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Baroness Hayman: My Lords, many noble Lords have spoken of the quality of the chairmanship of the noble and learned Lord, Lord Mackay of Clashfern. I echo that which has already been said. It was a privilege to sit on the committee and a real education. Our thanks go to him and to all the staff who supported us.

Like the noble Lord, Lord Patel, when I joined the committee I was uncertain as to the way forward and whether to support the Bill and the provisions being put forward by the noble Lord, Lord Joffe. The reason for my doubt was that I did not have a fundamental, faith-based approach that gave a simple answer to this question, such as is manifested in much of the correspondence that we have received on the subject. If you simply believe that when you live or when you die is in the hands of someone else, it is not a matter of debate whether we should envisage legislation such as this Bill. If you do not believe that, and if you believe that living an ethical or moral life and trying to legislate in the best interests of society is often a matter of justifying your inconsistencies rather than of total consistency, it is a difficult question.

I need no persuading that more people at the end of their life would be helped by improvements in palliative care and the availability of those services than would be helped by implementing the Bill as outlined by the noble Lord, Lord Joffe. But, like others who have spoken, I do not find those objectives irreconcilable. Nor is it impossible to believe that passionately; to campaign for it and be willing to work for it, and to understand that for most people their suffering—existential and physical—can be helped by excellent palliative care such as is being developed in this country. That is a given.

Equally, I cannot accept the assertion that has been made today in the Chamber that all suffering is amenable to relief. That was not the evidence that we received on the committee, either from patients or doctors. It is not the evidence that many of us have seen in our own lives among those for whom we have cared very deeply. Some suffering is not amenable to relief. Many professionals will accept that, even with the best palliative care.

Sometimes the perceptions of doctors and patients differ in that area. I always remember a lovely story about the late Queen Mother, who said that she had never appreciated the strength of the sense of humour that her orthopaedic surgeon demonstrated until she read, the day after she came round from an anaesthetic in hospital, his comments to the press that she was comfortable recovering from her operation. Doctors have to accept that people vary. My noble friend Lady David said that we should not say that all those who
 
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seek such assistance are controlling personalities, as though that were in some way wrong. Some people find some parts of the symptoms and experience of dying more difficult to cope with than other people do. Some symptoms are more amenable to relief than others.

If we are to accept that that is so, I have to ask myself whether there is a greater danger, in moving the line a little so that those people could gain assistance, that we would prejudice more—that we would create greater harm in society. That was the issue on which the noble Lord, Lord Patel, has just spoke. Would we necessarily cause fear and concern that pressure would be put on patients to die? That was not the experience that we saw in any jurisdiction that we visited. In fact, we heard lots of evidence of families persuading people or trying to persuade people not to take that course of action, but that they in the end did.

I bored the committee rigid by constantly questioning whether we really were crossing a Rubicon if we changed to physician-assisted suicide. For me, the difference between physician-assisted and physician-administered suicide was not clear when I embarked on the matter and became much clearer later. It is important to the medical profession, and I could support one but not the other. From the perspective of a patient who wants to die, what is the difference—what is the Rubicon—between being able to say, "Turn off my life-support machine" and having that enacted, or being able to say, "I don't want to take this medication", and leaving an advance directive to say, "I don't want artificial hydration and nutrition"? From the perspective of the patient who wants to end their life prematurely, what is the difference in being able to say, "I want to do this in a considered, controlled way with the assistance of doctors, when I know that it is going to happen, so that I can say my farewells"? I could never answer that question satisfactorily. I could not see a great danger to society, so I support the sort of Bill that the noble Lord, Lord Joffe, intends to introduce.

5.33 pm

Baroness Cumberlege: My Lords, in the past, medicine was simple, relatively ineffective and safe. Today it is very complicated, effective and potentially dangerous. We have moved from the time when the family doctor, with great kindness, prepared us for the inevitable. Today, for many, the attitude is quite simply negligent. Curing what was thought to be incurable, successfully operating on the inoperable and striving to achieve what is still unachievable is considered a triumph of progress. But in the end we all die. This evening, we are being asked to consider whether it is right to terminate the lives of those people beyond the extremities of medical progress. Fortunately, we have the excellent report, which is not only beautifully written, but well researched and finely balanced. The skill, wisdom and integrity of the committee's chairman shine throughout.

The committee, through the evidence of the noble and learned Lord the Attorney-General, heard that the Director of Public Prosecutions, when asked whether
 
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he should in future publish prosecution guidelines, had decided not to do so but to consider each case on its merits. That values the individual and recognises that every life is different, so three cheers for the DPP. During the summer, at the invitation of the noble Baroness, Lady Finlay, I visited Velindre Hospital in Cardiff. It was one of the most memorable and inspiring days of my life. If ever there were a case for human cloning when it comes to palliative care, it is Professor Finlay. Sadly, I do not have the time to describe that visit and what I learnt. If I have a criticism of the committee, it is that it as a body did not take up the offer to visit a hospice. I am sure that for some it would have been enlightening, and might have modified their support for the Bill.

Once a year, I have the joy of presiding over the graduation ceremony of 100 newly qualified doctors. Those young people are some of the brightest in the land. They are well motivated, see medicine as a vocation and cannot wait to start their real work in healing, treating and curing patients. In unison they make a pledge—it is much too long to recite today; anyway, I did so when we debated the previous Bill. That pledge means a great deal to those aspiring young doctors and their tutors, friends and families—and to me—for it is their contract with society. But we are told, in the section on the outline to the Bill, that,

"medical staff who comply with the terms of the Bill [are] to be immune from both prosecution and breach of any professional oath or affirmation".

Are we to jettison so lightly oaths and affirmations? For some of us, they are important. They guide our lives, behaviours, marital status and thinking. Do the oaths and affirmations made by judges, magistrates, and your Lordships in this House mean nothing?

According to the Bill, an oath or affirmation is simply a matter of words—a mere trifle to be discarded. That underlines one of my deep concerns with the Bill, both in its intention and in its practicality; namely, that inconvenience is to be jettisoned. A life which is deemed inconvenient and to have no value is to be cut short, not by the individual, as is allowed by law, but by others—by physicians.

At the moment, I am chairing a working group at the invitation of the Royal College of Physicians to define the nature and role of medical professionalism in modern society. It is tough. Getting a definition has consumed hours of debate and discussion. We have ended up with a long description and a short definition which states that,

"medical professionalism signifies a set of values, behaviours and relationships that underpin the trust the public has in doctors".

Doctors recognise that it is only by maintaining trust that they can help people to ease their way out of this world with dignity, and their families to be free from anger and guilt. In the report, we are told that,

"the majority of letters received from doctors expressed serious reservations about the impact of the Bill".

They are right. They are, in common parlance, the fall guys—the people to shoulder the burden of the execution of any Bill. Of course a conscience clause is proposed that allows doctors to opt out. But how is a
 
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patient to know whether they are dealing with a doctor who has opted out or opted in? It is hardly an appropriate conversation to have at such a vulnerable time.

Finally, I return to the DPP's remarks. Here is a lawyer saying that each case must be taken on its merits—do not try to define what is indefinable. I believe that a law will cause many legal battles adding to confusion, anguish and distress. It will start surrounded with good intentions but will end up being a charter to be exploited by venal relatives, determined to take the waiting out of wanting. A Bill, however well intentioned, will cause more harm than good.

5.40 pm

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