Ashley Dalton

The last time this House considered this Bill on Second Reading, I was keeping a secret. While hon. and right hon. Members were debating the issue, I was grappling with my own terminal diagnosis. I was told that I have stage 4 incurable metastatic breast cancer. I was overwhelmed with grief, fear and anxiety; I was scared of what was to come, and fearful of how it would impact my family and my loved ones. I was scared that I was going to get really poorly and thinking, “How will I cope? How will my family cope? How will I be cared for? How will I afford it? How badly will it hurt? How long will it last?” When you hear those words, depression, anxiety, grief, fear, shame and guilt come in bounds. Suicide risk is highest immediately after diagnosis, and it usually falls quickly, within three to six months. I would be lying if I said that when thinking about all that was to come, I did not consider that it might be fairer and easier on everyone if I just got the dying over with as soon as possible. Having treatable depression, however, will not exclude anyone from an assisted death under this Bill, and depression is common among people with terminal illness, but it is often treatable. Clinicians are trained to prevent suicide in people suffering from depression, but where would the line be drawn? This Bill makes no provision to support this difficult transition, or to create safeguards around it. A person can also be suicidal and have unmet mental health needs prior to developing a terminal illness, and then ask the state to kill them without any assessment of their psychological health, just an assessment of their mental capacity—because mental capacity and mental health are not the same thing. The Royal College of Psychiatrists recommends a holistic, multidisciplinary assessment of every applicant. The three-person panel at the end of the assessment process provided for by this Bill is not what most NHS clinicians recognise as a multidisciplinary team; it certainly does not allow for meaningful multidisciplinary decision making. The assessment needs to happen at the beginning of the process, not the end, and each team member should be independently assessing the patient in person. That is not what is included in this Bill. I do not know how long I will live. I will be on treatment for life, however long or short that may be. At the moment, I live between scans, in nine to 12-week blocks of time. The last scan might have shown that the disease is stable, but the next scan might show that it is growing again. If the disease is stable, the drug is working and we can carry on. Eventually, the drug will stop working, the cancer will grow, and we will have to try another drug and see if that works. At some point, we will either run out of drugs to try, or I will be too poorly to tolerate them—then I die. It could be months. It could be years. No one really knows. Prognosis is notoriously difficult to predict. Palliative care professionals and oncologists tell me that while they can more or less give me an indication of when I will die when I am a few days or weeks off, anything beyond that is the flip of a coin. The six-month prognosis in this Bill is something no one can ever be really sure of. What the palliative care professionals have told me is that palliative care can help me when I die. In the campaign around this Bill, though, it seems to me that it is being implied that a person with a terminal illness will have a dreadful, painful death unless they have access to assisted dying. That is simply not true; palliative care in the UK is excellent. Far too many people do not have access to the palliative care they need, but the idea that it is not possible to alleviate pain and discomfort is false. People have been terrorised—I have been terrorised—with tales of people vomiting up their own faeces, as though this is commonplace during death. It is vanishingly rare. Bowel obstructions are more common, but they are treatable. I know—I have had one. It is nothing short of irresponsible to scaremonger people like me into believing our deaths will be horrific when all the evidence suggests that, with access to good palliative care, deaths are, on the whole, gentle. The answer is not to terrify people and their families. It is to sort out palliative care and social care first, because none of this takes place in a vacuum. Until we can say that everyone who needs it has access to high-quality palliative care, we are offering nobody a choice. A terrible death or an assisted death is not a choice; it is a threat. While I speak today from the position of someone with a terminal illness, I am acutely aware that this is not about me. This debate is also not about an abstract concept or a position of principle. The question that will be put at the end of this debate will not be, “That this House has considered the question of assisted dying.” It will not even be, “That this House agrees with the principle of assisted dying.” The question will be, “That the Bill be now read a Second time”—this Bill, not the Bill it might have been, not the Bill that Members might have hoped it would be, and not the Bill it could be. This Bill is the only thing before us today. Incidentally, there is absolutely nothing before us about the House of Lords. That is not the question we are being asked. Whatever hon. or right hon. Members think about the principle of assisted dying, surely our first and foremost responsibility is to write law that is safe and workable. Not one of the professional bodies that would be tasked with delivering the Bill is willing to attest that it is, as it stands, safe or workable. The Royal College of Psychiatrists, the Association for Palliative Medicine and the Royal College of Physicians all say that the Bill is seriously inadequate. They are not opposed to assisted dying in principle, but they cannot support this Bill. Instead of bringing a Bill identical to the last, so that the Parliament Acts can be used and the Bill can be forced unamended on to the statute book, why did the proposers not spend the summer working with the royal medical colleges, the professional bodies and organisations to build a Bill that they could support? If they had done that, it would have been difficult for anyone opposed to the principle to argue against the Bill. But they did not do that. This is not about sides. This House is not a debating society; it is about making the law. While we may be campaigners out there, in here we are all legislators. It is our responsibility not to pick a side and dig in, but to work together to build the best laws that we can, and that is never truer than with a private Member’s Bill on a matter of conscience.