Kit Malthouse
MP for North West Hampshire · Conservative · United Kingdom
“We have heard time and time again that the situation that thousands of our constituents live with every single day is so horrific and appalling that even the best palliative care cannot alleviate their pain. I urge colleagues to consider what their vote may mean today.”
“I will not. Some of those Members had just a few months before been specifically rejected by the electorate and replaced in this House by others, and I am afraid that they cannot be trusted not to do the same thing again. I grant my right hon.”
“The Health and Social Care Committee of the House of Lords found that in territories that have assisted dying, palliative care generally improves, because people become less afraid of talking about death.”
“One of the most affecting people I have met over the last 11 years of campaigning on this issue is Warwick Jackson, who came to our party conference a couple of years ago. Warwick’s wife, Ann, was diagnosed with terminal peritoneal cancer. She basically knew that she was going to die a slow, suffocating death at the end.”
“I respect my right hon. and learned Friend’s expertise in this matter, but, as he has already heard on the Floor of the House, it is perfectly possible for this House to suggest amendments, negotiate them with the promoters of the Bill, place them against the legislation in the House of Lords and then have them come back to this House for…”
“As co-sponsor of the Bill once again, I am acutely conscious that there is more at stake today than merely the fate of those who are facing their end, because the conduct of the other place means that our democracy is also on trial today.”
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“My assumption is that once a commissioner is appointed, and in drawing up the regulations and guidelines for reporting, there will be consultation between the Government and the commissioner about what the commissioner actually wants to report on. From what the Minister is saying, I assume that, unless we collect the data, the commissioner will have nothing to say in their report.”
“Obviously the hon. Lady is a London MP, but I gently point out that particularly in a London context—and in other urban areas—someone’s postcode is actually a very poor indicator of socioeconomic status. I represented central London as a London Assembly member for eight years and, in large parts of central London, there is social housing in the same postcode as extremely expensive houses running into the many millions.”
“I want to emphasise that at the moment the patient reaches that point, they will have had their palliative care options explained to them extensively, under the Bill, and it is highly unlikely at that point, as my hon. Friend the Member for East Wiltshire said, that anyone would not be in receipt of palliative care, given the very late stage of their disease.”
“I am not entirely certain that my hon. Friend’s remarks are germane to the amendments, but nevertheless. As we discussed when debating clause 13, at the stage he is talking about, the patient will have had all their options—“all appropriate”, as I think we have amended the Bill to say, services that will be available to them—explained to them. If they are cancelling, the presumption has to be, in respecting their autonomy, that they are choosing one of the alternative paths that has been laid out to them. It is quite hard to legislate for a negative.”
“I am not sure what compulsion there is in wider legislation for there to be a duty of care to patients who do not choose assisted dying in the first place. For thousands and thousands of patients who die, there is no legislation that imposes certain duties on medics or others to look after them; we rely on the professional standards and overall atmosphere of the healthcare system, as we would in the case of these patients. As my hon. Friend knows, overseas experience shows that a large proportion of the people who obtain the right to an assisted death—up to a third—do not cancel but do not exercise it. As we have said before, for many people assisted dying is an insurance card that they may choose to use if and when they think their life becomes intolerable.”
“Does the Minister agree that, unfortunately, my hon. Friend the Member for East Wiltshire seems to be labouring under the misapprehension that there is some reputational test in becoming an attorney? In truth, I can appoint anybody I want to be my attorney. There is no verification or otherwise until there is some form of dispute around the exercise of the power of attorney. In fact, the regulations may mean that we have stronger verification of the bona fides of the person who is a proxy than we would have through the LPA route. Does the Minister not also find it slightly sad that, given the type of Conservative I know my hon. Friend the Member for East Wiltshire is, he thinks the concept of being of good standing in society is somehow meaningless?”
“I am a little confused by my hon. Friend’s logic. He has literally just proposed an amendment for the doctor to ask, at the last, whether the person still wants to proceed. Surely self-administration is the ultimate act of consent, which his own amendment requires a doctor to establish right at the last moment.”
“After 10 years of campaigning on this issue and spending so much time with people whose family have gone to Switzerland, one of the things they consistently say is that people went to Switzerland much earlier than they wanted to because they had to go while they were still physically able. I think this is a critical point that people have to realise. We should not compel people to do this earlier than they would otherwise wish to simply because of these restrictions.”
