Memorandum from Lord Joffe
Patient (Assisted Dying) Bill
1. BACKGROUND TO THE REQUEST
(a) The issue of assisted dying is of intense
public interest upon which there are passionately opposing views
within the House, amongst the public, health and legal professions
and religious groupings.
(b) The purpose of these briefing notes is not
to rehearse the arguments for and against the Bill but rather
to outline why I suggest that the House can only make an informed
decision on the Bill if it has the benefit of the findings of
a Select Committee.
(c) The purpose of the Bill (as amended by the
amendments of which I have given Notice) is to prevent unbearable
and unnecessary suffering by allowing competent terminally ill
patients to request assistance to die. The Bill is accordingly
very limited in its application. It does not apply to patients
who are mentally incompetent nor to any patients who are ~ terminally
(d) Opponents of the Bill, many of whom are concerned
that assisted dying is contrary to their religious beliefs, mainly
base their opposition upon concern that if assisted dying is decriminalised,
the vulnerable members of society will be put at risk and trust
between doctors and patients will be destroyed.
(e) In drafting the Bill, it was recognised that
there could be risks to vulnerable members of society and to prevent
these risks, a range of safeguards was introduced. However, the
Bill's opponents argue that these safeguards are inadequate.
(f) Inevitably the views of the Bill's opponents
on vulnerability and trust break-down have to be based on conjecture
rather that upon fact.
(g) As there is no available experience of assisted
dying in the UK, it is natural to turn to the experience of other
countries with similar health provision and similar standards
of living which have actually implemented similar legislation.
The Netherlands and Oregon qualify under all these headings with
experience of patient assisted dying going back to the 1980s in
the case of the Netherlands and 1997 in the case of Oregon.
However, the supporters and opponents of the Bill
have interpreted the experience of the Dutch and of Oregon very
differently. The supporters are convinced that the Dutch and the
Oregon experience provides positive support for the view that
assisted dying does not place vulnerable people at risk and that
there is no evidence of a break down in trust between doctors
and patients. The Bill's opponents however argue that the Dutch
and the Oregon experience illustrates the dangers to the vulnerable
and to doctor/patient relationships.
2. BASIS OF THE REQUEST
The House would be immeasurably assisted in making
an informed decision on the Bill if a Select Committee had taken
evidence and considered the issues set out below:
(a) The current experience of assisted dying
in the Netherlands and Oregon and in particular, whether the vulnerable
members of society have been put at risk and whether doctor/patient
relationships have been adversely affected.
(b) Whether palliative care can in all cases
provide the care which will enable terminally ill patients to
die with dignity and free of unnecessary suffering.
(c) Whether recent polls that show 80% percent
of the public supporting assisted dying accurately reflect public
(d) Whether the safeguards contained in the Bill
to protect vulnerable members of society are adequate and if not,
what further safeguards are necessary. The Joint Committee on
Human Rights in its report on 23 March 2003 was of the view that
they were but the Bill's opponents are not persuaded.
(e) The effect, if any, on resources for palliative
care if the Bill became law.
(f) The effect, if any, on health staff and the
families of patients if the Bill became law.
(g) The different views within the medical profession.
3. CHANGES SINCE THE 1994 SELECT COMMITTEE
The Lords Select Committee on Medical Ethics which
reported in 1994 recommended that the existing laws which make
assisted dying illegal, should remain in force. That was ten years
ago and much has changed since then including the following:
(a) At the time there was no legislation similar
to the Bill in any other country. Since then such legislation
has been introduced in the Netherlands, Oregon and Belgium.
(b) The views of the Select Committee were significantly
influenced by what they were told about the Dutch system. In the
light of developments in the Netherlands since then, I believe
that a new Select Committee may form a different view particularly
having regard to the facts that
- the Royal Dutch Medical Association (of which
the great majority of Dutch doctors are members), the Dutch Government
and the overwhelming majority of the Dutch population strongly
support the existing system
- the most recent Remmelink Report (an in depth
series of reports commissioned by the Dutch Government) published
earlier this year found no evidence of vulnerable people being
put at risk nor any increases in voluntary euthanasia in the last
(c) Three of the surviving members of the previous
Select Committee, Baroness Jay, Baroness Warnock and Baroness
Flather now support this Bill. This is particularly significant
as it demonstrates that a new Select Committee might well come
to a different conclusion from the previous one.
(d) The UK is now faced with the sorry spectacle
of terminally ill patients dragging themselves in desperation
to Zurich to be assisted to die.
(e) Surveys in the UK amongst doctors have shown
that a considerable number of doctors have felt compelled on grounds
of compassion to agree to requests by their patients to assist
them to die even though this is against the law. This sits uncomfortably
in a democratic society where the rule of law should prevail.
(f) Likewise wives who have openly broken the
law on assisted suicide in order to assist their husbands to die
in Switzerland, have understandably not been prosecuted and hopefully
never will be.
(g) The issue of assistance to die is now being
looked at afresh by the Council of Europe which had previously
expressed opposition to voluntary euthanasia and the French National
Assembly has just agreed to set up a Parliamentary Commission
to investigate issues relating to the end of life and formulate
proposals for addressing these issues.
(h) There is widespread support for the Bill
amongst Peers on all sides of the House.
(i) The terms of reference of the previous Select
Committee were much wider than what is proposed and most of the
other findings of that Committee are not being questioned.
I respectfully submit that having regard to the above
there is a powerful ease for a Select Committee, the findings
of which would ensure that the House is able to make an informed
decision on a Bill of significant importance.
22 October 2003