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00:04Last summer, MPs voted for a momentous and controversial change.
00:11This is a hugely significant vote which will have profound implications for society.
00:17It sets England and Wales on course to join a growing list of countries
00:23which have legalised some form of assisted dying in the past decade.
00:27But now the assisted dying bill has hit trouble in the House of Lords
00:32and looks close to running out of time.
00:35I am angry about what's happening. I'm not angry for me.
00:38I'm angry for the many people that this means so much to.
00:42I think democratically it is wrong.
00:44This is not about undermining the democratic will.
00:47This is about passing legislation which is safe.
00:51Assisted dying is a hugely divisive issue.
00:55I have been following the debate at home and seeing how the system works in Australia.
01:02We are not offering people a choice between living and dying.
01:06We are offering a choice between dying and dying.
01:12So, is change still coming to Britain? Or will it be stopped?
01:27You want it first? No, no. We can share the red helmet.
01:32Yes.
01:35Death is a taboo subject for many of us.
01:40But not at Dorothy House near Bath, one of more than 200 hospices in the UK.
01:47Art therapy is one of many ways it helps people with a terminal illness.
01:54It's been absolutely marvellous to come here and just try all these different things.
01:59Meet the most amazing, funny people.
02:03You know, and although we won't sit here and perhaps talk about what conditions we've got,
02:08but we know that we're all in the same boat.
02:10The hospice provides palliative care, which involves much more than treating pain and physical symptoms.
02:19It also covers emotional and practical support,
02:22with the aim of enabling terminally ill people to live well and die peacefully.
02:32Memory vases are part of art therapy.
02:37It looks a bit like an urn, doesn't it?
02:40Something Terry believes has helped her family come to terms with her terminal bowel cancer diagnosis.
02:48This was created with my daughter and grandchildren at Dorothy House.
02:55We asked the children what their memories, you know,
02:59was something about me that really sticks in their mind,
03:02so that we could make things to go on the vase.
03:04So my grandson Stanley straight away said,
03:08snakes and ladders, that's our thing that we do together.
03:12So it's a very soft, gentle way of dealing with the subject of death and dying.
03:19That is a real family heirloom.
03:21It really is.
03:22I can imagine future generations going,
03:25oh, what a hideous thing, where did that come from?
03:29The assisted dying bill is going through Parliament.
03:35You're terminally ill.
03:37Mm-hm.
03:37What's your view on assisted dying?
03:40It absolutely should be allowed.
03:42No hesitation whatsoever in that respect.
03:45With my type of cancer, you know, potentially my ending could be really quite not very nice.
03:52So when you come to that point where you really can't carry on,
03:56you know, I can't stand this anymore, you know, let me administer the drugs that I need to administer.
04:03Any change in the law is likely to come too late for Terry.
04:08If assisted dying is legalised, it could take up to four years to be introduced,
04:14to give time for the service to be set up and medical staff trained.
04:19A lot of detail of how it would work has yet to be decided.
04:29Most of the care provided by Dorothy House is in the community in Wiltshire and Somerset,
04:36helping people to continue living at home rather than being admitted to the hospice or hospital.
04:43Jemima is one of the hospice's counsellors.
04:46Today I am going to visit one of my patients.
04:50George has MND and although she is able to get out and about,
04:55it's more convenient that I visit her at home.
04:59George has motor neurone disease, MND,
05:03a progressive neurological condition which causes muscle weakness throughout the body.
05:11Is my hair OK?
05:12Yeah, it's OK.
05:14Yeah, it's OK.
05:14She's a single mum with a ten-year-old daughter
05:17and receives round-the-clock care at home funded by the NHS.
05:24George has also been an inpatient at the hospice.
05:28Hi, George.
05:29Hi.
05:30Hello.
05:31After being in Dorothy House, it definitely made me realise that it's my preferred place to be
05:39and I don't want to go back into hospital again.
05:41Yeah.
