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11 Nov 2008 : Column 219WH—continued
Hon. Members will be aware that, in September, we announced a £200 million mortgage rescue scheme, which will help up to 6,000 of the most vulnerable home owners facing repossession to remain in their homes. We are currently working hard with delivery partners to ensure that the Government’s mortgage rescue scheme is open for business as soon as possible. When my right hon. Friend the Minister for Housing came to her post
about a month ago, she was struck by the fact that the mortgage rescue scheme was set to open in January; she wants to bring the opening date forward as quickly as possible, and I commend her for that.
The mortgage rescue scheme will be firmly targeted on families with dependent children, the elderly and vulnerable groups who can no longer afford their repayments and who would be eligible for homelessness assistance if their homes were repossessed. My officials have also been holding a series of mortgage repossession summits for local authorities around the country, to discuss the regional position and to consult people on how the mortgage rescue scheme will work. I understand that the London summit will take place this Thursday, and we hope that officials will be back in the capital at the end of the month to host a delivery briefing, to outline how the scheme could operate.
I would also stress that lenders are examining further options to assist households that are due to experience payment shocks and concerns in the coming months, and we continue to work closely with the Council of Mortgage Lenders and other partners to achieve that aim. The Government, particularly my right hon. Friend the Chief Secretary to the Treasury, have been talking very forcefully to lenders about this issue and encouraging them to ensure that they do not go straight to repossessions and that other measures are put in place; the same aim was behind the interest rate cut last week.
I am very conscious of time. It has been an excellent debate that, unfortunately, we will need to have time and again. However, I hope that I have demonstrated that the Government are committed to improving housing supply.
11 am
Hugh Bayley (in the Chair): Order. I invite colleagues to join me in observing the two-minute silence.
A two-minute silence was observed.
Assisted Dying
11.2 am
Hugh Bayley (in the Chair): Thank you. Before I call Dr. Evan Harris to open the debate, I should inform the Chamber that he has requested that Mr. Speaker exercise his discretion to waive the House’s sub judice rule to enable reference to be made to the case of Miss Debbie Purdy, which is currently under appeal. The Speaker is willing to exercise his discretion to enable reference to be made to the Purdy case for the purpose of discussing the principles that it raises. Members should not, however, discuss the details of the case.
A large number of hon. Members are present, some of whom have written in. I shall try to strike a balance between the parties and between points of view. If colleagues seek to catch my eye and have not already written in, they might like to send me a note briefly explaining their point of view.
11.3 am
Dr. Evan Harris (Oxford, West and Abingdon) (LD): Thank you for that statement, Mr. Bayley. It is a pleasure to have you in the Chair.
Many hon. Members wish to speak. I intend to take 10 minutes, but if there are interventions, which I am willing to take, that will lengthen my time a little. However, I shall try to curtail my remarks. This is the first time in 10 years that the issue has been debated, but I do not intend to cover everything that could be said on it. The subject raises strong feelings on both sides of the House, across parties, in the media and among the public, and it is only right that Parliament should debate it and be seen to debate it.
It is right that the legislature should be seen to keep such things under consideration, and I hope that there can be a review—more active consideration than mere debate—and that the House will be allowed to come to a view on the matter at some point, as it is unlikely to be easily subject to manifesto commitments or party Whips.
I want to make it clear that although I have been an elected member of the British Medical Association medical ethics committee for many years, I am not speaking on its behalf. I am grateful to Dignity in Dying for its briefing material.
David Taylor (North-West Leicestershire) (Lab/Co-op): No doubt the hon. Gentleman would care to clarify that the majority of doctors were, when last asked, opposed to the legalisation of assisted suicide. All the medical royal colleges and the BMA have declared their opposition to it after extensive consultation with their members. He has rightly declared his connections, but will he acknowledge that he is probably in the minority of clinicians in the views that he holds?
Dr. Harris: I have never been of the view that what doctors say goes, and I do not believe that I am in a minority. If the question is asked fairly and properly, it is far from clear that there is not majority support in the medical profession for giving people autonomy, with safeguards, of course, over end-of-life decisions. The benign conspiracy in which many doctors sometimes participate for paternalistic reasons is, in this case, far worse than making clear arrangements, with safeguards, to enable patients to have more autonomy.
This morning, we heard about the very sad case of a 13-year-old girl who says that she wishes to die with dignity at home. There is a life-preserving operation with a good chance of success that she could have, and, as far as we know, she is not in pain or suffering. Doctors say that if she had that treatment she would not be liable to die very soon. Even in that difficult case and even though she is not strictly terminally ill or in unbearable pain and suffering, she has been allowed autonomy over that decision. She is entitled to do that at the age of 13, and the situation is even more clear-cut for adults. They can refuse treatment when not terminally ill, when not in pain and suffering and when that refusal will cause their death.
