Baroness Gray of Tottenham (Lab)

My Lords, I support Amendments 308 and 347 regarding the availability of assisted dying services to people who are homeless. The intention and the fundamental principle behind the Bill are that terminally ill individuals are able to exercise their autonomy and end their lives on their terms and at a time of their choosing. But, as many noble Lords have articulated during the passage of the Bill, that is a vision of autonomy that simply does not exist for far too many people. We do not live in a society where everyone is equally able to make decisions without being constrained by external influences, whether that is in the form of other people or simply follows from one’s own life circumstances. Indeed, the noble Baroness, Lady Grey-Thompson, has highlighted the ways in which society does not always afford even her that degree of autonomy despite her extraordinary career and achievements, from physical obstacles that prevent her having equal access to the public transport that is supposed to serve everyone to people who are not disabled telling her that, were they in her position, they would not keep on going. Not only are people who are homeless by definition cut off from and invisible to key public services, including healthcare, but they often have complex further needs, such as abusive relationships, poor mental health and addiction. How can we imagine that they will not be at risk of being offered an assisted death simply because those needs are judged too hard to meet, or because someone else has decided that their lives are not worth while? We have seen that happen in jurisdictions such as Canada, where the parameters for an assisted death were widened soon after the law was passed, and we duly saw examples of individuals dying by Medicaid explicitly because they were affected by isolation and homelessness. Yes, the Bill differs from the law in Canada in that it requires a terminal diagnosis, but as soon as that threshold is crossed there is nothing in the Bill that would stop a person accessing an assisted death for reasons that were nothing to do with their illness but simply because they had been too worn down for too long by problems that could have been solved with the right care, attention and funding. This year, Crisis and Pathway reported that almost 80% of health professionals say that homeless people are discharged from hospital with unmet health needs, and 92% of homeless people find mental health care difficult to access. The average age of death is 46 for a homeless man and just 42 for a homeless woman. Their circumstances deprive them of autonomy because they remove meaningful choice. That applies just as much to the gravely ill person sleeping rough or isolated in temporary accommodation as it does to the one who cannot afford proper palliative care at the end of life. While I have other reservations about the Bill and the pressuring effect it will have on disadvantaged groups, I am especially concerned that we are looking to introduce it at a time when the cost of living means that homelessness has reached critical levels throughout the UK. Only yesterday, the Government published a national plan to end homelessness, and I commend my colleagues in the Government on that, but there are some shocking statistics in that plan about the numbers who are homeless. It paints a picture of utter despair and isolation for some of the most vulnerable in our society. It is wholly impossible to justify leaving out safeguards that would prevent homeless people being coerced into an assisted death, whether through abuse, absence of choice or simply their despair. I urge noble Lords to support Amendments 308 and 347.