05:42And when you say to be, what do you mean by that?
05:45When I'm poorly, too poorly to be here at home.
05:50Yeah.
05:50So to be cared for at the end of life.
05:53Yeah.
05:54Yeah.
05:57George's passion is writing.
06:00It's a slow process as she uses a joystick to control her phone.
06:06It's just a way of letting go and clearing my mind, I suppose, from the reality of the illness.
06:16Tell me about your latest book.
06:18OK.
06:19It's a romance.
06:21It's not Fifty Shades of Grey, but it is a bit raunchy.
06:27And it's about a girl who ends up in this love triangle and she becomes poorly.
06:37But I won't tell you what happens at the end.
06:39No, don't.
06:43Is assisted dying something that has ever crossed your mind?
06:49I have talked about it in the beginning to a friend.
06:53If I was single and I didn't have any dependents, but my daughter keeps me going
06:58and that's my reason why I wouldn't go down that route now.
07:03I think it depends on your situation because I need to be with my daughter for as long as I
07:10possibly can.
07:18Yeah.
07:19OK, we've got the lovely 80-year-old lady.
07:22Yesterday she was quite kind of stable, but I can see a real change in her today.
07:27She is now actively dying.
07:29The hospice has just ten inpatient beds and they're much in demand.
07:37Hi, Raj.
07:39I've just got some medication here for you for lunchtime.
07:44Alice is part of the team that cares for Raj.
07:49He has a form of skin cancer which has spread rapidly despite treatment.
07:57There we go.
08:00I'm Fergus.
08:01Hello, lovely to meet you.
08:02Really nice to meet you.
08:04It's affected my mouth and eating and all that, so if I don't drink or anything like that my mouth
08:09gets sealed.
08:10So at night the nurses have to wake me up, they give me hot drinks and I have to unseal
08:15myself.
08:16I've had broken sleep after broken sleep.
08:18Because that's about every two hours.
08:20Every two hours they wake me up.
08:21Yeah.
08:21And what the hospice has done is enabled me to see family, see friends.
08:26And without the care the hospice gives, you know, I wouldn't be around.
08:33I wouldn't be around.
08:34Do you worry about your final days, Raj?
08:40I think I want what anybody wants.
08:42You just want to, if you're going to go, you want to go as painlessly as easily.
08:50Hopefully without knowing would be good.
08:54What are your views, Raj, on assisted dying?
08:57Being in a situation that I am, if that option was offered, I would, I would take it.
09:07It's a roller coaster because some days are better than others.
09:10Some days you think, no, I'm still me.
09:13But I just know it's just on the decline.
09:17And before things get too bad, I would take it.
09:21I would, I would make my peace.
09:25Say my final goodbyes.
09:27And at least I'd have control.
09:30I would take it.
09:34Thank you so much.
09:40Raj, who was 59, died at Dorothy House a month after filming with us.
09:48His family have agreed we can show his interview.
09:55Hospices could be asked to play a key role if assisted dying was introduced.
10:01But for now, most are staying out of the debate.
10:05Our view aligned to Hospice UK is that we hold a position of neutrality.
10:09We are not for or against.
10:11That's the tightrope we're going to have to walk and work out exactly what our role is providing specialist end
10:16of life care.
10:17In a scenario, should they be assisted dying?
10:19Because some people will expect us to provide that care throughout and others will be very anti.
10:25On the inpatient unit, it's a struggle to meet the demand for beds.
10:31We've had a call. It's a community patient.
10:34It does sound like she may be dying.
10:36We've got a bed, but we're lacking in medical staffing.
10:39If this lady really needs to come in, then I can try and jiggle things if she really needs to
10:46be here.
10:49Dorothy House costs almost 19 million pounds a year to run.
10:5420% comes from the government, which means it's heavily reliant on charitable fundraising.
11:02Like other hospices, it's under constant financial pressure.
11:07We did make cuts. We saved 800,000 pounds.
