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Viscount Brookeborough: My Lords, can the Minister comment a little further on the Reserve Forces and the amount of support being given? He has already told us about the support that will be given to the 7th Armoured Brigade. However, it is vitally important that in the future—in the medium term and further on—roulement units go at full strength. We know that they are under strength in this country as they stand and that they have to be supported by the Reserve Forces. Can the Minister give the House some idea of how sustainable that will be in the medium and longer term?

Lord Drayson: My Lords, the role of our Reserve Forces is crucial to the roulement, as I have said, and in particular to the process by which the forces take over in the coming month. I shall give the House some idea of the level: as at 8 September, there were 650 reservists deployed in Iraq, carrying out a range of
 
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duties relating to matters such as medical support, force protection and individual reinforcements to units. The need for reservists to continue to deploy is part of normal business for our Reserve Forces. Their deployment will ease the burden on the troops that are there of routine security tasks. It is essential to our operational strategy in theatre.

Lord Clark of Windermere: My Lords, can the Minister update the House on the activities of NATO troops in the training of Iraqi personnel? Does he feel that the balance is right between the training carried out in Iraq and without Iraq?

Lord Drayson: Yes, my Lords, we believe that the balance is right. As I have said, the key focus is on the development of capability, and we now have some 190,000 trained Iraqi forces. It is about developing that capability over time, and that is best done in theatre. We also have Iraqi officers here in the United Kingdom at our training establishments, and clearly that is important. But there is no substitute for the development of characteristics such as leadership and, importantly, logistics and command and control, and that needs to be done in theatre.

Lord Marlesford: My Lords, can the Minister confirm that the British contingent, at a force of 8,000 military personnel, is the second largest overseas contribution after the United States to the coalition forces? Can he tell us which is the next largest and, indeed, what is the total of non-Iraqi, non-American and non-British coalition forces?

Lord Drayson: My Lords, I can confirm that we are the second largest. My understanding is that the next largest after us is the Italian force. I shall confirm the details for which the noble Lord has asked, and I will write to him giving the specific totals for each of the countries contributing to the coalition forces. A total of eight countries contribute to the coalition in the area for which we are responsible in MND (South East).

Assisted Dying for the Terminally Ill Bill: Select Committee Report

5.4 pm

Debate resumed.

Baroness David: My Lords, I congratulate the noble and learned Lord, Lord Mackay of Clashfern, and his committee on producing an excellent report. It is a very thorough report and very helpful to all of us who understand the difficulties inherent in the subject. Nevertheless, it seems to come down fairly strongly in wanting the Bill of the noble Lord, Lord Joffe, to be reintroduced into the House this autumn and for it to go to a Committee of the Whole House with the safeguards and amendments that the noble Lord, Lord Joffe, has agreed to make. I hope that the Bill will go through and finally become law.
 
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I have been a member of the Voluntary Euthanasia Society for a long time. I am delighted that, at its AGM in November, it will vote for a change of name to Dignity in Dying, removing the word "euthanasia", which tends to alarm people. My proxy vote is already in. Compassion for those who are terminally ill seems of primary importance.

I strongly believe in personal autonomy and the right of individuals to decide when and how they die. As somebody aged 92, I think it is patronising for opponents of the Bill to suggest that elderly people are unable to make informed decisions about their lives, as the noble Baroness, Lady Thomas, has said. If I were terminally ill, I believe that I would be the only person with the right to decide how I die and whether I preferred palliative care to assisted dying. It would provide me with an additional option on how to end my life, which I would find tremendously reassuring, whether or not, in the end, I decided to exercise that option.

I note that in paragraph 52, a consultant in palliative care, on the basis of his own experience, felt that patients requesting assistance to end their lives tended to be people who wished to be in control—people who are not willing, or prepared, to engage the issues that may underlie the problems that arise. I resent that, although I have to admit that some of my children sometimes refer to me as a control freak.

5.6 pm

The Earl of Arran: My Lords, I, too, express my appreciation for the manner in which my noble and learned friend Lord Mackay so skilfully led our very lengthy consideration of this highly difficult issue. His Scottish canniness in retaining his neutrality as chairman was quite remarkable, while his diplomacy and sensitivity have helped to produce a report which should ensure that the quality of debate, both inside and outside your Lordships' House, is greatly improved.

Death is not a pretty affair, and it was a most humbling experience, and a great privilege, to have been appointed to this Select Committee. I would like to say how impressed I was by the dignity and the compassion of the witnesses who came before us, both here and abroad.

