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Lord Phillips of Sudbury: My Lords, I am most grateful to the noble Lord for giving way. I hope that my comment will be short and helpful. Is not the case even worse than he says? He referred to the attending physician as the family doctor. He may or may not be the family doctor. If the attending physician to whom the person first goes—the family doctor—is by reason of conscientiousness unwilling to contemplate the measure, the person will be passed to another doctor who will consider the matter. He or she will not be a family doctor or know anything about the

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antecedents, background or family of the person concerned. I seek to be helpful to the noble Lord. I think that the position is worse than he indicated.

Lord Neill of Bladen: My Lords, I am grateful to the noble Lord for his intervention. I believe that I can claim the privilege of being the first Peer who has spoken who has caused any intervention to be made. That is a first for the day. I had taken the definition of the physician who has the primary responsibility for the care of the patient as being in the ordinary way the family doctor. I entirely take the point that he might refuse, on conscientious grounds, to have anything to do with it. It would then be another, new primary-responsibility doctor, and a second doctor as a consulting physician.

If one considers the wording of the Bill—this is not the occasion for that—I am surprised that none of the right reverend Prelates has focused on the words that it is the duty of the first doctor to explain to the patient the process and probable consequences of being assisted to die.

The Lord Bishop of Portsmouth: My Lords, perhaps we are assuming that people might realise that.

Lord Neill of Bladen: My Lords, I make a short point. Although in some conditions and possibly in many cases the Bill could confer great benefits, it has within it the tendency to be disruptive in society, damaging to the medical profession and damaging to families and victims.

3.57 p.m.

Lord Bridges: My Lords, I do not expect to detain your Lordships for long. I do not object to the purposes of the Bill but I have some doubts about some of the detail. I should like to draw attention to what I believe to be a significant lacuna in the Bill in relation to safeguards.

It is not surprising that the Bill focuses on the role of doctors attending a patient. The role of the attending physician as proposed in the schedule is critical. I have no objection to that, as from my limited experience the medical profession has behaved with exemplary care and good judgment in dealing with patients with terminal illness. Its guiding thought seems to have been as recommended in the well-known lines of the poem by Arthur Hugh Clough:

    "Thou shalt not kill, but need not strive,

officiously to keep alive".

However, the Bill goes a good deal further than that. I was interested to hear members of the panel of distinguished doctors who spoke recently to a number of us in the Moses Room refer to what they called the "slippery slope"—a phrase mentioned by a number of noble Lords—which the Bill would create. Evidently many doctors are uneasy about the procedure proposed.

The lacuna is different. In the passage of one generation to another, the intentions of a testator in disposing of his or her property are very important. As

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the noble Baroness, Lady Cumberlege, said, where there is a will there is a relative. I suggest that where there is no will there are several relatives. The beneficiaries under a will may well have different interests and intentions and that may have a bearing on their attitude to assisted dying. The Bill says nothing about this. The proposed declaration does have a role for a solicitor but that is largely formal. It does not make provision for a situation in which family members may have a disagreement about the assisted death or the consequences of such a death and the distribution of assets following it. The schedule does not even provide for a solicitor to confirm that the patient has made a valid will. I am uneasy about that lacuna, as it is a gap in the procedure. It could be filled in a number of ways, possibly by including a reference to the Court of Protection in certain circumstances. Incidentally, that court was mentioned in the earlier report from the Select Committee on Medical Ethics. The family division of the High Court might be consulted, although that is of course a much more expensive procedure.

Like others, I assumed that it might be difficult for this Bill to complete its parliamentary process in the lifetime of this Session. The noble Lord, Lord Joffe, will no doubt consider the advice that he has been gratuitously given by a number of us, in good faith, and notably by the noble Baroness, Lady Jay, that a Select Committee might be invited to review the report of the last Select Committee on this subject and might make a recommendation in the light of the comments made in this debate. If he quails at the thought of such endeavours, perhaps I could remind him of another well-known line by Arthur Hugh Clough,

    "Say not the struggle naught availeth".

4.1 p.m.

Baroness Wilkins: My Lords, I am grateful to the noble Lord, Lord Joffe, for his openness in seeking out the views of disabled people and for meeting me with Jane Campbell. Sadly we failed to persuade him with our arguments. I have just had a message from the right reverend Prelate the Bishop of Liverpool, who is confronting cancer, as noble Lords will know. He has e-mailed to say how deeply affected he was by Jane Campbell's letter and wanted to express his outright opposition to the Bill.

I, too, am deeply opposed to this Bill, and want to add my voice to that of the Disability Rights Commission, Disability Awareness in Action and the many, many disabled people whose letters have filled our mailboxes expressing their fears. I oppose the Bill because I believe that the legalisation of assisted suicide is a threshold that we cannot cross without deeply damaging our society. Once we accept assisted suicide, the way is open to a gradual and insidious devaluation of the worth of all people, however sick, deformed or imperfect we might be. It is not possible to provide sufficient safeguards to protect the thousands of vulnerable people—sick, elderly and severely disabled people—from all the overt or hidden pressures to end their lives.