“Does the Minister agree that my hon. Friend the Member for East Wiltshire is perhaps unintentionally creating a lack of clarity where there is clarity? Surely there is complete clarity in the distinction between assisting a patient to be in a position to carry out their final desire and act, and performing or even jointly performing that final act with them. Is it not the case that in overseas jurisdictions there is quite a lot of assistance with technology? It needs to be prepared and put in place, but it can put even those who are the least physically able in a position in which the final act of administration can be clearly theirs. In many ways, our life is made easier by modern technology in that regard.”
“The hon. Member might be interested to know that many hospices and, in fact, the hospice movement have developed what they call hospice at home, which is for people in the advanced stage of illness who want to die in their own home. Services are provided to them to palliate them as they reach death at home.”
“On a point of order, Sir Roger. Is there any chance somebody could attend to the heating? I do not know whether I am the only Member who is starting to feel a bit cold. As the evening wears on, we are likely to get colder. If we could have it turned up slightly, that might assist our proceedings.”
“Member for Spen Valley says she is willing—but I do not understand how the collective view of the organisation would be reached.”
“I am sure my hon. Friend did not mean to equate assisted dying with prostitution—I would not want anybody on social media to misinterpret what he said. I have been subject to that myself, and I want him to be clear of that. I am intrigued by this notion. I fully appreciate and support the idea that individuals should be able to opt out from the process and not participate, but by what means would the view of these institutions be ascertained? Would it be the view of the management? My hon. Friend said that other residents might be disturbed, so will there be a residents’ vote? How will these organisations come to a collective view? Practically, the Bill refers to individuals—it is an easy one for us that people do not have to participate; we have talked about the wider application of that and the hon.”
“I have just two quick questions. First, I am intrigued to know how my hon. Friend imagines these organisations would reach this collective view. Secondly, if they could reach a collective view, should they still be able to deny what is a legal service, if they are in receipt of public funds?”
“Let me remind my hon. Friend—first, she is saying that the views of, say, the residents count for little compared with the views of the directors, but my second question was whether she believes these organisations should be able to discriminate in that way, even if they are in receipt of public funds.”
“In the interest of symmetry, if I work for one of these organisations and it takes that decision, can I conscientiously support it? We are saying that at an organisation that allows it, staff can conscientiously object. If there is an organisation that conscientiously will not allow it, can I conscientiously support it as an employee, or am I automatically fired?”
“Technically, as we established earlier, cancer is a disability and therefore a protected characteristic, so under the law, anybody who has cancer cannot be discriminated against by an organisation that is offering services to the public. I want to make a wider point. The point we are trying to make about the amendments is that very few people will move into these organisations and live in them in the expectation that they will get a terminal disease. They will move in in their twilight years, whether it is an almshouse or a care home, for retirement purposes or other reasons—”
“As my hon. Friend heard yesterday from the hon. Member for Rother Valley, there are multiple points in the new system at which family could make their views known. Indeed, they could apply very quickly for an injunction if they thought something was untoward. My hon. Friend has talked a lot about families knowing best. Surely it should be the dying person who chooses how best to handle their family. The evidence overseas is that giving dying people choice about the manner and time of their death also gives them the choice about how to handle their family, and particularly their children. My hon. Friend might have a particular approach, and mine might be completely different, but I should have that choice. She seems to think the family know best for the dying person—how come she does not think the dying person knows best for their family?”
“That is certainly what they see in Australia, where families try to persuade somebody not to do it. I think the hon. Lady has good motivations, but I am concerned that she might actually produce the opposite effect and drive people into secrecy.”
“I have to say that my concern about the hon. Lady’s amendment is growing. We have talked in the past about policing the conversation and the process to the point that it becomes guarded. Say I had a strong, long-standing conviction that I wanted assisted dying if I was in extremis, but I had a child who I knew was violently against assisted dying; if the hon. Lady’s amendment were in place, and there was the possibility of appeal, surely my tendency would be to keep my disease and diagnosis, and my approach to the system, secret from that person. By opening this formal door, I would effectively be encouraged to conceal the process from a family member who I know may object. I say that particularly in the light of the fact that, as we heard from overseas experience, coercion more often than not comes the other way.”
