Terminally Ill Adults (End of Life) Bill

Dear residents of Bicester, Kidlington, Woodstock and the surrounding villages and areas,

When Kim Leadbeater announced that she would table a private members bill on the right to an assisted death, I said I would take time to listen carefully to the views of my constituents and those who are expert on these topics. 

This is a very significant piece of legislation and deserves careful thought and consideration. I am full of respect for Kim Leadbeater and her team who have done an incredible job in preparing this legislation and in leading a debate where Kim has not only emphasised but demonstrated the importance of listening respectfully to all perspectives. 

In the course of weighing up the decision that Parliament is being asked to take, I have spoken to and read the letters from many constituents, medics and healthcare staff, lawyers and academics, fellow parliamentarians, those living with debilitating or terminal illnesses and those who have experienced the deaths of loved ones with those conditions. 

I know how passionately those involved in this debate care about the issue. I want to thank them for contacting me and for generously and openly sharing their expertise and experience. Every person I have spoken to has shown respect and compassion for others involved in the debate. 

22 years ago, when I was a young man, my father died from lung cancer. He died at home, surrounded by those whom he loved, and had benefited from incredible care from palliative nurses from our local hospice and Macmillan. He did not, however, die peacefully but traumatically, following a haemorrhage of his lung.

Every time I have spoken to a bereaved relative about their experience, I have been transported back to the early hours of that morning and to my own grief. I understand very personally why so many of my constituents who have seen their loved ones suffer at the end of life want to change the law so that others may in future have a different choice. At the start of this process, I felt the same and anticipated that I would vote in favour of this legislation. 

However, as I have looked more closely at the issue, listened to those with whom I have met and weighed more carefully the context in which an act would be implemented and the consequences it might have, my doubts have grown. 

As legislators, we have the job of trying to work out what is best for society as a whole. Even if we are convinced a piece of legislation will benefit one individual, we have to be sure that its full effect will benefit more people than it might harm. 

My first concern is around how we support those who are in the final months of their lives. I have spoken to palliative care doctors and those who run and work in hospices. They do incredible work for their patients and the depth of their humanity was very clear as I heard them talk about how they seek to ensure that each person has a pathway towards their death that gives them agency, dignity and pain management.

Yet our hospices and palliative care services are underfunded. One in four people who seek palliative care do not get it before the end of life. Those who do often get it too late after their diagnosis or the service that is available to them is insufficient to give them all the support they might need. A number of hospices have recently had to cut staff and services. The level of hospice grant funding depends on which health board region a patient comes from and even then hospices rely on charity fundraising for much of their funding. There is no level playing field for palliative care. 

This matters enormously since it means that those being asked to make a decision on how they want to manage the end of their lives are not being given a full choice. If we introduce assisted dying into that conversation, we ask patients who are often fearful of the pain they may experience or how their lives will end to choose between the uncertain alleviation of those symptoms or the certainty of assisted dying. Before posing that choice, I believe we should make sure that everyone who chooses to can have the highest possible quality of life in their final months. 

My second concern is how legalising assisted dying will change the relationship between a patient and their doctor in respect of the preservation of life. As it stands, the state looks to keep its citizens alive. If someone says to their GP that they are having suicidal thoughts, they will be offered counselling or psychiatric interventions to help them reduce or eliminate them. Adopting this legislation, in which doctors are the counsellors, validators and facilitators of a decision to die will fundamentally alter that relationship. 

I am also concerned about the impact of the legislation on the vulnerable. The bill contains safeguards to protect individual patients. However, there are potential impacts of this legislation that no safeguard around a single patient’s decision can address. This is especially worrying in a context where we cannot be sure all patients will get the support they need. If I am depressed, or think that I may be a burden on my family, my carers or society, this legislation will signal to me that, under certain circumstances, doctors will assist me to end my own life. This is a particular concern since many patients quite understandably experience depression when they are first given a terminal prognosis. As it stands, the state’s position is clear: while understanding that some people may choose to end their lives, the state has a duty to protect life. If this legislation is adopted, that changes. 

I do not pretend this is easy. There are many doctors among those I have spoken to and read from who support the bill. They believe that this tension can be successfully managed and I respect their experience and view. However, I have heard from other doctors who have grave doubts about how this would change their relationship with their patients. Those who have studied the implementation of assisted dying regimes in other jurisdictions note that, in many of these, family doctors find assisting a death traumatic and so elect not to participate in assisted dying; instead, there are specialists in the practice who are called upon when a patient wants to take that route. In Oregon, for example, only 1.1% of doctors opt to be involved in assisted dying.

Every week, I hear from constituents who say they cannot get a GP appointment or that they have been waiting months, even years, for a specialist appointment. Despite the incredible work of its staff, our NHS is struggling. The government has committed to invest in the NHS this year. That is urgently needed. In this fragile environment, anything that might discourage doctors from joining the profession or encourage those who are working hard in our NHS to leave, must be carefully considered. 

I will therefore be voting against the bill when it comes before the House of Commons on Friday. 

I know that this decision will disappoint and upset many people, especially those constituents who have told me why they hope I will support it. I trust you know that I have taken a very hard decision carefully and reflectively, and hope that you will understand my reasoning, even if you disagree with it.

Yours sincerely

Calum Miller MP