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Baroness Greengross: My Lords, I add my congratulations to the committee for the wonderful and thoughtful work that it has carried out. I have worked with older people for almost all my adult life. It took me many years to decide how I feel about the issue. In the end I feel very strongly that most of the older people I have known are very scared of the process of dying, not of being dead and not of death itself, and want an assurance that whatever happens they will not suffer intolerable pain and lack of dignity when they die.

We are not talking here about prolonging life or giving people life rather than killing them off, we are talking about people who are very near death; they are all dying. I think that the six-month period suggested in the Bill is too long for the prognosis of death. Perhaps it should be reduced.

We must recognise that part of the dignity of an older person's life is that, when they are mentally competent, they retain a degree of autonomy. We are talking about people who often in our society do not have their views listened to when they are alive and well, let alone when they die. People's fears about losing even more autonomy and the will to make decisions are very real. We are talking here about love and care at the end of life for as long as people are alive, not about killing people off. This is about how we treat people when they are still alive, and being alive is very important until you take your last breath. Luckily, in our society, because of medical and social care developments and advances, most people who die are older people, so this is terribly important. Of course, our respect for people must continue until the last moment of life.

We are talking about how we spend the remaining very short time that we have left to us. Death is inevitable; critical, intolerable pain is something that we all want to avoid. I am a tremendous admirer of the palliative care movement, of the doctors who practise palliative care, of the hospice movement and of our country's reputation in this field. My father died in a hospice. I was absolutely overwhelmed by the care that he received, as I have been in many other cases of people who have died in that way with good palliative care. We are here talking only about the few cases
 
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where palliative care does not work, where people suffer intolerable and dreadful pain and the only way to control that is to knock them out completely. I have difficulty saying that one is all right but the other is some sort of murder. That is untrue and rather hypocritical. We are here talking about good care.

Surely a dying person should not have to plead for his or her wishes to be carried out. Just knowing that, whatever happens, your wishes will be carried out so that you have control over those last moments of your life is very important. It is important that that person's wishes to die in the way that he or she wants are carried out because as competent adults we want to be respected, to say our farewells and to finish any outstanding business with which we need to deal.

I would like to talk about disability, the disability movement and the many Members of this House who are shining examples of the courage of many disabled people. Those who I have known have very much enriched my life. I admire people who manage to make a life, often while suffering terrible disabilities. The fact that many disabled people are undervalued and feel that the Bill would add to that undervaluing is something that I do not understand. I work with disabled people and believe that discrimination against them is unacceptable in whatever form we discover it. We must deal with that where it still exists. It is absolutely nothing to do with the Bill. We must deal with any forms of discrimination as such, not muddle them up with the Bill.

In fact, discrimination against disabled people is reflected if we do not let the Bill pass in some form because under English law an able-bodied person is not committing a crime if he or she commits suicide, but if a person needs a bit of help to take the appropriate medication, they are discriminated against because of their disability. So we deny disabled people the ability to take their own life as able-bodied people can under our legal system.

We must deal with abuse wherever it exists. It is another form of discrimination. I support the Bill and the decision of the noble Lord, Lord Joffe, to restrict it to assisted dying and to drop the voluntary euthanasia part of the Bill at this stage.

Safeguards to stop abuse of any person who is dying, or anyone else, are essential. If further safeguards need to be built into the Bill, I know that the noble Lord will be very willing to incorporate them. I support that view. This is about how we die, not how we live. People's wishes—your wishes, my wishes, everyone's wishes—must be respected. This is about common humanity, not about killing people.

6.45 pm

Baroness Wilkins: My Lords, I spoke in opposition to the assisted dying Bill that the noble Lord, Lord Joffe, introduced in 2003, and after careful reading of
 
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the Select Committee's excellent report—I join other noble Lords in congratulating the noble and learned Lord, Lord Mackay, and his committee on it—I remain fundamentally opposed to any change in the law on assisted suicide or voluntary euthanasia.

I believe that to make that change would cross a threshold in the safety of our respect for the value of human life which could never be recrossed. We must not cross that boundary. As the noble Lord, Lord Walton of Detchant, who chaired the Select Committee on this subject in 1993-94, stated in his evidence:

"society's prohibition of intentional killing is the cornerstone of law and social relationships . . . It protects each of us impartially, embodying the belief that we are all equal".

My personal autonomy has to be outweighed by that greater claim of a just and equal society where no one is given cause to fear that their life has less value than others.

However many safeguards are put in place to ensure that an assisted dying Bill was used only for those for whom it was intended, it is impossible to create a safeguard against the wider, unintended consequences of changes in society's attitude to the value of life. Again to cite the report of the noble Lord, Lord Walton, who, by chance, is following me in this debate:

"the message which society sends to vulnerable and disadvantaged people should not, however obliquely, encourage them to seek death but should assure them of our care and support in life".

For me, one of the most striking elements of the Select Committee's report is the evidence of the very small number of people who would actually take advantage of any change in the law. It states:

"There was general agreement among our witnesses that the number of people who might be regarded as serious about ending their lives, who are not psychiatrically ill and who are unlikely to be deflected from their purpose is very small indeed".

