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Lord Carter: My Lords, I congratulate the noble and learned Lord, Lord Mackay of Clashfern, and the Select Committee on an excellent report. Having served on four Select Committees examining Bills—chairing two of them, including the Joint Select Committee on the draft Mental Capacity Bill—I know how hard it is to keep to the terms of reference, which is the Bill itself, and to examine the principles of the issue. The committee did that admirably.

Your Lordships will have seen the briefing from the leaders of the British faith communities. But the "sanctity of life argument"—perhaps I may call it that—is not my reason for opposing this legislation. As legislators our religious beliefs are bound to inform our deliberations, but our overriding concern and responsibility should be to consider the best interests of society as a whole; that is, for those with religious beliefs and those without.

In 1990, according to one survey, 35 per cent of people surveyed thought that there was always a clear distinction between right and wrong. By 2000, that figure had shrunk to 20 per cent with 75 per cent believing the exact opposite; namely, that there can never be universal standards of what is right and wrong because each judgment must always depend on circumstances. We live in a pluralist society and we must legislate accordingly.

My reason for believing that this legislation would not be in the best interests of society is based on a genuine concern about the fundamental change in attitudes and belief regarding the end of life that I am convinced would result from a change in the law. In the real world, end-of-life decisions would inevitably move from the moral to the utilitarian.

If the law changed, the extent or compass of euthanasia would change. The noble Lord, Lord Joffe, and others have made it clear that this Bill is only a first stage. The logical extension of the argument can be found in Appendix 6 of the report, which is the Euthanasia Statement of the Dutch NVVE. It sets out the Criterion for requesting euthanasia. The medical
 
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conditions that would come within the Criterion are quadriplegia, dementia, blindness and/or deafness, motor neurone disease, multiple sclerosis and other crippling but non-terminal conditions. I am not exaggerating when I say that there are many older and disabled people who are genuinely fearful of the change in the attitude of society towards them if assisted dying is legalised.

One aspect of disability is rarely mentioned. There is an unspoken fear, except to each other, among parents of disabled children, whatever the age of the children may be. They ask, "What will happen if we die first? Who will take life and death decisions if we are not there?". Last week, at the RADAR conference which debated assisted dying, one mother described the concern expressed by her son who had a progressive and terminal condition that stretched over 30 years until he died. He required 24-hour care for most of his life. When he died he was fully competent, but, for a long time, had been concerned about the burden that he placed on his parents. Of course, they were there to reassure him.

What would his attitude and that of those who cared for him have been if his parents had died first and assisted dying was an option? I know of one couple, both of whose disabled children died. Their only consolation was that their fear of dying first had been removed.

I turn to what may seem to be a technical point, but is very important. The noble Lord, Lord Joffe, has indicated that he would amend his Bill to exclude Scotland. This would raise exactly the same dilemma that faced the Government when considering whether abortion should be a reserved or devolved matter in the Scotland Act. It was reserved to the Westminster Parliament on the ground that it would not be in the best interests of society to have different regimes for abortion in the two countries. The same argument applies to euthanasia. We have heard of suicide tourists to Switzerland. I imagine that we would not wish to have suicide tourists crossing Hadrian's Wall.

The Select Committee received a vast amount of evidence, but if time allows me to quote from only one submission, it should be that of the National Group of Palliative Nurse Consultants at pages 85 and 88 of Volume III:

"It is well known in the caring professions that nurses, not doctors are the clinicians who look after patients as they die. There is absolutely no recognition of this in the Bill . . . We firmly believe that the law needs no change to allow for euthanasia or any form of therapeutic killing to meet the needs of people approaching the end of their natural life. It is our view that no suffering is unamenable to relief when a patient and family and expert practitioners work together to tackle its complexities. It is our opinion, based on many years of clinical and personal experience that this Bill is fundamentally flawed and sets a dangerous precedent.

That is the opinion of professionals who, unlike most of us, spend their working lives helping the terminally ill.

In conclusion, I have one important question about the progress of the Bill that I wish to put to the Minister and about which I have given him notice. We all know that Private Member's Bills which start out in
 
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this House have no chance in practical terms of reaching the statute book unless the Government co-operate over the allocation of time when the Bill reaches the Commons. If the Bill the noble Lord, Lord Joffe, intends to introduce is agreed to by this House—and that is by no means certain—and it does reach the Commons, will the Government help to find time for it there? I am sure that noble Lords will agree that the attitude to the Bill of this House as it passes through its various stages would certainly be influenced by knowing whether, to put it bluntly, it is going nowhere or whether it has a chance of reaching the statute book.