“If the state, rather than the dying person, is effectively deciding how the family should be handled, we are naturally giving that person an incentive to keep this thing quiet until they are ready to tell their family, which may be well towards the end of the process. As the hon. Member for Rother Valley said, there are multiple points at which the family can intervene if they know. My concern is that this kind of—what is the word we have been using?—embroidery actually drives people in the opposite direction to the one my hon. Friend the Member for Reigate wants to achieve.”
“Through my hon. Friend, may I respond to the point made by my hon. Friend the Member for East Wiltshire? It is not necessarily about not having faith in the panel. Somebody may, for example, have a relative driven by a strong religious faith who wants to create some form of delay in the system, just to put off the awful day. Even if a commissioner were to take that relative’s application and decide that it was not valid, that would inject delay into what is naturally a time-limited process. A person may want to retain the right to handle their family themselves, and have the choice about how to do that.”
“The amendment is very sensible, not least because there are some conditions in which people experience a very significant decline at the end. In a matter of days, they may lose the ability to speak, while retaining capacity, so the ability for people in a small number of cases to give pre-recorded answers is incredibly sensible.”
“I am just intrigued. My hon. Friend is talking a lot about the evidence. Did any evidence on anything in the Bill change his mind on any aspect of it?”
“To be clear, does my hon. Friend envisage that I would either be in the hearing, or lying in my bed listening to the hearing—the fungating tumours in my neck restricting my ability to breathe—having gone through all the eligibility criteria, but having to listen to someone argue that I should go through a death that I am trying to avoid, by arguing that I do not have capacity? Does he not see that that could be profoundly distressing to someone who is in the closing moments of their life? In many ways, it might actually be cruel and traumatic for me to hear somebody arguing, frankly, that I should endure the pain, in their opinion.”
“I rise briefly to amplify a couple of points from the excellent speeches by the hon. Members for Rother Valley and for Ipswich. First, in clarification, I understand that there are situations where judges can sit in essentially supervisory positions—not least, for example, on the BBC board—and they can of course be Cross Benchers in the House of Lords. They are allowed to undertake other charitable trustee roles, although they are restricted in their activities.”
“In my personal view it is not, but at the time my view was that if as a footballer I could show up in the middle of the night and get an injunction to stop The Daily Mirror from publishing unpleasant stories about me, then the judges should be able to find time in their schedule to accommodate the requirements of my death.”
“It will impose new burdens on the judiciary and the police, as will the new offence of spiking. No doubt the immigration Bill coming through will also put significant extra burdens on the police and the courts. There are two separate questions here: one is what Parliament does, and the other is the capacity of the public sector to absorb that. The answer is not to say, “Well, I am afraid all you people have to go through a death you do not want to go through”; it is to say that we do not have enough judges and to recruit more judges, if that is required.”
“My understanding of judicial opinion was that, certainly in Lord Sumption’s view, that level was unnecessary; I think he referred to it being a profoundly intimate conversation that really should just be between the patient and the doctor. However, I think my hon. Friend the Member for East Wiltshire is right that the weight of the moment and opinion in the House then was that there should be that third layer of scrutiny and opinion. I also dismiss the argument about the capacity of the judiciary to absorb this. I fear that if we start to accept that argument, we go down a very difficult road for Parliament—not least, for example, because we should then have opposed the Bill that went through the House on Monday night, because of its greater impositions. As many will know, the Crime and Policing Bill went through without a vote.”
“No, I do not acknowledge that at all. Over the years we have started to use judges relatively flexibly—even, for example, for non-statutory inquiries; my hon. Friend has referred only to statutory inquiries—and that is so much the better. I am not a lawyer myself but I believe in the rule of law, so I think that having judges opining on our freedoms or otherwise is generally good for the country. I want to amplify a couple of points. On Second Reading, I made the case for the High Court to be involved. I agree with my hon. Friend the Member for East Wiltshire: at that stage, I was very happy for there to be effectively a scrutiny and authorisation third layer to the Bill.”
“No, I do not share that regret, because until today, and until we all vote on it, the Government do not actually know what they are facing. They have undertaken that they will produce exactly the assessment that my hon. Friend is talking about between the end of this process and Report, so we can all have a look at what it will be. At that point, Members can put a price on other people’s death and other people’s pain if they want to, but there are lots of situations where the House of Commons decides about things on the basis of moral principle and public interest, and then we ask the public sector to absorb it. If that causes operational problems, then we solve those separately. In my 10 years in the House, I cannot remember anybody ever standing up and saying, “We shouldn’t do this because the public sector can’t cope.””