My consideration of the Bill benefited greatly from travelling to Switzerland, the Netherlands and the state of Oregon in the USA. All those jurisdictions permit some form of assisted dying, and these visits enabled me to consider the concerns and proposed benefits of changing the law in the context of what happens in practice. While the models used in the first two countries seem to be working satisfactorily, the system used in Oregon impressed me the most, and I intend to concentrate on their experience.

The law emerged as a result of a people's initiative in 1994, and is similar to that set out in the Bill of the noble Lord, Lord Joffe, with the exception of not allowing voluntary euthanasia for those unable to ingest the medication. The legislation has been in force for seven years and the take-up is very low. Only 208
 
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terminally ill adults have taken the medication, which equates to 0.13 per cent of all deaths in the state. But a significant number of patients who were provided with the medication did not take it, and died of natural causes. However, as the noble Baroness, Lady Jay, said, the fact that they had it available and accordingly remained in control removed an enormous load. It gave them comfort and allowed them to come to terms with their impending death. As the committee noted, if the Oregon experience were replicated in the UK, on a pro rata calculation it would result in around 650 deaths per year.

Perhaps the most interesting information that we gained in Oregon was from Ann Jackson, the director of the Oregon Hospice Association, who was the primary spokesperson for the hospice movement there. She confirmed that the Oregon legislation had not adversely affected the hospice movement. In fact, since legislation, the number of Oregonians dying under hospice care had continued to increase. In 2003, all patients who were assisted to die were offered hospice care. Of those, 89 per cent were actually in hospice care and the rest had left or refused it.

Many of the negative predictions about what would happen when the legislation was passed, such as that patients who used it would be more likely to be the poor, the uneducated, the uninsured or depressed, had turned out to be unjustified. Furthermore, there was no abuse of the system. The committee held 10 sessions in Oregon at which evidence was given. In nine out of the 10 sessions, it was agreed that the system was working effectively and that there was no evidence of abuse or a slippery slope. This was the view, among others, of the Oregon Medical Association, the Oregon Board of Examiners—which is responsible for controlling the conduct of doctors—the Oregon Nursing Association and Oregon's equivalent of the Department of Health, as well as a number of researchers.

In only one session, comprising three doctors, a politician and a nurse, was evidence given against the legislation. However, when challenged, these witnesses were unable to explain why they had not taken up their concerns with the relevant authorities. Since our visit, one of these witnesses, Dr Kenneth Stevens, has made a presentation to Members of your Lordships' House. Unfortunately, he made a number of statements which are totally inconsistent with the evidence we heard from all of the reputable organisations to which I have just referred.

I also asked the chief operating officer of the Oregon Medical Association whether there were any common characteristics among the doctors who opposed the Oregon Act. He replied, "Yes. Dr Toffler"—who was one of the witnesses—

"is perhaps the most devoted religious Catholic I have ever known and I think it is fair to say that his abhorrence of not only physician-assisted suicide but abortion is based on that".

This was not uncommon. Opposition to the Bill was often based on strongly held religious beliefs, but these were not always explicitly stated. Your Lordships may be asking why, if assisted suicide has existed in Oregon
 
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for seven years, other states have not adopted it. Here it is interesting to note that Oregon has one of the lowest levels of church attendance in the USA. This would appear to be a key determinant of why this type of legislation has yet to be introduced in other states.

I would like to make one suggestion. A majority of the committee members who travelled to Oregon, as well as a majority of committee members more generally, thought that the Oregon model was working well. As a result, should the noble Lord, Lord Joffe, decide to reintroduce his Bill, he may like to consider amending it to reflect the Oregon Act even more closely by dropping his voluntary euthanasia provision.

It is my belief that society will, in its own time, eventually push such a Bill forward until the clamour for action becomes too great for Parliament to resist. Thus it was with homosexual reform and abortion, both of which at that time became unstoppable. When and if this happens with assisted suicide, it is essential that this House gets the Bill right and, above all, that we ensure that the safeguards are sensible, secure and workable.

In closing, I quote, very briefly, from one letter among so many from a gentleman with motor neurone disease. It states:

"It would be a great comfort to me . . . to know that if I reach a point where, having lost my dignity and control of my physical faculties and I cannot endure my illness any longer, I would be able to ask my doctor for help to die. Society appears to agree that patients like me should be given this fundamental choice and our laws should reflect this".

I suggest that that time is now approaching.

5.13 pm

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