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We downplay the slippery slope argument at our peril. On the face of it, the provisions of this Bill appear utterly humane. We all fear the manner of our dying and want to protect ourselves and those we love. No wonder the Voluntary Euthanasia Society can quote such high percentages of people in support of the Bill. But once you give society the legal right to start tidying up the things that we find deeply distressing, the pressure begins to build in our own minds and those of others. "I want to end his suffering" too easily masks "I want to end my suffering". Society's attitude begins to change towards the value of life and, as we have heard so powerfully expressed by my noble friend Lady Howells and others, the most vulnerable in our society will be put at risk.

As human beings we have pitifully poor imagination in putting ourselves in the shoes of others. We can see someone who is severely disabled and think, "I couldn't bear to live like that—I'd rather be dead". Maybe one must experience the gulf that exists between the reality of life as a disabled person and the perception of disability as suffering and tragedy, before one can begin truly to appreciate how dangerous current attitudes to the quality of our lives can be. Noble Lords should not dismiss the fears that disabled people have expressed in their letters, or comfort themselves with the thought that the Bill is not about those people. Its immediate provisions may not be but, once assisted suicide is legalised, severely disabled people know that their hold on the right to life would he weakened, that their lives would be too easily judged as not worth living and that there is no stopping place on that slippery slope.

Disabled people have yet to win a right to live equal lives in this society. There is widespread discrimination, endemic in every part of our society. Services to support disabled people to have lives of acceptable quality with dignity and independence are severely rationed. Although the Bill is presented as a humane measure, it could prove an unbearable pressure on terminally ill and older disabled people to choose death in a society where they are made to feel inferior and a burden on relatives, on their carers and on public resources.

It has been argued that there are strong safeguards in the Bill to prevent abuse. However, as the Disability Rights Commission has pointed out, it has yet to find any country that has managed to frame a law that allows assisted suicide or voluntary euthanasia for people with terminal illnesses while ensuring that disabled people are protected from coercion, pressure and involuntary euthanasia.

The Bill certainly has many flaws. The definition of "unbearable suffering" is one. Often the unbearable suffering is due to the lack of palliative care and, while the Bill requires the physician to offer this option, there is no guarantee that it will be available. Are we really proposing to offer assisted suicide and euthanasia because of lack of resources? Noble Lords beware the lesson of the "comfort care" Medicaid package in Oregon, which can enable people to secure resources for assisted suicide but not for treatment and services. The lack of suitable social services in this

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country to enable people to end their days with dignity is no reason for offering assisted suicide. The solution must be to improve provision.

One of the most worrying flaws in the Bill is the definition of informed consent. The Bill as a whole does not recognise the context in which decisions are made. If someone believes they will be a burden and if they have no access to services that will enable them to live with dignity, then any choice they make to die is not a true choice. There is no provision in the Bill for independent advocacy or help with communication. Doctors are certainly not equipped to provide unbiased information and effective choice. Research over the years has shown repeatedly how negatively medical professionals view disabled people and the value of our lives. The recent judgment by Judge Dame Elizabeth Butler-Sloss is but one example: a hospital had denied a man with kidney failure life-saving treatment, purely because he had autism. Parents are told that the possibility of having a disabled child is unfair on the child and that they will have a life of pain and suffering. There is considerable evidence of putting the "do not resuscitate" notices on disabled people without any consultation of their wishes.

Those are but two of the concerns with the detail of the Bill which has striven to safeguard against abuse. I believe that no Bill can be framed with sufficient safeguards. If we cross this threshold of legalising assisted suicide and euthanasia we will create a change in society's attitude to the value of life and of all those who can be seen as a burden on others. The Disability Rights Commission said:

    "Until disabled people are treated equally, their lives accorded the same value as the lives of non-disabled people, their access to necessary services guaranteed, their social and economic opportunities equal to those of non-disabled people—then the 'right to die' will jeopardise people's right to live".

I urge your Lordships' House not to allow this Bill to pass.

4.8 p.m.

Baroness Flather: My Lords, I should like to congratulate the noble Lord, Lord Joffe, and express my admiration for him for the brave and timely introduction of this legislation. It is a very difficult subject, as we have seen. It also affects all of us, as we have seen from the number of speakers. It has also been the most incredibly thought-provoking debate. I have not heard such a thought-provoking debate in this Chamber for a very long time. I thank him.

One of the reasons why we are so interested in the subject is that we all anticipate the end of our lives. I see many other noble Lords who, like me, are entering the fifth bit of their life. We are coming closer to the point where some of the provisions may affect us very personally. I was a member of the Select Committee and had problems then with the double effect. I am grateful to the noble Lord, Lord Plant, and to one or two other speakers who have taken up that issue and put it into perspective.

I was also at the consultation on euthanasia at St George's House, in Windsor Castle. I am not in favour of a second Select Committee in any event as I do not

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think that a Select Committee would give us very clear indicators. Usually a good chairman manages to smooth the rough edges and bring the members into some sort of consensus. That is what happened at the last Select Committee. Those who know the noble Lord, Lord Walton, will know that he is very good at that. So for that reason, and also because of the delay, I would not suggest a second Select Committee. However, I should like to see much more clearly defined and objective research into exactly what is happening and in order to discover the views of doctors and patients. What we have heard so far has been orchestrated by interest groups. I should like to have some objective evidence of what people feel on the subject.