“The hon. Lady puts it exactly right. These are two separate questions, and we should not conflate them. Certainly, we should not allow the House of Commons to be constrained by those capacity constraints from doing what it thinks is the right thing. We should do the right thing, and then put pressure on the Government to provide the facilities that we think are required.”
“As I recall it, there were a number of questions at the oral evidence stage about the notion of there being a panel, specifically when we had the panel of lawyers. We asked about that. But the hon. Gentleman is right; the issue was an emerging one at the time. That is the nature of the kind of iterative policymaking, or legislative process, that we are going through at the moment. The Government have said that they will produce an impact assessment, so we can all have a look. It will not be long—three or four weeks—and then we will all be able to make a judgment.”
“I share the confusion of the hon. Member for Spen Valley. By the time we get to clause 13, my understanding is that the two doctors and the panel are already satisfied of the person’s eligibility, so they are by definition terminally ill. I do not understand why they would then seek to render themselves doubly terminally ill by adding the characteristics the hon. Lady is talking about. Maybe I am getting confused. I could understand the hon. Lady’s case if she had made it way before, but at this stage the person has been through two doctors and the panel and got permission to go ahead. I do not understand why they would then starve themselves.”
“I agree about the primacy of autonomy, but does the hon. Gentleman agree that, given the status quo and the many stories that we have heard about individuals who took their lives but kept it secret from their families, whether by going to Switzerland or by doing it in a horrible way in lonely circumstances, a regulated atmosphere would makes it more likely that people will talk to their family about what their death will be like and, as we have learned from overseas, make arrangements for their family to be around them, or at least to say goodbye, as they move into that process? At the moment, because this area is unregulated, way more people do it in secret than need to.”
“In truth, the CMO producing guidance within 12 months will be no more effective than those organisations have been, and possibly less. As the hon. Gentleman himself pointed out, we are dealing with a collective action issue. An organisation can issue guidance, and a small percentage of parents may pick up that guidance and observe it, but if the percentage is below 20%, so strong is the peer pressure and so addictive is what we are dealing with that those parents end up in screaming matches with their teenage children on a daily basis.”
“Parent after parent in millions of homes across the land is screaming for help and assistance from the Government. As the hon. Gentleman rightly pointed out, we are allowing smoking for the brain in our youngest children, with the long-term impact that that will have. I am afraid to say that in the face of all that overwhelming evidence and momentum, the hon. Gentleman has been done over in bringing forward this Bill. When we look at what we are presented with, as I said, we have nothing more than a gesture. The first point is that the CMO should bring forward guidance. As the hon. Gentleman surely knows, there is already plenty of guidance out there for parents—the NSPCC has online guidance, as does Internet Matters. Lots of organisations, including schools themselves, are issuing guidance for parents.”
“The hon. Member for Whitehaven and Workington (Josh MacAlister), from the far and beautiful north-west, has made an extremely strong case for the original Bill that he envisaged bringing before this House. I am afraid that today I will speak not to celebrate progress, but to lament the gutting of what could have been a landmark Bill. Sadly, this Government, like the last—notwithstanding the Online Safety Act 2023—have dithered, diluted and capitulated, and I am afraid that what remains is a hollowed-out gesture and an opportunity missed. As the hon. Gentleman said, the evidence is strong, the damage is profound and the public support is overwhelming. Documentary after documentary details the significant damage being done to our young people on a daily basis.”
“I am not convinced that the guidance created by this Bill will be any more authoritative than that created by the NSPCC or by Internet Matters. The point I was making was not necessarily that the guidance is going to be pivotal, but that we need to get to a critical mass of observance before guidance is likely to have any impact. The original Bill was likely to do that, not least through the ban in schools, which created a nucleus of clear space for children that could be translated into homes. Many Members may have heard on the BBC this morning a short piece on the Fulham boys school, which has an absolute ban on even bringing a smartphone to school. That ban during the school period has resulted in the periods before and after school also being phone-free, and therefore much more social and beneficial to those pupils.”
