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Lord Taverne: My Lords, perhaps I too may say what a pleasure it was to serve on the committee chaired by the noble and learned Lord, Lord Mackay of Clashfern, who presided over our proceedings with such skill, charm and fairness.
I accept the present inclination of the noble Lord, Lord Joffe, to promote assisted suicide only, but I want to put the case for euthanasia, based on the evidence we heard in the Netherlands. The Dutch experience is often referred to and often misrepresented. Indeed, I am not entirely satisfied that the summary of it in our report gives an altogether balanced picture, because, in trying to be as fair as possible in representing both sides, it perhaps gives undue weight to critical witnesses who are part of a small minority and did not reflect general opinion.
In the Netherlands, euthanasia has overwhelming support among the public and the medical profession. Dutch experience shows that there is no conflict with palliative care; it has in no way undermined trust in doctors; there are fewer cases of involuntary euthanasia than in other countries; it has not led to a slippery slope; and there is not a shred of evidence of danger to vulnerable groups.
More than 90 per cent of the public and doctors in the Netherlands support the law. The official government study shows that 85 per cent of doctors
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believe that helping their patients to die improved the quality of their dying considerably. The noble Baroness, Lady Finlay, gave the example of one doctor who was vehemently opposed to the Dutch law. Of course there are doctors who are vehemently opposed to it, but it would be quite wrong to suggest that they were part of a majority opinion. There is no doubt of the overwhelming support of the Dutch medical profession for the law there as it stands.
On palliative care, the Dutch Ministry of Health and the Dutch Medical Association told us that, since the law came into force, interest in palliative care has grown and has led to a boom in the training of GPs and others. I refer to the passage in questions 1304 and 1396. The respondents saw no conflict. A Dutch palliative care consultant at a Catholic hospice told us that they were happy with the possibility of providing euthanasia in the hospice and added—Catholics and reverend Prelates please note:
On trust in doctors, in 2002 a BMJ survey of 11 European countries, including Britain, showed that trust in doctors is highest in the Netherlands. There is much more open discussion there of end-of-life decisions with patients and families—far more than in any other European country. The actual experience of the law in the Netherlands in no way upholds the contention that a change in the law would undermine the relationship between patient and doctor.
It is often mentioned that there are 1,000 cases in the Netherlands of active ending of life without explicit request, amounting to 0.7 per cent of all deaths. However, the available evidence suggests that involuntary euthanasia occurs much more frequently in countries without legislation. Professor van der Wal, the person who led the official study into the practice of euthanasia, told us that in the Netherlands there is no association between enacting the law and the number of cases of involuntary euthanasia; see question 1683. Indeed, his research showed that these were examples of alleviation of symptoms rather than deliberate ending of life—all of them cases of people who were incompetent and suffering severely. Doctors estimate that in 33 per cent of those cases, life was shortened by less than 24 hours, in 58 per cent by less than a week and in 6 per cent by less than six months.
Lastly, it is often alleged that changing the law leads to a slippery slope and endangers vulnerable groups. The Dutch evidence explodes those myths. There has been no significant increase in the number of cases since the law was passed. One of the witnesses, a hospice director who opposes the law, agreed that there was no evidence of growing laxity in the use of the rules. Here, he said, there is no slippery slope; see question 1510. Of course, it is somehow alleged that the Netherlands does provide evidence of that, because there are now demands for a change in the law, but that is not what is normally meant by a slippery slope. There are always demands for a change in the law—some for making the law more restrictive and some for making it more relaxed. But that is not the same as the question about whether there is a laxity in the use of the rules. That is what is normally meant by a slippery
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slope. One witness, who conducted the official study, told us that there was no evidence that disabled groups were affected more than others. Indeed, most euthanasia cases in the Netherlands do not involve the very old but relatively younger people; see questions 1664 and 1666.
To sum up, the evidence shows that in the Netherlands the law works well. It provides far more dignity in dying than we allow, and shows far greater humanity than we do towards those who experience unbearable suffering at the end of their lives. Unless one is obsessed with theological principle, that is surely what matters. When it comes to what we allow some people to suffer when they die—well, you would not do it to an animal.