I am a Hindu and was brought up as a Hindu. I do not know whether it is the same in the Christian tradition, but for us Hindus death is very much a part of life. We live with it from the very beginning. We are taught not to fear death. I like to think that I do not fear death. In fact, I do not fear death. However, I do fear what is known as a bad death. I think that that is what we are talking about today. We are not talking about getting rid of vulnerable people. I am saddened to hear so much talk about "getting rid" of people we do not want. An awful lot of us would be got rid of if that happened. Perhaps we could start with the politicians. This is not really about vulnerable people. If there is a voluntary decision, that would absolutely presuppose a person's ability to make some kind of a decision. If a person cannot make a decision for whatever reason, he could not apply. That is how I understand the Bill. I should like to think that others understand it that way too.

We have heard that patients will feel they are a burden. Some already feel that way. Very many patients feel that they are a burden to their family. It is either up to the families—the loving, caring families, or the non-loving, caring families—to make them feel better, or up to the doctors to tell the families to clear off.

We have also heard about wills and inheritance. However, such cases already arise. People moan and groan about the fees they are paying and wait for their elderly relatives to die. What is the difference between the situation now and the situation if assisted suicide were permitted? It is more likely that such a patient would be "taken care of" now. If no one is watching over him or her, the relatives might try to "take care of" him or her. It is more likely to be her as we women outlive the chaps to such an extent. I am not sure that that is a factor in my equation.

Time is passing quickly. I turn to religious views. I was grateful to the noble Baroness, Lady Richardson of Calow, who came to a different conclusion although from the same starting points. That gave us an opportunity to see the two sides of the argument. I say to the right reverend Prelate the Bishop of St Albans that I hope that I shall find the peace he mentioned when I am in extremis, but I have my doubts.

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The noble Lord, Lord Alexander of Weedon, was right to say that we should not decide what others should do on the basis of our own moral background. It is very important that this matter should be free of that kind of constraint.

I do not believe that the Bill attacks the disabled. I have a disabled husband, whom many noble Lords know. I have lived with disability on a personal level. Once you are close to disability or to a disabled person, you become very aware of all the issues that surround disability. For the first 10 years I was my husband's sole carer but as he became more disabled and I became older we have had to rely on outside care. But I say honestly that if he were suffering unbearably and he asked me to help him in the way that we are discussing, I would do so. I would risk being sent to prison. I would give my husband that help not because he is vulnerable but because I love him.

The doctor-patient relationship might be under strain even now because doctors cannot perform the very profound and important service for their patients that we are discussing. Would they feel happier if they could see their patients being taken out of suffering? It remains to be seen how that would develop. As such a situation does not exist here, we can only look to the experience of the Netherlands. If one is to believe what the noble Lord, Lord Taverne, said, things are changing there. When I served on the Select Committee my noble friend Lord McColl went to the Netherlands to examine the situation there. At that time the situation there was not very satisfactory. However, I am told that the position is improving and I have heard much in that regard from invited guests.

Why is there a thread running through the debate that somehow it will become compulsory to commit suicide, or it will become compulsory for doctors to offer suicide as part of the care package? That will not be the case. I say when in doubt, do not do it. It is very simple. It is like the button on your television set. If you do not like the programme, change it. Do not grumble about a programme, just change it. Autonomy does not mean that someone will approach you and give you a lethal injection.

We have the narrowest of windows. We must start thinking about the fact that we are living and living and living. Sooner or later we shall have to consider this issue. In the past few years life has been prolonged enormously, but the quality of life and the control of some diseases has not improved with that. If we do not get our act together on palliative care, euthanasia will occur because more and more people will not want to hang about. This is a wake-up call to those who provide palliative care. They must ensure that everyone is looked after to the point where they do not seek assisted suicide. I leave noble Lords with that thought.

I support the Bill as I should like the opportunity it offers for myself. I hope that everyone who does not support it will put their hand on their heart and say, "I do not want this for myself but I have heard other views expressed". Peace in the future is what we seek—peace in our dying and peace of mind. That is all that we ask for.

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4.19 p.m.

Lord Tombs: My Lords, I want to explain briefly why I oppose the Bill despite the obvious good intentions of its supporters and the undoubted fact that the suffering of loved ones is heartbreaking and a desire to avoid it entirely understandable.

But the deliberate taking of human life has been forbidden for centuries and is enshrined for Christians in the sixth commandment, "Thou shalt not kill". That special regard for human life is not restricted to Christians; on the contrary it is shared by most established religions and it forms an essential part of our legal system and of our way of life. To remove it would risk damaging the entire fabric of society and would be likely to have consequences reaching far beyond the intentions of the Bill.

Many people suffer greatly, and not only those in the throes of terminal illness. But it should be noted that associations that represent the aged and the disabled do not support the Bill. The reason is not difficult to see. The vulnerable feel threatened by the power of others to control their very existence. The safeguards written into the Bill are well intended, but there is ample evidence from abroad that voluntary euthanasia can easily become involuntary under the pressure of dependence on others and the feeling that sick people are imposing an unjustified burden on others and perhaps on the welfare system.

The medical profession seems to have little doubt of that and of the damage that voluntary euthanasia would do to the doctor-patient relationship of trust. It is overwhelmingly opposed to the Bill.