If someone wishes to be actively helped to die, they cannot get that help in this country under the law, even when there is no doubt about their capacity. That is true even when it has been checked that there has been no coercion, when they are terminally ill and when they are suffering. They might not be suffering from pain, with modern palliative care, but they might still be suffering unbearably, in their view. The difference between the treatment of those two cases, when the outcome is the same, is so extreme that it cannot be justified.
Mr. Andrew Smith (Oxford, East) (Lab): I am grateful to my neighbour from Oxford for giving way. I am sure that we can all understand the sensitivity of the case to which he has referred, but does he not accept, as I think most of the public do, that there is an important difference between not intervening artificially to prolong life and actively intervening to shorten it?
Dr. Harris: Of course I accept that there is a difference, but it is not so great that autonomy should be taken away completely in one situation and respected absolutely in the other. The end result is the same, and the wish is the same; it is only the activity or passivity that is different. It is not right that we should defend forcing someone to be kept alive against their will simply on the basis that assisted dying involves an act—their own act, in most cases—rather than simple refusal. I do recognise that there is a difference though.
On the current law, the Suicide Act dates from 1961, and is in need of revision. Assisting someone to die is punishable by a maximum penalty of 14 years’ imprisonment, but such a punishment would be inappropriate in the sort of case that we are discussing. We all know of examples of people who are seeking help to die, and that is different from assisted suicide. The hon. Member for Bridgend (Mrs. Moon), who is present, knows that we are not talking about assisted suicide. Assisted dying is for people who want to live, not for people who want to die, as with assisted suicide. I have no difficulty with the current law criminalising assisted suicide when people are suicidal and are helped through websites or indirectly. I hope that she will have the chance to acknowledge that point later.
In the case of Debbie Purdy, although the court recognised the argument that the current situation was unsatisfactory, it specified that it was for Parliament to change the position. Parliament should examine the 1961 Act. It is not the case that the law ain’t broke, so we shouldn’t fix it. We cannot say that, and I shall give examples of the negative consequences when terminally ill people are forced to look for alternatives to exercise control over the manner and timing of their death when they feel that their suffering has become unbearable.
Figures suggest that 16 British citizens travel to Dignitas each year. The Home Office has identified about four cases of so-called mercy killings each year, which is probably a small fraction of the real number, as they often never reach the courts. Each year, a number of terminally ill people resort in desperation to violent and often botched suicides, and a number of people find that they have to refuse food and water to exercise control over their time and manner of death. They use their ability to refuse treatment because the fairest and most humane way of exercising control is not available to them. More than 900 people a year receive assistance in dying from their doctor, on their explicit request. They are forced to get illegal assistance to die, and the consequences of that can be severe not only on the manner of their dying but on those who seek to help them.
Dr. Julian Lewis (New Forest, East) (Con): Will the hon. Gentleman tell us how many people who have assisted others to commit suicide have actually suffered a term of imprisonment, suspended or otherwise?
Dr. Harris: Did the hon. Gentleman say “assisted suicide” or “assisted death”? I assume that he is talking about assisted dying.
Dr. Lewis: If the hon. Gentleman wishes to quibble about the point, I am speaking in the context of what he is discussing. Will he answer my substantive question? How many people who assisted that which he wants them to be able to assist without consequence suffered a term of imprisonment, either actual or suspended?
Dr. Harris: I do not know the answer to that question, but—
Dr. Lewis: I suspect that it is zero.
Dr. Harris: But I do not know whether the hon. Gentleman is happy that people are doing that and not being imprisoned, or whether he thinks that it is bad that people are not being punished for what is strictly an offence. Not knowing whether they are liable to be prosecuted and imprisoned is a traumatic experience for many, particularly the recently bereaved.
The Parliamentary Under-Secretary of State for Justice (Maria Eagle): I can give the Chamber the opportunity to hear the answer to the question asked by the hon. Member for New Forest, East (Dr. Lewis), which is zero.
Dr. Harris: The Minister must be asked the same question, then. Is it a good thing that people are apparently breaking the law but not being imprisoned, and perhaps not even prosecuted? Either way, we ought to have a law that says what it means and means what it says, rather than making people feel that they have to take a chance. Some think that they cannot take that chance, so they are unable to give or receive assistance.
There is not a choice between palliative care and assisted dying. Everyone recognises that palliative care is an important part of end-of-life care, and the suggestions for legislation on assisted dying have included palliative care. However, it is a form of treatment, and at some point a person is entitled to say that they are fully
palliated as far as medical and nursing care can provide for, and that they do not wish to have any further palliation as an alternative to a dignified death. It is not for us to impose on them our view that they must be satisfied with the palliative care that they get. In jurisdictions where there is assisted dying, there has been an increase in the provision of palliative care, and rightly so. In Oregon there is no perceived conflict between the two.
