Choice at the End of Life All-Party Parliamentary Group Speech

Below is the speech Torrin Wilkins gave to the meeting of the End of Life All-Party Parliamentary Group during a meeting focusing on assisted dying laws in Australia. The meeting was chaired by Kit Malthouse MP, who introduced Torrin as the Director and Founder of Centre Think Tank. The audience included Members of Parliament and Members of the House of Lords.

The speech was as follows:

“First of all, I would like to thank Anna and Liz for sharing their experiences. They are vitally important to properly inform this debate.

Today, I would like to speak about our paper on assisted dying laws, “The Case for Dignity,” which was published recently. This paper informed the Isle of Man second reading, which passed with an overwhelming majority. It also informed the Westminster Hall debate, which took place recently, a debate which was vital in moving the wider debate on this issue.

The paper focused on the western United States, with case studies looking at California, Washington, and Oregon. It also looked at the Australian states of Victoria and Western Australia. These are areas which specifically offer assisted dying to terminally ill, mentally competent adults.

We aimed to look at the impact of assisted dying on palliative care. It was also to understand how safe the system is in practice and what safeguards are in place.

Today I want to speak about the conclusions of this paper, the lessons we learnt and more generally what we have learnt from years of supporting this change in the law.

On the safety and safeguarding aspect, there are concerns that people may be coerced or may be pushed into the system. However, when we looked at these different systems we found no evidence of coercion despite the range of reporting systems in place and the multiple counties that have these systems.

However, we did find cases of coercion which were the opposite of what we would expect. Where someone was pressured towards not having an assisted death. This is important as it shows these systems are picking up on coercion, even if it is not the type we expected.

These systems also give individuals full control and autonomy over the process. In every area we looked at, they can leave and enter the process as they wish.

The wider concern around safety is not just whether coercion happens but whether the system rejects those who are subject to coercion, manipulation or mental health issues that would make them unable to give consent. This is achieved through safeguards and checks for those who want to access assisted dying.

In the areas we looked at, there are checks not only to ensure that people are nearing the end of their life but also to determine whether they are mentally competent and can make the decision. There are also further checks for those who may need them. For instance, there are psychiatric examinations for a number of those accessing assisted dying services in Oregon and Washington.

Finally, I want to address the concern that we could end up with a system similar to Canada, which is much broader than the one we support. However, I think it is important to recognise that this system was one led by the Canadian Charter of Rights and Freedoms and the courts in enforcing this. We would not have the same issue within the UK.

In the areas we looked at, there was no evidence of any slippery slope. The access criteria for assisted dying did not extend, and even the groups using the system stayed roughly the same.

The paper also focused on the palliative care sector and how assisted dying would impact an already struggling service. Within the UK, palliative care gets a large amount of funding from the government and needs far more investment. The concern people have is that assisted dying may be used as an alternative to a struggling palliative care system.

However, what we saw in Australia was that palliative care often improved when the law was passed. It resulted in more funding within the areas we looked at, more conversations around end-of-life care, and placed it higher on the political agenda.

Out of this, I wanted to highlight six lessons I feel we can learn from Australia and Western American states.

First, we need to use evidence to tackle fears about a new system; in effect, we need to focus on facts and not fear. We know these systems can be safe and that there is plenty of evidence to back this up.

Second, we need to ensure everyone understands that this law would only apply to “terminally ill, mentally competent adults”. Not only are we not in a remotely similar position to Canada, but we would only support a law change if it applied to these groups.

Third, we should increase palliative care funding alongside a law change. We have seen in countries around the world that this works for palliative care and moves the conversation towards end-of-life care.

Fourth, we need to learn best practices from these states when proposing our legislation. For instance, the Western Australia Statewide Care Navigator Service is extremely valuable in guiding individuals through the process and giving them the information they need.

Fifth, whilst we discuss how safe these systems are, it is important to understand that a new system would be even more safeguarded than the existing systems abroad. The bill proposed by Baroness Meacher, for instance, required two independent doctors and a High Court judge to agree for someone to access assisted dying services.

Finally, the American and Australian systems we covered are far better than our existing unregulated system. It would move us from a system which makes people travel overseas to access assisted dying towards safe systems that give people a choice.

Thank you so much for listening, and I look forward to answering your questions.”

Kit Malthouse MP

Kit is Co-Chair of the All-Party Parliamentary Group on Choice at the End of Life. He has served in several Government positions, including Education Secretary and senior ministerial posts in the Home Office and the Ministry of Justice. Before entering Parliament in 2015 for the North West Hampshire constituency, Kit was a member of the London Assembly and a Deputy Mayor of London.

Dr Anna Negus

Anna is a specialist anaesthetist. Born and raised in Bristol, where her family remains actively involved with the local Dorothy House Hospice, she completed her undergraduate medical training in the UK before moving to Auckland, New Zealand, and then Melbourne, Australia, by Fiji and Tonga. Anna now works in Perth, Western Australia, and acts as a provider under the States Voluntary Assisted Dying Act, which came into force in 2021. Anna is a Fellow of the Australian and New Zealand College of Anaesthetists.

Liz Reed

Liz has been involved with Dignity in Dying following the assisted death of her brother Rob, who moved with his family to Queensland. Liz will share her family’s experiences with attendees at the APPG and her desire for a legal change in this country. Liz is a graduate of Law with Spanish, who has travelled extensively across Spain and Latin America. She worked in financial services for a decade and is now settled back in Hertfordshire, where she lives with her 3-year-old daughter.

Torrin Wilkins

Torrin is the Founder and Director of Centre Think Tank, established in 2020 with the mission to rebuild the centre ground and to create more centrist and moderate politics. Torrin previously chaired Liberal Leave and, following the EU referendum, campaigned for the UK to remain part of the single market. Centre is a non-profit foundation which is both a think tank and a pressure group.

In April, we published the paper, ‘The Case for Dignity’, on the assisted dying debate, which informed the Westminster Hall debate and received coverage in The Guardian.