I digress briefly to comment on the observation made by several noble Lords that a point in favour of the Bill is that a minority of doctors who practise euthanasia would thereby be excluded from the criminal law. That seems an extraordinary proposition, because most laws are broken by a minority of people. If the argument were to be followed to its logical conclusion, we could dismantle the entire criminal justice system, which is not an objective. The law surely establishes for most law-abiding people an acceptable set of standards and a framework of behaviour. It is much more profitable to regard it in that light than in that of criminal sanction.

In seeking to relieve the suffering of terminally ill patients who request assisted suicide, we are likely to create a whole range of different problems with wholly unintended consequences. Innocent, vulnerable people would be pressured and exploited by societal norms and expectations.

The unpalatable fact is that hard cases make bad law. The laudable goal of removing suffering from the human condition is unachievable and carries a real risk of abuse. There is no set of measures that will insulate human beings from suffering and sorrow. That has been the lot of humankind through the ages and the only real difference today is that pain management and palliative care are better than they have ever been. I hope, for the sake of society at large, that the Bill will not survive.

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4.23 p.m

Baroness Prashar: My Lords, I will begin by quoting a letter that I received in support of the Bill. We have all received a number of letters, but this one summed up a very good point. The letter said:

    "This Bill means a great deal to me because I have a severe form of multiple sclerosis. In spite of the doctor's best efforts, the attacks are painful, but, even so, I don't want to die now. I do, however, want the assurance of being able to exercise my own wishes over how I die, if things deteriorate to a point where life becomes intolerable. This disease could leave me stuck in a nursing home or hospice, slowly dying whilst enduring things you would not put your worst enemy through. Pain is not the only concern that I have. It is the indignity of absolute physical deterioration. I only want the choice for myself and totally respect the views of other sufferers who want medical science to prolong their lives as long as possible. However, unless this Bill becomes law, my own wishes in respect of my own life will be ignored".

The letter sums up admirably what the Bill is attempting to achieve; that is, to give choice to those who wish to decide when to end their life. This very specific and narrowly defined Bill would provide the means of ensuring that that takes place at their express and well-considered wish, and provide the means for proper safeguards and public scrutiny.

As the debate has illustrated, and as we all recognise, this is not an easy issue. We have all agonised. It involves moral, ethical, religious and, of course, many practical issues.

That brings into very sharp focus two value systems: one involves the issues of individual autonomy, liberty, choice and dignity, and the other involves religious beliefs in the sanctity of life and a redemptive view of suffering. Both of those views must be respected. However, those who want autonomy and self-determination currently do not have that choice. One is looking not for unlimited choice but for choice within the framework of law.

The Joint Committee on Human Rights, of which I am a member, concluded, as we have already heard, that the safeguards in the Bill will be adequate to protect the interests and rights of vulnerable patients and ensure that no one could be subjected to assisted dying unlawfully without their fully informed consent. The Bill therefore does not interfere with the beliefs in the sanctity of life or redemption through suffering. It provides choice for those with a different view.

I turn briefly to other arguments that have been advanced by those who oppose the Bill. I recognise that the concerns expressed by those with disabilities—that the legislation would reinforce negative attitudes and that the quality of life of people with disabilities would not be valued—cannot be dismissed lightly. However, we must recognise that those concerns are symptomatic of the general inequality and lack of fair treatment that they face. Apart from the safeguards in the Bill as a practical way of protecting the vulnerable, the point that must be made strongly is that as a society we must make greater efforts to ensure that fair and equal treatment exists for all vulnerable groups. We must do everything in our power to ensure that their human rights are protected. That is a wider societal responsibility. That is what I will look for in terms of

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the common good. It is the common good in terms of a fair and equal society but not a reason for not extending the choice of those who wish to die.

I was saddened by the comments this morning of the noble Baroness, Lady Howells, about institutional racism. I recognise that there is racism in society. I have spent most of my career fighting racism. However, to say that the Bill would lead to undue killing or assisted dying of people from minorities is a step too far. We must obviously ensure that there are safeguards but the statement that the Bill would lead to further discrimination should be challenged.

Another argument is that we need better palliative care and that the legislation would impact on such care. As other noble Lords have said, we need palliative care; that is not a question of either/or. The right to ask for medical help to die is one of the options in the range of palliative care procedures. As other noble Lords said, we need better provision for palliative care. Pain control is not the only issue in that regard; there is also the question of being protected from the indignity, humiliation, fear and loneliness that many feel in the final stages of terminal illness. No amount of palliative care can address concerns regarding one's loss of autonomy or control of one's bodily functions.

Finally, the present situation is unsatisfactory because the absence of a law that would allow terminally ill people to ask for and receive medical help to die leaves the courts having to tackle mercy killings without an adequate frame of reference. That results in a real lack of public control regarding assisted dying and leaves the vulnerable unprotected. I believe that it would be better to have a legal system that would enable terminally ill people to be able to ask for medical help to die within strict safeguards, so that any instance of assisted dying outside legislation would be far more rigorously scrutinised and the criminal law applied consistently and appropriately.

To conclude, the Bill is about recognising that the rights of those who wish to exercise their choice within a framework of law is a better alternative to the current unsatisfactory situation. But as this debate has illustrated, there are a number of issues at a practical level which need to be considered further. I was attracted by the recommendation of the noble Baroness, Lady Jay, for a Select Committee to consider the issues further. I very much hope that the Government will not close this debate but begin to consider some of the issues raised.