“I am sorry to say that the hon. Member for Whitehaven and Workington has been sold a cosmetic pup. The third and final point is that the Government have to publish this “assessment”—whatever that may be—which, as far as I can see, is fundamentally to tell us something we already know, and which the hon. Gentleman has illustrated extremely vividly. We should all be furious about the delay and prevarication that is being injected into what could have been a huge step forward for parents and children.”
“I would be willing to accept the hon. Gentleman’s encouragement if this were advice to schools, but it is not; it is advice to parents and carers. If there were going to be authoritative advice for schools, as well as other organisations that have charge of children—scout troops, children’s clubs, and other publicly funded organisations that look after children—I would have said, “Possibly,” even though there is to be a 12-month delay before the CMO tells us stuff we already know, as the hon. Member for Whitehaven and Workington pointed out. The second step is for the Government to publish a plan for research within 12 months. That is not the conclusion of research, and there is no time limit—just a plan, a vague aspiration that we should have a plan, with no commencement, no sense of budget and no idea of when it might come.”
“] The Minister is indicating zero, and that is useful to know, but I cannot then understand why the Government have pressured the new Member for Whitehaven and Workington to produce what is, frankly, a cosmetic pup, betraying our children and capitulating to big tech. I am afraid that this Bill is a shell of what it could have been, and as a result is yet another missed opportunity to improve the lives of our young people.”
“Anybody who has a teenage child and has tried desperately to move them off from cradling this precious phone at the dinner table or even from watching TV at the same time will see how they cannot get away from their phone and will realise the addictive nature. The fact that neither of those two steps is now in the Bill is, I am afraid, deeply lamentable. It feels to me as though the Government have capitulated to big tech. I had a look online to see—I am not casting aspersions—but it would be helpful if the Minister could tell us in his remarks what meetings he had with big tech companies in the run-up to this Bill, and whether he has consulted or spoken to them. [ Interruption.”
“In school upon school across the country, they are bringing in their own policies, often in the teeth of opposition, whether parental or from children. Their life is made immeasurably more difficult by not having an absolute ban. The second thing that was promised and the second reason why we should be furious was the raising of the digital age of consent. By not including that in the Bill, we are consenting to those tech companies—as they have admitted in meetings in the run-up to this Bill—using children’s data to addict them to their services. We know that happens, and we see it happening.”
“There are plenty of people out there in the country who should be furious, because two key things were promised in the original Bill. The first was an absolute school ban. All Members will know that when they go to visit schools, one of the features coming through strongly when we talk to headteachers is the increase in parental aggression towards schools. The source of conflict at the school gate is around all sorts of issues, not least the use of phones in schools. By advocating a complete blanket ban on phones in schools, we would be removing at one stroke a source of conflict between parent and teacher, as well as at the same time creating completely clear space for those kids to concentrate on their education.”
“As I said at the start of my speech, I lament the dithering and delay by the previous Government, too. There were attempts by Back Benchers—and I was one for the last two years of the Government—to change the Online Safety Bill to take exactly these sort of measures. That was rebuffed by Ministers at that stage, and I regret that completely. To me, this is a national, if not international, emergency, about which we are being far too passive and complacent. I am not necessarily making a political point about this; it is about the weight of Government and, frankly, the weight and influence of big tech against the health and welfare of our children. That applies to Governments of all stripes in all countries across the world. It is not just we in this Chamber who should be furious.”
“As the hon. Lady says, the hon. Member for Whitehaven and Workington (Josh MacAlister) has done an enormous amount of work, and it is obviously desirable for the Government to act in the face of evidence. Does she think that the Bill, as negotiated with the Government, constitutes action?”
“My hon. Friend vividly illustrates the problem with this kind of collective action and peer pressure. Has she reflected on the fact that it is not just the addictive nature of the application that is pulling in our kids, but the fact that they are free, and therefore everybody is encouraged to get them? We then get 100% coverage, and it is very hard to deny them to our child, if they will be the only child without.”
“I also attended events that the hon. Member for Whitehaven and Workington pulled together. Does my right hon. Friend agree that the strong characteristic that came out of all of them was deep and profound anger among parents about what has been allowed to develop?”
“As I think we all know, the Government are likely to adjourn the debate on the Bill. Will my hon. Friend’s case be made if the case for adjournment is that the Minister commits that he will go and do these things anyway, and therefore the legislation is unnecessary?”