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Lord Patel: My Lords, I, too, thank the noble and learned Lord, Lord Mackay of Clashfern, for his outstanding chairmanship of the committee. It was a privilege and a pleasure to be a member of a committee chaired by him and an added pleasure to witness his incisive questioning of the witnesses. All the credit for what turned out to be a balanced report, despite the polarised views held by the members of the committee, goes to him, for it was not easy to get a consensus report. The noble and learned Lord achieved that, and I thank him for all his efforts.
As noble Lords are aware, I am a doctor, but I have witnessed thousands more first breaths of life than I have last breaths of life. My experience of dealing with patients at end of life is limited, and I draw my conclusions from evidence as presented to the committee—unbiased.
During the months of the committee's deliberations, we heard from many doctors, as representatives of professional organisations and as individuals, generalists and specialists. Subsequent to the publication of the report, I also wrote to the presidents of all the Royal Colleges and faculties in the United Kingdom to seek their views on the report.
Assisted dying is an issue that increasingly divides the profession, and the views of the professional organisations seem to change. The British Medical Association opposed any change in the law when its representatives gave evidence to the committee, but more recently it has changed its mind and now holds a neutral position, feeling that it is for society and Parliament to decide, as do many of the Royal Colleges, including the Royal College of Physicians of England, the Royal College of Surgeons, London, and the Royal College of Psychiatrists, to name but a few. On the other hand, the Royal College of General Practitioners now opposes any change in the law, in contrast to the view expressed by its representatives when they gave evidence to the committee.
The greatest opposition comes from some of the doctors more closely involved with the care of patients near the end of life. We do not have the results of surveys carried out involving all the doctors in the United Kingdom to be able to know the views of
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individual doctors, particularly on clearly defined legislation. All we can say for now is that the views of the profession on assisted dying are divided. Although the medical profession is divided on the issue, there is wide consensus that any change in the law must be accompanied by wider availability of good quality palliative care, strong safeguards in the legislation for patients, training and support for health professionals, a robust monitoring of the law and clear conscientious objection clauses, all of which I would strongly support.
I agree with the view expressed in the report that at the end of the day the acceptability or otherwise of a change in the law on assisted dying is a matter for society as a whole to decide and not for any groups of health professionals. I do not, however, believe that the implementation of any change in the law could be placed outside the current system of mainstream healthcare. I say that because of the strong doctor/patient relationship that exists in our healthcare.
In a previous debate on the original Bill introduced by the noble Lord, Lord Joffe, I said that I could not see myself supporting any change in the law, although I recognised that the medical view was divided. My main concern then was how any change in the law would affect vulnerable groups such as the elderly, the disabled and others. During the deliberations of the committee, we heard from many individuals and organisations representing so-called vulnerable groups, and again their views were divided.
Although I was not there to listen to the evidence, I refer to the views expressed in the light of their experience by Professor Raymond Tallis, a respected geriatrician and an ethicist, who gave evidence to the committee on two occasions; Dr David Cole, a clinical oncologist; and Dr Carole Dacombe, a medical director of St Peter's Hospice, an organisation providing hospice care to a wide community. They gave evidence to the committee regarding a small number of individuals for whom legislation related to assisted dying would be appropriate.
Dr Carol Dacombe described her experience,
"of consistently and persistently encountering a small number of patients who despite the whole range of services available to them . . . have felt a need to express a wish to see their life ended".
As she said, they are often people who have a long life history of seeking control over their own destiny and who do not find help and support—as most of us do—in faiths and spiritual concepts. They feel their suffering through illness to be unbearable and wish it to be ended.
All the evidence presented to us, including that from the state of Oregon, suggests that the number of individuals seeking such a course will be quite small. The evidence presented to the committee suggests support for a Bill limited in scope, much in line with death with dignity legislation—which would be a much better title than the one used in the Bill proposed by the noble Lord, Lord Joffe. It suggests support for a Bill as enacted in Oregon, with all the safeguards for individuals and robust monitoring of the law in place,
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allowing patients to take charge and decide for themselves. Such a Bill would have wider society and health professional support. At least it would allow for a debate that is more focused and confined to a tighter Bill.
5.26 pm
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