4.30 p.m.

The Earl of Arran: My Lords, and so the argument sways back and forth. As expected, many of your Lordships who have so far supported the Bill have recounted their own very personal and at times intimate experiences of relations and friends who have suffered appallingly towards the end of their lives. I, too, share similar experiences with close members of my family, and in doing so it cannot but fail to make the most scarring and unforgettable impact on one's memory.

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The circumstances surrounding the Bill remind me somewhat of that hugely controversial piece of legislation passed in 1967: the Bill to legalise homosexuality between two consenting males, the Private Member's Bill introduced into your Lordships' House by my father—a Bill that at that time besides the Church and the medical profession, many noble Lords found profoundly offensive and distasteful. That was a Bill perhaps before its time but the analogy between that Bill and this is that it needed immense moral courage, conviction and commitment to get it on to the statute book. So, the noble Lord, Lord Joffe, likewise with this Bill, will need similar determination. I congratulate him on introducing the Bill today. It, too, may be before its time; we shall see. But because of the apparent overwhelming public support for a Bill of this kind—some 82 per cent according to a public attitude survey—it will, I am sure, be placed on the statute book in due course.

Having listened carefully to many points of view so far expressed today, it is plain that the lines of disagreement, contention and conviction are pretty tightly drawn. I detect very little give on either side. The Church, particularly the Catholic Church, and the BMA to mention but two, are strongly against the Bill. But I would just gently point out to those two great ethical edifices that most of us who are in sympathy with the Bill are also Christians and patients.

However, I believe there to be tacit respect and understanding by each side for the other, certainly for the Church, who would confound and astonish me if they were to take any other line. For the doctors, too, it must be difficult as it is alleged that there already exists assistance to help the patient to die. Indeed, if there were to be legislation, apart from all else it could be seen as offensive and, indeed, contravening the Hippocratic oath.

It really comes down to what each of us personally believes; what each of us really feels strongly about; and what our own personal and moral convictions are both as a Christian and a patient, not sheltering behind a great organisation of which we may be a prominent member fearful of upsetting its membership. We have been bombarded today by statistics of all sorts from all sides. As always with statistics there is no clear winner, but the Bill is not about winning; it is far more serious than that. As I said, it is about deeply held personal convictions of a very private nature, the last wish of a living soul.

Like all noble Lords, I have received many letters, some of which contend that the Bill would put elderly and disabled members of society at great risk of abuse. Having considered the Bill and the current situation in this country, that concern appears unfounded on two accounts. First, from the medical surveys conducted in the United Kingdom it is clear that regardless of the current prohibition, medically-assisted dying already takes place but without regulation or reporting. Surely, does not the current lack of guidelines and transparency already put the elderly and disabled at risk?

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Secondly, I have also reviewed the 10 significant safeguards contained in the Bill. What becomes apparent is that they interrelate with each other throughout the process, ensuring a number of safeguards come into play at any one time. The result appears to be that it would be very difficult for someone to slip through the net. Indeed, that conclusion is echoed by the Joint Committee on Human Rights. I say no more as your Lordships have already pointed that out.

However, no doubt as the Bill passes through your Lordships' House, further amendments will be necessary to tighten these clauses since appropriate and doubly stringent safeguards are the fundamental key to the outcome of the Bill.

It seems strange that the elderly are depicted by opponents of the Bill as being vulnerable and therefore opposed to these proposals. I am of retirement age, as are many of my friends and colleagues and I would argue that we have grown stronger in mind and spirit as the years have passed. That view is shared—I am happy to say—by the majority of the Townswomen's Guild. Its 80,000 members are well known for their strength of spirit and conviction. Indeed, in 1997, it approved a Motion which called on Her Majesty's Government to legalise voluntary euthanasia. Like the members of that guild, who are often retired and sometimes disabled, I am fearful of how I depart this world and would like, in extremis, a choice of how that happens.

These views are well expressed by Sir Ludovic Kennedy when he wrote:

    "I have a dread of reaching a state when I die, inert and incontinent in bed, tubes in the nose and a drip-feed in the vein, all love of living gone and yet still forbidden final release".

After those very moving words, I add my own very simple ones:

    "Most of us will need assistance to enter into this world, some of us may need assistance to depart from it".

4.37 p.m.

Lord Chan: My Lords, I, too, thank the noble Lord, Lord Joffe, for introducing this very important Bill which focuses attention on the care of the terminally ill. As a member of the medical profession I have had to attend dying patients, which is an experience that is particularly painful when those patients are children.

None of us can doubt the deeply humane motives that led the noble Lord, Lord Joffe, to introduce the Bill. Even with a well-developed NHS there is, as the Royal College of Physicians described in its response to the Bill,

    "much unalleviated suffering associated with illness which is in many cases incurable and sometimes terminal".

The purpose of the Bill is,

    "to enable a competent adult suffering unbearably as a result of a terminal or a serious and progressive physical illness to receive medical help to die at his own considered and persistent request".

Like other noble Lords, I agree that the definition of "serious physical illness causing unbearable suffering"

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is much too broad. Most doctors will agree, and I am sure others will too, with the Royal College of Physicians that,

    "the greater part of medicine in developed countries is about caring for people with serious and progressive physical illness".