11:11But the sad reality is we also had to say goodbye to 17 members of our team.
11:15The majority of us die in hospital or at home.
11:19It's estimated that one in three, around 170,000 people a year in England,
11:26don't have access to adequate palliative care at the end of life.
11:32It's a key concern for doctors who work in this area.
11:36Access to palliative care in Britain is very far from where we want it to be.
11:40It is a postcode lottery.
11:43Some parts of the country have much more well-established services providing coordinated,
11:47high-quality palliative care and other areas just don't have that.
11:51You're less likely to access and have palliative care available if you're an older person,
11:56if you're from a minoritised community, from a socio-economically deprived area,
12:02or if you don't have cancer.
12:04We've just got so much more we need to do to enable everybody to access the palliative care that they
12:09need.
12:10And I think, unless you can offer that, assisted dying won't be safe,
12:14both for the people who want an assisted death and for the majority who don't.
12:24Is there a risk that, if assisted dying is legalised, that some people might choose an assisted death
12:33because they can't get a hospice bed, they can't get access to good quality end of life care?
12:40I'd love to say to you that that wouldn't happen,
12:42but I think we both know the reality that somebody might do that.
12:45At Westminster, I put that point to the backbench Labour MP
12:51whose private member's bill would legalise assisted dying in England and Wales.
12:58Isn't it wrong to try to introduce assisted dying when palliative care around the country is patchy and in many
13:07cases inadequate?
13:08Look, I've always been really clear, this is not either or.
13:12Yes, we should of course be improving palliative care and doing everything we can to support it and properly fund
13:19it,
13:19but we should also be giving terminally ill people choice and dignity in their final days.
13:27The bill going through Westminster would allow terminally ill adults in England and Wales
13:33who are expected to die within six months to have an assisted death.
13:38They must have capacity and be acting free of coercion.
13:42It would need to be approved by two doctors and then considered by a panel of a senior lawyer, psychiatrist
13:50and social worker.
13:52The whole process might take up to two months.
14:02So how might assisted dying work in practice?
14:08I've come to Perth in Western Australia, where it was introduced in 2021,
14:14joining a small but growing number of places over the past decade to legalise it,
14:20including New Zealand, Spain, Austria and Canada.
14:31At one of Perth's main hospitals, I'm meeting the doctor who set up the Voluntary Assisted Dying Service in Western
14:39Australia.
14:42What we're talking about is offering a dying person a choice and some sense of agency and control in the
14:51manner and timing of their inevitable death.
14:54We're not offering people a choice between living and dying, we're offering a choice between dying and dying.
15:03To qualify, adults must be expected to die within six months or 12 months if they have a neurological condition.
15:12They must also have decision-making capacity and be acting without coercion.
15:19But can doctors be sure that people are not being pressurised?
15:24We're trained not just through the Voluntary Assisted Dying training but throughout our entire medical career to spot coercion.
15:33To a greater or lesser extent, capacity and coercion are things that we seek to detect every single time we
15:40offer anything to anyone in a healthcare context.
15:43And with assisted dying, yes, the stakes are higher, but the determination of individual patients to prove to you themselves
15:53that this is what they want is remarkable.
15:58The hospital now has an End of Life Choices Coordinator, a new role since assisted dying was introduced.
16:08I look after everything that's related to assisted dying within the hospital setting.
16:12So patients, their families, staff, wards, and just making sure the whole thing happens.
16:18So it's a pretty vital role.
16:21Yeah, I think everyone calls me when they panic.
16:23They hear the word assisted dying. I'll just call Jo.
16:28Come in. Hey, Kevin.
16:30Joe introduced me to Kevin, who is terminally ill with end-stage heart failure.
16:37His request for an assisted death had already been approved by two doctors.
16:43Kevin, thank you for chatting to me.
16:46You're welcome.
16:47Can I start with, it's quite a big question.
16:50Yes, Kevin.
16:51Why have you chosen to have an assisted death?