I shall give some examples of the difficulties that people face in knowing what will happen to them if they assist someone with death. As we know, Dignitas helps people with incurable illnesses to die, and it regularly features in the British media. We understand that 650 British citizens are members of Dignitas, and more than 100 have travelled to Switzerland to have an assisted death since October 2002. I wish to mention the case of Reg Crew, who had motor neurone disease. His wife Win Crew and their daughter Jan Healey accompanied him to Dignitas when he died in January 2003. His wife Win has written:
“Although I am a Roman Catholic, like many others in my position, when Reg said he wanted medical assistance to die, to avoid a long and painful death, I felt this was the right thing to do. I agreed with him that the disease should not rob him of the ability to choose the manner of his inevitable death...For several months after my return, I had the threat of legal action hanging over me but what alternative was there?”
The problem with the current state of the law for people in that situation is that they fear legal consequences for their loved ones on return to the UK. That is cruel. A lack of legal certainty about prosecuting those who accompany loved ones to Dignitas leads some terminally ill people to travel to Switzerland all by themselves, and as a consequence to go earlier than they would have liked. It forces people to make that decision while they are still able to make it themselves and do not need assistance. They are forced to die in a foreign country, away from familiar surroundings and in some cases without their loved ones.
The second example is mercy killing. Under current law, anyone who ends the life of another can be convicted of murder and receive a life sentence, even if the act is a compassionate response to a dying person’s request for help to die—a so-called mercy killing. Despite the risk of a murder conviction, a number of people who resort to mercy killing regard it as the final act of love towards a loved one who is dying and requests help to die. Home Office records show that in the past 15 years, a total of 57 suspects in homicide cases could be described as being involved in mercy killings. Again, that probably represents a small fraction of the true number.
The impact of that is, again, very negative. There is obviously a risk of imprisonment, long drawn-out trials and public labelling. People who have committed an act of mercy killing often also suffer long-term effects on their mental health, which can lead to self-harm or even suicide. A Home Office report states that of the 57 suspects of the act of mercy killing, 21 have committed suicide.
With no clear policy in place, people may claim to have committed a mercy killing or assisted a suicide for compassionate reasons, when in fact their motives were more sinister or selfish. We do not have a law that provides safeguards. Mercy killing is clearly not the answer, nor is the status quo, so we have to recognise what is happening and consider what can be done to avoid the all-round negative consequences.
Violent or botched suicides are another consequence of the current law. People take the act into their own hands and attempt suicide, which can lead to long drawn-out and painful deaths. It is impossible to calculate the number of such cases, but examples are known. My final example is Sue, who has said about her terminally ill father’s attempt to commit suicide:
“My father had prostate cancer. At some point there was nothing more doctors could do. My Dad sadly experienced how the laws in this country operate. He threw himself down the stairs in an attempt to kill himself. It didn’t work, but the doctor left him there as long as he could, waiting to see if he might die. This is how the law forces doctors to abandon their patients. My father was left at the bottom of the stairs for two hours with a cut on his head. Eventually he died a week later at home.”
As a consequence of the law, people are sometimes forced to die a lonely death in the absence of their loved ones, out of fear of the legal consequences for anyone they ask to be present at the time of their death.
As it is illegal for anyone to help another person to die, some people choose to commit suicide while they are still able to do so. Again, that may mean that they die earlier than they would wish. Authorities in Oregon are aware of 94 terminally ill people who were prevented from committing violent suicide because the option of assisted dying was available to them, and 50 of them went on to die a natural death. I do not have time to go into the case of people who refuse food and water, but again it means a more protracted death than the painless one that is available through assisted dying.
Peter Bottomley (Worthing, West) (Con): The hon. Gentleman is helping the House and the country by talking about death in a way that is not embarrassed or afraid. Can he give the number of people in the Netherlands who have had death brought on early by request, and compare it with the overall suicide rate?
Dr. Harris: I think those figures are available and if the hon. Gentleman will allow me, I will try to come back to that later, because I do not have them to hand.
Finally, I want to say a word about doctors helping their patients to die and about the review of the murder laws. We know that there are occurrences of involuntary euthanasia, where doctors help patients to die without their wish, and of voluntary euthanasia, which is the patient’s wish. I shall quote from a research paper by C. Seale, “National survey of end-of-life decisions made by UK medical practitioners”, in Palliative Medicine 2006, volume 20. On pages 3 to 10 it shows that
“of all the deaths in the UK in 2004, 0.16 per cent. were cases of doctors ending life following an explicit request from the patient”.
That means, in broad figures, that 936 deaths were a consequence of patients receiving assistance in dying from their doctor on their request. Such assistance is given outside any legal framework and without any safeguards. We know that assisted dying is taking place at the moment and it would be far better, as has been done in other jurisdictions, to put it on a legal footing, with whatever safeguards the House feels are appropriate. If people are worried about the protection of the vulnerable—I understand that concern—the answer is to have the safeguards in place. It is not a question of the principle of providing for autonomy.
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