The Bill could lead to more than the 8,000 to 9,000 deaths resulting from its use as estimated by the noble Lord, Lord Joffe. Like the noble Lord, Lord Neill, I would concentrate on the consequences of the Bill on the family, the doctor-patient relationship and on the development of our health and social care services. It would lead to a subtle reduction of concern for the very old, the disabled and people suffering serious progressive illness in the minds of healthy and busy people who cannot find time to be carers of the vulnerable.

In the case of older people with serious, incurable and progressive physical illness, subtle pressure could be applied on the patient by family members who are no longer able to care for them. Instead of organising for them to access high-quality palliative care in a hospice, family members may imply that the patient could opt for assisted dying, or voluntary euthanasia.

It is also clear that palliative care is failing to reach all those who need it. My noble friend Lady Finlay said that 300,000 people who need palliative care are unable to access it. Management of pain, especially chronic pain, is of poor quality. Doctors in hospitals and primary care are not adequately trained to manage pain in patients with terminal and progressive illness. We need to include palliative care as a compulsory part of the training of medical students and doctors, whether in primary care or working in hospitals and hospices.

If the Bill were to become law, there would be little incentive to improve the training of doctors in the management of chronic pain, or to expand palliative care services. Many suffering patients with protracted illness and loss of basic ability to care for themselves would be offered assisted dying rather than access to high-quality palliative care that is holistic, going beyond pain control.

Economic expedience will also dictate the options offered to patients. If the Bill became law, its administration would require funding, and it is likely that the cost of assisted dying would come from the allocation for palliative care. That would further slow down the improvement and availability of palliative care.

If I may, I shall now comment on other cultures today. There, the presence at home of an older person with progressive illness is a source of strength for the family. The process of dying is an opportunity for relationships among family members and the patient to be improved. Children seem to have a positive effect on the mood of a dying adult; children also learn about death and the fear of death is removed because death is natural in that environment.

In conclusion, there will always be a gap between legislation and practice. The issue of assisted dying is much too important for it to be held hostage to the uncertainty of best implementation. So, for all those

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reasons, especially the relationship between patients and doctors, where doctors would be given new powers and responsibilities in assisting patients to die, and the need to prioritise palliative care and improve support for patients who are dying to be cared for at home with their family, I ask your Lordships to oppose the Bill.

4.43 p.m.

Lord Hughes of Woodside: My Lords, I support the noble Lord, Lord Joffe, and his Bill wholeheartedly. I repeat the Long Title of the Bill: it is a Bill to:

    "Enable a competent adult who is suffering unbearably as a result of a terminal or a serious and progressive physical illness to receive medical help to die at his own considered and persistent request".

I repeat:

    "at his own considered and persistent request".

There is not a shred of compulsion in the Bill. Far too many of the letters that I have received are written on the basis that the Bill brings in involuntary euthanasia. I have received plenty of letters that said, as did my good and noble friend Lord Ahmed about his grandmother, "I had an old granny. She lived for 10 years. If this Bill had been in existence, she would not have done". There is absolutely no foundation for such a leap in logic and judgment.

Let me make it clear. The Bill is not one of public policy. It does not say, "The state shall" do this, that or the other.

This is not a Bill dealing with a matter of social policy. It is not saying that we, the state, or we, society, shall decide who shall live and who shall die. It has nothing whatever to do with social policy. The Bill is a matter of individual right and individual choice. I respect individual right and I respect individual choice.

I have received a great number of letters from people of many religions—for example, from Christians and from Muslims—who have prayed in aid their own particular religious beliefs as to their opposition to this Bill. I respect that. They are entitled to do that. But they are not entitled to say to me that those who take a different view must bow to their will, their decisions and their faith. That is an arrogance which I hope that I do not carry forward.

I have been very saddened by a supposition stated in many of the letters that I have received and which has been repeated more than once in the Chamber today; I am very sad that my noble friends Lady Howells and Lady Wilkins and the noble Baroness, Lady Masham, should say, with absolute certainty, that this Bill is discriminatory against disabled people and people of race. I resent that assumption. I think that it is offensive. It has no validity in fact. It certainly does not appear anywhere in the Bill.

Of course I cannot understand directly the lives of disabled people. I cannot understand how they feel in relation to the undoubted society discrimination which they encounter. As a non-black person, I accept that I cannot understand directly the views of those who are black. I have some insight: my youngest daughter, who is adopted, is partly Jewish and partly

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West Indian. I have lived with her through different trials and tribulations, but that does not make me an expert. I have a great fear that the constant repetition that the Bill is discriminating and is threatening vulnerable people—such as the disabled and those of race—is suggesting to those who have not read it that there is some validity in that opinion.

We must take care as to how we pursue our objectives. I support every word said in this Chamber today about the lack of resources for vulnerable people—whether as a result of age, disability or race. Of course, we do not do enough. I support that we should do much more. But we should not pray in aid a lack of resources as a means of preventing the Bill from moving ahead and raising unnecessary fears. That is wrong. I hope that my noble friends will understand why I am so upset about it.