16:56My heart functioning rate is between 12% to 13%.
17:00I'm at End of Life, and I don't want to struggle.
17:04I don't want to have anyone wiping my bottle, changing my nappy.
17:08Was it a difficult choice to make?
17:11It's a very difficult choice.
17:12As days draw closer, it gets realities, it gets harder.
17:18This shit's real.
17:20It's a decision not taken lightly.
17:22And I've chosen that path.
17:25I can back out any time.
17:27There's been no coercion.
17:28I'm cool with that.
17:30I've dealt with it.
17:32As best as I can.
17:34And then I'll be at rest.
17:39Kevin has chosen to die in hospital rather than at home.
17:50Three days later, he decides the time has come.
17:56It's very kind of you to invite us, but I just want to be sure, are you happy for us
18:02to be here today?
18:03I am too.
18:10Today's the day that you've chosen for you to use the voluntary assisted dying medication.
18:16But if you do choose to take that medication today, the design of that medication is that it's lethal.
18:22All right?
18:23But really importantly, it's you. It's got to be your decision.
18:29It's...
18:35In Western Australia, most of those who have an assisted death ask a doctor to give them a lethal drug
18:43intravenously.
18:44That wouldn't be permitted under proposals in Britain, where patients would need to self-administer, usually drink, the deadly medication.
18:55This is the method which Kevin chooses.
18:59Hello, Mary.
19:01Thank you for trusting us to look after you in this way.
19:04Thank you for trusting us to look after you in this way.
19:07Yeah.
19:09Within a few minutes of drinking the lethal dose, Kevin falls into a deep sleep.
19:16He never regains consciousness and dies after 25 minutes.
19:23Kevin was proud of his Aboriginal heritage and chose to die holding the ceremonial wooden sticks.
19:34It's hard. I'm not going to lie. It's definitely a challenging thing to be part of on a host of
19:40different levels.
19:41But I think what's important to bear in mind is that Kevin was suffering terribly, and now Kevin is at
19:49peace.
19:50And that, for me, makes what I do worthwhile.
19:57But not all doctors in Western Australia support assisted dying.
20:03Omar Khorshid is a surgeon and was a prominent critic of the legislation when it was going through Parliament.
20:12We're very aware of the risks that are involved in going from a situation where the medical profession is all
20:17about saving lives and crossing that line into potentially ending people's lives.
20:22And once you do that, you open up a range of risks, a range of changes to the culture of
20:27medicine.
20:28You change almost the definition of what it is to be a doctor.
20:32Only around 100 doctors in Western Australia out of 13,000 have participated in an assisted death.
20:41Why do you think there are so few doctors who are involved in this whole process?
20:46Participating in euthanasia is a hugely challenging thing for most doctors.
20:52A lot of doctors believe it's reasonable to be available as a service, but do they want to do it?
20:56Absolutely not.
20:58In Britain, though most medical bodies have a neutral stance on assisted dying, the Association for Palliative Medicine is opposed.
21:09Surveys have shown that about 80% of our members were not in favour of assisted dying, 5% are.
21:16Every single view that you could expect in society is reflected in our membership, but it is skewed towards reticence
21:24to assisted dying.
21:27In 2024-25, 480 people chose assisted dying in Western Australia, up from 293 the year before.
21:39It now accounts for one in 40 deaths.
21:43Critics are worried rising demand will lead to pressure to relax the rules around eligibility.
21:51There is no doubt there is a slippery slope all over the world when it comes to physician-assisted suicide
21:57and voluntary euthanasia.
22:01It is clear in every jurisdiction that the laws gradually become weaker, the protections are removed, the so-called barriers
22:09are removed as demand increases.
22:12What is the cost to society when we start to accept death and suicide and euthanasia as reasonable ways to
22:19treat conditions?
22:25At Westminster, the assisted dying bill is now in the House of Lords.
22:31It is right and possible to pass a law which allows those who are terminally ill to die with dignity
22:38and at a time of their own choosing.
