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Lord McColl of Dulwich: My Lords, perhaps I may point out that we do not cut for stone. It is done with
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a machine that smashes up the stone inside you and the dust is then passed. We do not cut for stone—unless we really have to.

Baroness Tonge: My Lords, I am well aware of that, but we went through the stage of cutting for stones. Indeed, many members of my family were relieved of their gallstones and were very grateful for it. I do not think that lithotripsy is used for gallstones, but I may be mistaken.

Lord McColl of Dulwich: It is, my Lords.

Baroness Tonge: My Lords, I want to address common concerns expressed in letters that I have received from all over the country by referring to replies from—yes—the Oregon Medical Association and the Dutch Medical Association in response to questions that I put to them. Neither of these organisations gave evidence to the Select Committee, but they are representative of doctors who are putting the law in their country into practice.

Many articles have been written and talks given. I have received many letters expressing worry that the disabled, the elderly and the terminally ill will be under pressure to die to save relatives or society the pain of looking after them. In my experience, the reverse is often true. It is the relatives themselves who cannot bear the thought of the death of a loved one and so will encourage those people caring for the dying to keep their loved one alive at all costs. In our modern society, it is death that must die in many people's eyes. Many hospital doctors are afraid that relatives will sue if they think that enough was not done to save their loved one, so the suffering is prolonged.

I have seen people kept alive at all costs. People are tortured to death—I mean that—instead of being allowed to die with dignity and in peace. My noble friend Lord Carlile said that he preferred death by nature. I wish him luck. If he prefers death by nature, he should not go near any doctors when he is dying, because I suspect that that would not happen.

Lord Carlile of Berriew: My Lords, I cannot allow my noble friend to get away with that. She has grossly misrepresented what I said. I did not say that I preferred death by nature. I said that death as a natural process and through disease seemed to me to be at least as dignified as having someone else end your life for you. That is a completely different point. I ask my noble friend not to misrepresent what I say.

Baroness Tonge: My Lords, I thank my noble friend for clarifying his position, but I urge him to think very carefully about it, because we would all like death by nature, but as I said earlier, a lot of people do not achieve that because other people will not let them have it. They prolong their lives unnecessarily.

When asked whether they had had any evidence of vulnerable people being forced into receiving assistance to die, both the Oregon Medical Association and the Royal Dutch Medical Association said that they could not give any examples. The
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patients to whom we are referring in this regard want to maintain control over their life and death, and they can do so in Oregon and the Netherlands.

Asked about the "slippery slope" argument, both Oregon and the Netherlands responded with demographic evidence that the law is being used as intended and that the number of people opting for doctor-assisted dying is stable and not rising. Evidence from the United Kingdom published in the Lancet a year or so ago, to which I believe my noble friend Lord Russell-Johnston referred, suggests that there are already about 18,000 medically assisted deaths in the UK per annum. I do not know where that figure comes from, but presumably those assisted deaths are performed by doctors without any regulation or oversight. I wonder how many of those deaths were done with informed patient consent. Surely that could be the slippery slope that we so dread. It must be regulated, and the doctor-patient relationship must change, with patients being in control of their lives and their deaths, not the doctors. The Oregon Medical Association found it difficult to assess whether the new law had affected that relationship, while in the Netherlands the problem had been the number of doctors who refused the patients' request; they said that 66 per cent of requests were not met because the doctor felt that the criteria for assisted suicide had not been met.

The problem of palliative care was another question posed. As we have heard, some practitioners of palliative medicine claim that if we had better facilities in the United Kingdom, no patient would want to be helped to die. I would argue with that. Pain and its relief is not the only issue; total paralysis is the fear of many with incurable neurological disease. The most famous cases, such as that of brave Diane Pretty, fall into that category. No palliative care can alleviate the suffering of total paralysis, being unable to speak, swallow, blink or scratch—a complete nightmare. Many patients in intractable pain would prefer not to end their days in a diamorphine-induced trance, unable to communicate with their loved ones properly and eventually succumbing to the "double effect" when their breathing fails. Palliative care is much needed for those people who want it, and the responses from the Oregon Medical Association and the Royal Dutch Medical Association—from authoritative associations—suggest that the reverse is true of the fears expressed in this House. In Oregon, task forces delightfully called "comfort teams" have been set up to help clinicians, and they say that no one in Oregon now goes without palliative care if that is what they want.

In conclusion, many of the objections to doctor-assisted dying come from people with a political-religious viewpoint—which is fine for them, but they should not impose their view on others. Many other objections are based on anecdotal so-called evidence, which is inadmissible. We have assurances from both the medical associations that have seen the proposals in practice. We hear much about choice nowadays; terminally ill patients have a right to choose, too.
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Whether they choose palliative care or assisted suicide or opt to continue suffering is their decision—and they must be allowed to decide for themselves.