Another matter that disturbs me is the very low esteem that many of your Lordships have expressed for society at large, for the relatives of terminally ill people, and for the relatives of old people. Apparently, they are all waiting for this Bill to be passed so that they can all nudge their relatives to ask for assisted dying. I do not think that that is the case at all. To suggest that that is the case is a huge leap in logic of the wrong kind. As for leaps in logic of the wrong kind, I must say that some of the arguments about the role and thoughts of the medical profession beggar belief.

Despite other evidence, we are told that the medical profession is bitterly opposed to this Bill. We are told that the nursing profession is against this Bill. We are told that the social work profession is against this Bill. Seemingly, the passing of this Bill will unleash a huge reservoir—there is a big dam out there in the real world waiting for this Bill to be enacted; there will be a rush of doctors ready to administer involuntary euthanasia.

A noble Lord, who is not in his place, said that lucrative businesses will be set up by the medical profession on the back of this Bill. By and large, the standard of debate has been extremely high, but suggestions like that defy any logic whatsoever. Therefore I ask noble Lords to look at the Bill as it is. There is no attempt at compulsion; there is no attempt to bring in automatically involuntary euthanasia. It is simply not the case. The "slippery slope" argument is a very bad one and I wish that noble Lords would not use it.

I understand those who say that they are totally and utterly opposed to euthanasia on grounds of belief, religious or otherwise. But they should argue the case on the basis of the rights of the individual. I believe that the rights of the individual would be covered by this Bill. Huge safeguards have been put in place. I hesitate to say this in case it is misconstrued, as I am certainly prepared to look at further safeguards. However, the safeguards already in place are so powerful that there is a strong possibility that at the point when someone actually asks for assisted death under the terms of the Bill, by the time all the checks had been gone through, that person may very well no longer be with us. That is not an argument against the

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safeguards; I simply say that they are extremely strong. As I have said, if further safeguards are needed, then I would be prepared to look at them.

I finish on the proposal put by my noble friend Lady Jay whether it would be possible to set up another Select Committee to look at the matter. If another Select Committee considers the subject, it would take two or three years to go over all the arguments again, and I do not think that that would take us any further forward. Although I do not know whether it is feasible, it has been suggested to me outside the Chamber that a committee should be set up purely to consider the Bill and its functions. That might be a way of making progress; the Bill would then be considered in detail rather than there being another consideration of the generalities.

I support the Bill. I hope that I have replied faithfully explaining my views to those who have written to me. In my replies I have said that I believe they are mistaken over what has been said in the generated letters. People are entitled to generate letters, but as they are outside this House they do not understand the Bill. I hope that they will better understand it when they have read our debates. I hope that the Bill makes progress. If a Division is called, I shall certainly vote in favour of it.

4.52 p.m.

Viscount Craigavon: My Lords, in supporting the Bill put forward by my noble friend Lord Joffe, I echo his support for the work done by the hospice movement. Almost everyone who has spoken in the debate supports the marvellous contribution of the hospices. Having said that, however, I distinguish between the services they provide and the general philosophy that they appear to hold as a consensus regarding how we should proceed. I apologise for summing up this point rather briefly, but part of that philosophy seems to be that everything is so difficult to measure that we can never be certain of what we are doing. Therefore we should not do anything in terms of what the Bill might recommend. I apologise for being so brief in that summary.

The main point I wish to raise in such limited time is to seek to show how debate on this subject, including the debate on this Bill, has become very diverse and fragmented, and none the worse for that, I think. Any attempt to rely on what were the old certainties and the old formulae is almost certainly bound to fail. Over recent years the language we use in this area has changed, as has the way we view the doctor-patient relationship and the meaning of the words "life" and "death". That is a crucial point. For those who do not realise it, we attach different meanings to what is meant by "life" and "death", and that is perfectly justifiable. As the noble Lord, Lord Patel, pointed out, at the beginning of life, with which the noble Lord is concerned, many different definitions apply. If we do not appreciate that, then we shall be talking at cross purposes.

Contrary to what some speakers have said, I do not think that we should take as our starting point the 1994 House of Lords report on medical ethics. Two

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members of that committee have since changed their minds. We heard a good speech today from the noble Baroness, Lady Jay, while the other person to change her mind was my noble friend Lady Warnock. I hope that the House does not mind me also recalling—for those who remember her—the presence on that committee of the late Lady Llewellyn-Davies of Hastoe, whose views I agreed with.

The Government might justify any inaction by relying on the report as remaining a valid base-line from which to give the impression that we do not need to do anything else in the field. I draw attention to the sometimes large minorities in organisations that have correctly been reported as opposing the Bill. A considerable minority of BMA members support euthanasia. A quotation has been made today from a report by the Royal College of Physicians. Needless to say it is against the Bill, and one understands the reasons it gives in its intelligent and interesting analysis of the issues surrounding the Bill. As the noble Baroness, Lady Jay, and someone else quoted, there is at the back what might be called a minority report from the college's committee on ethical issues. Because it is so important I shall quote at some length. Paragraph 5.2 says:

    "There is no doubt whosoever that many individuals suffer appallingly, and that death for many people is protracted, undignified and agonising. It is, therefore, not enough to simply oppose the Bill without offering alternative suggestions. This is a problem that cannot be ignored, and it would be deeply unethical to walk away from it."