Are we really to jettison that fundamental safeguard that our lives have value—the bulwark that killing is a crime—to satisfy the personal autonomy of a small, albeit tragic, group of people? I am convinced that satisfying that small group of people would mean that thousands live in fear. As the report states:

"There is a concern that . . . others will find themselves pressured in one way or another into taking a course of action which they would not have sought if the law had not allowed it".

The report goes on to discuss those "hidden pressures", which many noble Lords have cited today on elderly people who begin to feel themselves to be a burden on their families and whose care is eating into their children's inheritance and who may begin to feel that they should tidy themselves up and dispose of themselves. I have had many conversations with my disabled friends, who genuinely fear going into hospital if they have an acute period of illness and need intensive medical care, and that they will meet the prejudice of doctors who are imbued with society's prejudice that their lives are not equal to others and that it would be better to be dead than to be disabled.

As the law stands, it provides protection for such people. It proclaims to all of us that our lives have value. The current law protects the vulnerable and we remove it at our peril.
 
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6.50 pm

Lord Walton of Detchant: My Lords, I echo the congratulations expressed from all sides of the House to the noble and learned Lord who chaired the Select Committee. I also congratulate the members of the committee on producing a thoughtful and balanced report. In giving evidence to that committee, I said that I wholly appreciated and understood the sincere and compassionate reasons why my noble friend Lord Joffe had introduced the Bill. As the noble Baroness, Lady Wilkins, said, I chaired the House of Lords Select Committee on Medical Ethics, which reported in 1994. We produced a unanimous report dealing with issues of exactly this nature. I have not changed my mind, even though I now realise that three members of my committee who, in the end, subscribed to a unanimous report, have done so: the noble Baroness, Lady Jay, and, I believe, my noble friend Lady Warnock and the noble Baroness, Lady Flather.

Having said that, I endorse Clause 15 of my noble friend Lord Joffe's Bill:

"A patient suffering from a terminal illness shall be entitled to request and receive such medication as may be necessary to keep him free as far as possible from pain and distress".

That is the motivation of the hospice movement in the UK, which is increasingly influential in treating individuals with terminal illness of all kinds. Palliative care, of which my noble friend Lady Finlay is such a noted exponent, is not just delivered in hospices, but it is a philosophy of care that extends into a community and is practised by many general practitioners.

The principle of double effect has not been mentioned today. The noble Lord, Lord Russell-Johnston, suggested that many doctors in this country already practised euthanasia. I do not believe that they do. They practise what we in our committee report endorsed as double effect. In effect, it means that, if it is necessary in order to relieve pain, distress and suffering, to give such doses of medication as may have—not invariably—the secondary consequence of shortening life, that is perfectly acceptable in law and in medical practice. I admit that some philosophers regard that concept of double effect as hypocritical, but it has been practised widely for very many years. I believe that the use of that double-effect principle produces death with dignity.

Perhaps I may now raise one or two points from the report produced in 1994. We totally accepted the concept of informed consent to medical treatment and endorsed the right of a competent patient to refuse consent to any medical treatment, even if that ultimately resulted in death. We also confirmed that there was no obligation on the healthcare team to embark on or to continue with futile treatment that added nothing to the well-being of the individual as a person. We endorsed advance directives. I have signed an advance directive, which makes it clear that, if I become incompetent or terminally ill, I would not wish to be subjected to certain forms of life-prolonging treatment.

As the noble Baroness, Lady Wilkins, said, many of us had experience of relatives or friends whose dying days or weeks were less than peaceful or uplifting, or
 
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whose final stages of life were so disfigured that the loved ones seemed already lost to us. However, we did not believe that those arguments were sufficient reason to weaken society's prohibition of intentional killing, a prohibition that is the cornerstone of law and of social relationships. It protects each one of us impartially in the belief that all are equal. We did not wish that protection to be diminished, and we therefore recommended that there should be no change in the law to permit euthanasia or physician-assisted suicide. In fact, we found that it would be virtually impossible to ensure that all acts of euthanasia were truly voluntary and that any liberalisation of the law would not be abused. I appreciate that many Members of your Lordships' House have expressed concern about the concept of the slippery slope, but the possible erosion of any such legislation, whether by design or by inadvertence, or by the human tendency to test the limits of any regulation—as has clearly happened with the Abortion Act—gave us concern.

I was gravely concerned by what I found in Holland 14 years ago. The situation was that euthanasia was not legal—it was legalised in 2001. Every year, more than 1,200 individuals were subjected to voluntary euthanasia under certain conditions, but more than 1,000 were subjected to non-voluntary euthanasia because they were neither competent to withhold or to give consent. The Royal Dutch Medical Association now says that doctors can help patients who ask for help to die, even though they may not be ill but simply suffer through living. That is a situation and a recommendation that goes far beyond what I would regard as acceptable. As others have said, our committee was concerned that vulnerable, elderly, lonely, sick or distressed people would feel pressure—whether real or imagined—to request early death.

This is a carefully phrased and well-balanced report, but, having considered it carefully and having looked in detail at my noble friend Lord Joffe's Bill, I have to say, after almost 60 years of medical practice and having looked after many dying patients in the course of my professional career, that even with amendment to remove the voluntary euthanasia section, I cannot support it. In all conscience, I would have to oppose it.

6.56 pm

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