the current language— “inevitably progressive…disease…which cannot be reversed.” I think “inevitable” and “cannot be reversed” are enough of a safeguard to make this a good clause.

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

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  I would like to make a short comment. It is very important that the Committee does not get too hung up on anorexia, because the Bill is very clear about what is excluded. Deprivation of nutrition is always reversible. Someone who is anorexic and about to die would go into multi-organ failure and be unconscious and unable to give any sort of consent. Before that, the nutritional deprivation is reversible and therefore not covered under the Bill.

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

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  Sorry—will my hon. Friend not accept that this Bill will work in such a way that people may register for assisted dying, but only actually do it when their death is close? Therefore, if they get better and unexpectedly live longer, they will not take their lives.

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

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  Actually, there is a lot of debate about whether terminal states of eating disorders actually exist or not, so they cannot be said to be a real thing in that way. Some people in the profession think they certainly do not exist, so I would contest the point made by the hon. Member for East Wiltshire.

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

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  Does my hon. Friend not believe that an eating disorder is reversible? Under the Bill’s provisions, if someone has a condition that can be reversed by treatment, they would not be appropriate for assisted dying. Is she saying that eating disorders are not reversible?

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

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  I must admit that I rejoice in these stories—it is fantastic that these things can happen—but shall we just outline exactly how the Bill will work? If you are given a prognosis of six months by a doctor and you decide that you want to—

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

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  In my experience, often the reason people talk to me about assisted death—obviously, it is not legal at the moment—is fear of uncertainty at the end of life. That is one of the major things. For example, if someone has a bronchial tumour, it might suddenly haemorrhage, causing them to die by drowning in their own blood. That is something that people will do a lot to avoid. That is not pain; it is something else. As the right hon. Member for North West Hampshire mentioned, a tumour on the carotid artery can suddenly bleed catastrophically. That is not pain, but it is another reason for doing it. I believe it is that fear of what might happen at the end of life that drives most of this. Sometimes it cannot, but usually pain can be palliated —there are many ways to do that—but that fear of what will happen cannot be. We must not do this just for pain.

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

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  In carcinoma of the bronchus, it is a real risk—and it is a risk that oncologists will tell me and tell the patient. That is the sort of thing that people adopt assisted dying to avoid.

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

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  As a doctor, if I, under this legislation, came across someone who gave their main reason for ending their life as being that they wanted to save money for their family, that would come under pressure or coercion, even if it was from themselves.

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

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  I do not believe that the intention of the Bill is simply about being able to have an assisted death because of pain. Nothing in the Bill says that. We heard evidence from Dr Hussain, who was against assisted dying, but she admitted that there are people for whom we cannot control the pain, so that is another point. The whole interpretation of the Bill is incorrect. It is not about pain at the end of life; it is about controlling one’s own death.

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

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  I think we are going slightly off topic. The hon. Gentleman is talking about pain control, not whether pain can be used as the sole criterion to qualify for assisted dying. I do not know, Mrs Harris, whether—

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

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  This is a really interesting discussion, but it misses the point of how clinical people assess coercion. What we really do not want is a tick-list saying, “Confirm that you have not been encouraged” and so on, on a piece of paper. It is a much more open discussion. To get to real coercion, we have to leave it completely open. We follow the flow of the patient’s conversation. I do not think that any particular words will help in that context.

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

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  I do believe that what was actually said in evidence was that one of the reasons was that the person felt a burden, but there were other reasons. From the Californian doctors, we heard that feeling a burden is not in itself a reason to approve an assisted dying request.

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

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  There is something called continuing healthcare, which would fund end-of-life care, if someone has a terminal prognosis of six months or less, so care costs would be covered by the state.