Next, and finally, there is a separate point in the same report:

    "Palliative care services—their quality, their availability—should be reviewed. In particular the (empirical) claim that palliative care services can always ensure a good death should be examined critically . . . If it does prove to be the case that, even where excellent palliative care services are available, a small minority of patients still experience unbearable, protracted suffering, then it would be reasonable to revisit the issue".

That is from the Royal College of Physicians. In The Times today there was a quote from the chair of the ethics forum of the Royal College of Nursing, who personally supported the Bill, although I acknowledge that the Royal College of Nursing does not. The point of such examples is that within all those organisations there is no monolithic agreement. There is a vibrant and active minority who are addressing the issues presented by the Bill.

Many of the letters that we have received originate from Christian or religious principles. A good part of the opposition to the Bill in this House is informed by such principles. I am delighted that those people's decisions and lives are so guided. However, those of us with other views have to continue to say that we do not wish our lives to be ruled by those principles and that we do not agree with the fundamental assumptions that are offered. I invite any correspondents, to whom I am afraid I probably shall not have time to reply, who wrote to me quoting their Christian or religious principles, to read excellent speeches of two Christians in this House—the noble Baroness, Lady Richardson of Calow, and the noble Lord, Lord Laing of

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Dunphail—who, with perfectly good logic, came up with the opposite view to most of the other religious people in this House.

Finally, I believe that the Bill, and the work of the noble Lord, Lord Joffe, has already made a considerable contribution to the present general debate on the subject. As I quoted from the Royal College of Physicians, it would be deeply unethical to walk away from the problem. I hope that the noble Baroness, Lady Richardson of Calow, is right in her nicely phrased comment that this is a Bill whose time has come.

5 p.m.

Lord Clement-Jones: My Lords, it has been a privilege to listen to the debate today and it is a privilege to reply from these Benches. I hasten to add, however, that the views I will be expressing are personal because, with regret, I disagree with a number of my noble friends.

It has been an absorbing debate and we have heard some exceptional speeches. Like the noble Lord, Lord Neill, I welcome the correspondence that we have all received in the run-up to the debate. Some of it was formulaic but a great deal of it was very personal. The personal experiences outlined and the testimony given were very useful in helping us to make up our minds ahead of the debate.

A number of powerful arguments have been put forward today by the proponents of the Bill. I have certainly given them careful consideration. But I should not go much further without thanking the noble Lord, Lord Joffe, for introducing the debate.

The key principle put forward by those who support the Bill is the principle of patient autonomy and the ability of an individual to determine the manner of his or her death in a dignified way. Another powerfully put argument, which increased in strength throughout the debate, was that currently there is a belief that patients end life with the connivance of their doctors already. Indeed, my noble friend Lady Thomas went so far as to say that in a well regulated environment such as the one she considers would be provided by the Bill, cases such as Shipman would be less likely to occur.

There is another strand. Palliative care, which has been the subject of considerable debate today, is not considered by the proponents of the Bill to be the be-all and end-all in this area. They agreed that it could relieve pain although services were not provided widely enough. However, when it comes to the feelings of indignity, fear, and loneliness of patients who felt that they were suffering unbearably, palliative care cannot cater for people in such circumstances.

Further, as regards the Select Committee report which has been referred to by a great many of your Lordships today, there is a feeling that that was written in a different context and that, because of the Dutch experience and perhaps the Oregon experience, it was no longer as up to date as it should be.

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Reference was made to the safeguards in the Bill and whether or not they were adequate, and the fact that the Joint Committee on Human Rights believed that they accorded with the convention. A number of individual cases were mentioned by noble Lords.

I probably have not adumbrated all the pros of the Bill—I could not possibly in the time available—but I respect the humanitarian motives of the noble Lord, Lord Joffe, and other proponents of the Bill. Speaking as a lawyer, this is probably very close to the best Bill that could possibly have been drafted to give effect to the intentions of those who wish to see patient-assisted suicide.

However, ultimately, I have been heavily influenced by the Select Committee which reported in 1994. Despite the recantation of their views by the noble Baronesses, Lady Jay and Lady Warnock, I believe that their remarks about the interests of individual patients not being able to override the interests of society as a whole are absolutely crucial to the debate. The noble Lord, Lord Brennan, said that autonomy must be put in its social context. I believe that to be very much the case and at the absolute nub of the arguments on the Bill. It cannot be right to enable a few patients to die in the way envisaged in the Bill, if a large number of patients are potentially put at risk . We need to examine the risks that would prevail following an enactment of the Bill. In those circumstances, I believe that the arguments I am about to put forward should prevail.

I refer first to the duty of doctors. I believe that the duty of doctors, as far as possible, should be unambiguous. An attempt to create safeguards in these circumstances blurs the issues. We want doctors to strive for life, not to assist in death. That is why palliative care doctors are against the Bill.

The noble Baroness, Lady Cumberlege, referred to the training of doctors. Whether or not doctors swear the Hippocratic oath, we have all been brought up to believe that it is at the core of a doctor's duty. The noble Baroness also referred to the pledge that qualifying doctors make. The Bill would create conflict for doctors; it would undermine trust, I believe, and the relationship between doctors and patients would be affected. For that reason, the majority of doctors oppose having the powers envisaged in the Bill, as many of your Lordships have said.

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