The Lord Bishop of Winchester: My Lords, before the noble Baroness sits down, is it her view—as it appears to be the view of others—that those who speak on these issues in the public domain from a position of religious faith are uniquely disqualified from doing so because that is among the positions from which they speak? Has it also occurred to her that bishops and others who speak on these matters do so in part out of a centuries-old tradition and from experience of being alongside people who are dying? Not only medical and nursing practitioners but clergy and ministers, too, speak out of that continuing experience—bishops continue to be priests and pastors. I wonder if those questions have informed the things that the noble Baroness has been saying.

Baroness Tonge: My Lords, it is very important that bishops and priests continue to express their views on these issues from their religious background, because those who hold those religious beliefs want to hear what they have to say about them. Indeed, they have much experience and I would listen to every word that they say; I frequently hang on the words of the right reverend Prelate the Bishop of Oxford, who is frequently on the "Today" programme, because he is so wise. I am only saying that one cannot legislate for other people from a religious point of view; it must be their decision.

7.45 pm

Lord Tombs: My Lords, I first join others in congratulating the noble and learned Lord, Lord Mackay of Clashfern, and his committee on dealing with such a complex and emotional subject in so careful and sensitive a way. I will not repeat the arguments so clearly set out in the report and expanded upon by previous speakers. The issues are by now clearly understood, and personal autonomy plays a major part in the arguments.

For my own part, I believe that regard for personal autonomy has played too large a part in recent developments of society and a growing recognition of this appears in the constant pleas for a recognition of individual responsibilities to accompany discussion of individual rights. But what I believe has gone unrecognised in the general discussion is the role of the law in maintaining the delicate balance on which the stability of society depends. A right, once recognised by law, is unlikely to be withdrawn, and a more likely development is a steady extension by seemingly marginal amendments. Hence the "slippery slope" becomes in practice a "legal ratchet"—a fact well recognised by human rights campaigners and exploited by them with considerable success. The extension is presented as small and so is perceived as unimportant compared with the large, earlier step.

Even more dangerous than this mechanism of gradual extension is what might be described as the background effect of the law in shaping society's
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values. The fact that something previously illegal becomes legal, albeit under clearly stated conditions, is in a real sense permissive and even encouraging. The general public perception is one of relaxation of previously condemned behaviour and a resulting relaxation of controls without a perceived need for any further legislation. Such a development has occurred in abortion practice, where the legislative safeguards have become steadily eroded in practice, with no resulting enforcement action. This increased disregard of carefully constructed law is unhappily present in Holland, where evidence to the committee showed a substantial number of cases of what is euphemistically termed "involuntary euthanasia", when a doctor has killed a patient without that patient's consent. That is not even assisted suicide, it is quite simply murder, although it has resulted in no prosecutions. This startling development was accompanied by an admission that 46 per cent of cases of euthanasia are not even reported, despite a legal requirement to do so—again with no enforcement action. It is hardly surprising, then, that some elderly patients in Holland choose to go to Germany for medical treatment.

It is clear that the bulk of the medical profession in this country is strongly opposed to this Bill, in spite of the disreputable manipulations of some supporters of euthanasia in the councils of some medical organisations. Happily, the general opposition remains unaffected and I would like to pay tribute to the vocation of healing that underpins that opposition. The UK scene differs from that of most countries in that we are comparatively well provided with hospices for the terminally ill, a provision which is gaining ground worldwide. The founder of the movement, the late Dame Cicely Saunders, pioneered pain management and produced that memorable aim, "dying with dignity". Today, the philosophy of the hospice movement is,

What a wonderful contrast to the bleak notion of assisted dying! Palliative care, too, is an area of medicine in which Britain is a world leader. Many patients have died naturally and with dignity as a result of adequate and supportive palliative care. Unhappily, neither of those initiatives has received adequate government support. The hospice movement remains heavily dependent on voluntary support and palliative care is not readily available in many areas of the country. As the voice of society, the Government bear a heavy responsibility in these areas and I hope that the Minister will address the problems in his closing speech.

Respect for the life of the individual lies at the heart of society, and a departure from that long-held position, at a time when pain control and palliative care are at an all-time high, seems to me perverse in the extreme. The difficulties of reliable prognosis of terminal illness and the pressures which can so insidiously creep into the minds of sufferers should themselves make us reject the proposals of the Bill of the noble Lord, Lord Joffe. I shall do so in the event of its return to this House.
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7.50 pm

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