22:40This is not an assisted dying bill. It is an assisted suicide bill.
22:46Despite being approved by MPs with a majority of 23 votes in June last year, the bill is now stuck
22:54in the Lords,
22:55where opponents argue it's unsafe, will undermine the doctor-patient relationship and is a threat to disabled and vulnerable people.
23:06More than 1200 amendments have been tabled, half of them by just six peers.
23:12My Lords, this bill as written does not improve patient choice or control.
23:20True choice would ensure patients get the care they need.
23:25Baroness Finlay, a doctor and palliative care expert, has put forward nearly 200 amendments, more than anyone else.
23:35The way the bill is written at the moment, any two doctors,
23:39they might have almost no experience in the disease that you've got, can say that you may be terminally ill.
23:47That's inaccurate. There's no check that the diagnosis is correct.
23:52The capacity clause is completely inadequate and there is no adequate assessment to make sure that you haven't been coerced.
24:02The bill has multiple safeguards throughout it, which makes it far safer than the status quo and still gives terminally
24:09ill people the choice, the compassion and the dignity that I think they deserve in their dying days.
24:13I intentionally called it the terminally ill adults end of life bill.
24:17If the bill doesn't become law by the end of this parliamentary session, in April or May, then it will
24:26run out of time.
24:27That now seems certain because peers still have hundreds of amendments to discuss.
24:34I think democratically it is wrong for a relatively small number of unelected peers in the House of Lords stopping
24:43this legislation passing through.
24:44I am angry about what's happening. I'm not angry for me. I'm angry for the many people that this means
24:50so much to.
24:51And when you've spent time with campaigners who've worked on this issue for years, on the back of their own
24:57grief and loss,
24:58then it's really upsetting to think that they were given the hope that the House of Commons gave them and
25:04sadly were in danger of that hope being taken away.
25:07You're not elected. Aren't you undermining democracy?
25:11We are not an elected house. We're a house of people who come with experience from various walks of life.
25:20And I've worked for half a century in palliative care.
25:25I've looked after thousands and thousands of patients.
25:29This is my area of expertise. It would be irresponsible to not share it.
25:35This is not about undermining the democratic will.
25:38This is about passing legislation which is safe.
25:42I reject the suggestion that I'm sabotaging the bill.
25:46The bill's supporters say they won't give up.
25:50We can see very clearly the direction of travel around the world, in other jurisdictions, in the British Isles, that
25:57the public support this and change is coming.
26:00So even if it doesn't get through this time, it will get through. This is not an issue that's going
26:05away.
26:05We will bring it back next time and we will use the Parliament Act, if necessary, to ensure that the
26:12Lords cannot block it a second time.
26:18It's not just the Westminster Parliament which is grappling with this issue.
26:23MSPs at Holyroot are about to have a final vote on whether to introduce assisted dying in Scotland.
26:30In Northern Ireland, there are no proposals to change the law.
26:36And whatever happens in the UK, assisted dying is on track to come to the British Isles.
26:43Both Jersey and the Isle of Man have passed bills which are awaiting royal assent, though it would be for
26:51residents only.
26:52Their systems could be in place in 18 months.
27:03I've been covering the assisted dying debate for more than two decades.
27:08Its introduction would be a massive social change, ranking alongside the legalisation of abortion and the abolition of the death
27:18penalty.
27:18For supporters, it offers choice, dignity and a pain-free death.
27:25For critics, it undermines the value of human life and places the vulnerable at risk.
27:31The arguments will continue whatever lawmakers decide.
27:41Later tonight, a new documentary investigates the ugly side of social media inside the rage machine on BBC Two in
27:50half an hour.
27:53For more information, visit us at the Cine's Carpenter in перемотя in the UK.
27:53Thanks for listening.
28:00I'll see you again.
28:04I'll see you again.
28:05Thank you again.
28:05I'm open-view for you.
28:06Thank you again.
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