3.37 pm

Baroness Thomas of Walliswood: My Lords, I start by paying tribute to our chairman, the noble and learned Lord, Lord Mackay of Clashfern, whose qualities of sagacity and discretion combined with the saving grace of humour are well known to this House. I do not believe that we could have had a better leader when considering this difficult and controversial subject.

I came to the work of the committee as one who generally supports the objectives of the Bill, a point of view I acquired—if that is the right word—from my mother, who was born in 1909. I mention that merely to indicate that the ideas set out in this Bill are not new. I should like also to draw attention to the support for some of the ideas in the Bill of the noble Lord, Lord Joffe, expressed outside Parliament. That is in sharp contrast to the views within Parliament, particularly in the House of Commons. While our chairman has highlighted the less than ideal sophistication of some of the polling methods used, nevertheless the general trend of opinion polls shows increasing support for the ideas set out in the Bill. Interestingly, 47 per cent of people might be prepared to break the current law to assist a suffering terminally ill patient to die. Over recent years, sentences in the courts seem to show understanding of the difficult choices which some people have faced in this respect.

Turning to opinion within the medical profession, it is clear that support for some form of assisting terminally ill patients to die has risen over past years among both nurses and doctors. The attitude expressed to us by the BMA in its evidence was neutral on the grounds that it was for society as a whole to determine such matters. Obviously it recognised the difficulties that such legislation might pose for some professionals, in particular those frequently involved in end-of-life care. Any new Bill would need to provide a watertight conscience clause.

The Royal College of Nursing gave evidence against the Bill but it is fair to say that this approach may have represented the feelings of the council rather than of the membership as a whole. An independent survey of nurses by the Nursing Times in 2003 showed that two-thirds of nurses supported a change in the law.

One of the aspects of the Bill—to which the noble Lord, Lord Carter, referred—which I found unsatisfactory was the lack of attention paid to the role
 
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of nurses in end-of-life care. Their role might need more recognition in a new Bill. The evidence from Oregon and the Netherlands does not suggest that nurse-patient relationships have been damaged or changed by legislation in those countries.

My third point is the apparent conflict—at least for some—between palliative care and the approach taken by the noble Lord, Lord Joffe, in his Bill. I am aware that the noble Baroness, Lady Finlay of Llandaff, a distinguished practitioner and teacher of palliative care—who, I believe, follows me in today's debate—may well express different views, but I can see no such conflict, and nor do we find evidence of it elsewhere. It may be that palliative care is less well developed in Holland than in the United Kingdom—that may be connected to the fact that most people there die in the care of their GP—but Dutch doctors are certainly working hard to acquire palliative care skills. Meanwhile a most welcome development in the UK is the increased training of GPs in end-of-life care of their patients. A wide spectrum of alternative treatments is highly desirable.

Fourthly, I want to address the frequently expressed fear that any legislation along the lines of the Bill of the noble Lord, Lord Joffe, would be a danger to disabled people or to those who might think they ought to die so as not to be a burden on their families. Again, I think that the case is quite the contrary. Evidence given to us suggests that some severely disabled people who need to go into hospital already fear that doctors may assume, for example, that the disabled person would not want to be resuscitated in the operating theatre—a totally unfounded assumption made in a lordly fashion on behalf of patients—whereas the whole point of these proposals is that it is the patient who decides these matters, not the doctors or the families, who are excluded by the Bill from playing any part in the process which might lead to assisted suicide or voluntary euthanasia.

That leads me to my next point—namely, the character of those who seem to choose to take advantage of legislation giving patients choice in the manner and timing of their death. They tend to be people who have always exercised a high degree of choice in their manner of life and wish to do the same in respect of their manner of death, particularly where death by self-administered medication is involved. It pains me to be at odds with the right reverend Prelate the Bishop of Oxford, speaking on this point this morning, but in a secular society people of all walks of life value the freedom to choose how they live their lives. Apparently they are also willing to grant to others, or to claim for themselves, the same freedom to end those lives if they become intolerable by reason of terminal illness or unbearable pain. After all, suicide is not a crime.

My last point is a simple one. The Bill considered by the committee forces no one who disapproves of it to take advantage of it. Experience elsewhere suggests that not many people would take advantage, but it does give some people in specified and desperate circumstances the freedom to choose to die, even if they are not able to commit suicide unassisted.
 
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I hope that the House agrees the Motion before us today and that, in due course, we may return to debate a new Bill which will change the law. I would prefer that the Bill contain provision for both assisted suicide and voluntary euthanasia, if only to test the opinion of the House of Commons and to make it think as hard as we have thought on these matters. It is time for Parliament to face up to these issues.

3.44 pm

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