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Baroness Chapman: My Lords, I have read the report we are now discussing. There are several issues that I could talk about, but I shall start by telling your Lordships about my experience of terminal illness.

My mum died of cancer 16 years ago. She was diagnosed with it 11 months earlier. It was not a pleasant experience. To watch someone you love die is
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indescribable. When it became obvious that the cancer was winning, mum chose to go into Wheatfields Hospice in Leeds. She was expected to live only a few days when she was admitted on 9 August 1989. She died in the early hours of 9 September 1989.

We had a whole month of borrowed time. Mum had her 53rd birthday. I think back to that month. How can one month be the best and yet the worst month of your life?

Our whole family have so many memories of that month. Yes, they are tinged with sadness but they are good, positive memories. Mum's pain was controlled and we had the illusion of improvement because of the skills within the palliative care team. She concentrated on her family, ensuring that we all had strict instructions to look out for each other. My life is better for having those memories.

If a Bill such as the present one had been in place we may have been deprived of those memories. Mum was, unlike me, a quiet, reserved person who hated to inconvenience anyone and worried about the stress her illness put on her family. I dread to think what choices she may have made to protect her family.

It was my first experience of palliative care. Do we want to jeopardise that kind of support, not only for the patient but also for the family?

When I began writing this speech, I wondered how to explain my concerns. Then I remembered a debate I took part in which I feel explains how I believe this Bill would affect society's attitude to people with chronic, long-term and terminal conditions.

I received a phone call from Radio Scotland asking whether I would take part in a live debate on the support for parents of disabled children with terminal conditions. The trigger for the debate was a man who was appearing in court for killing his 10 year-old son. The son had a condition where his life expectancy was 14 to 20 years. His father admitted smothering him, but was claiming that it was a "mercy killing".

I took part in the discussion. Also speaking was an MP from the Netherlands. As noble Lords can probably guess, I was defending the child's right to live his life to the full. The MP said that euthanasia was a great idea and that "they"—whoever "they" are—believe a child as young as seven knows whether he wants to live or die. I was appalled. I told him that I would not let a seven year-old child choose his menu for a day. His response was that a "good parent" would do this for his child. At that point I told him that that was an insidious use of language. His statement implied that only a "bad parent" would want to keep his child alive. He did not respond.

Bringing up a child is not easy. Doing what you think is right for a disabled child increases the pressures a thousand-fold. This Bill does not cover children, but if it becomes law we will be on an inevitable path that will be a very lonely and frightening one for many people. For all the report's claims that society will not change its attitude to life and terminal conditions, I feel that that story shows fully the reality of that kind of law on societal beliefs.
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I firmly believe that palliative care should, and indeed must, be available to all, as very few people are aware of the range of support that it gives. However, there are no guarantees of palliative care within the Bill and, without considering the multitudes of other issues involved, people who are in pain and do not receive emotional and/or physical support may choose that option. They do not want to die, but living without the pain control and support is untenable.

I am concerned about other things: the terminal diagnosis and the fact that many people live way beyond their expected lifespan; the two-week delay for people to change their mind is a very short time and gives people no time to adapt to their new situation. Lots of people adapt to chronic, long-term, life-threatening conditions. They get on with their life and enjoy their right to life. In giving people the right to die, we must not jeopardise people's right to life.

8.51 pm

Lord Cavendish of Furness: My Lords, I have listened to many outstanding contributions this afternoon and the last one, by the noble Baroness, Lady Chapman, is among them.

My interest in this debate, which I now declare, stems from my having been in the late 1980s among the founders of St Mary's Hospice, Ulverston in Cumbria. I have had continuous involvement with it and am its current chairman. Not unnaturally, I believe with great passion in the work done by hospices in Britain and I also believe that there remains almost unlimited potential for development and innovation in this sphere of palliative care. I and many others touched on that in the debate initiated by the noble Baroness, Lady Finlay, just before the Summer Recess.

That belief does not blind me to the possibility of the law being improved as it applies to those few people whose suffering is most terrible and intractable and who, in full possession of their reason, wish to terminate their lives. I have no quarrel with the humanitarian motives that lie behind the proposals. However, I would be most uncomfortable if the Bill were to come into law as it stands and even more uncomfortable if it ran its course without serious consideration being given to the concept that palliative care, allowed and encouraged to continue its development, could in fact make the Bill redundant.

The very distinguished work of the Select Committee under the chairmanship of my noble and learned friend has rightly been widely praised. However, I feel that it was flawed in one respect. The committee travelled and consulted widely but, for reasons I still do not understand, its members did not visit a single hospice. The same point was made by the right reverend Prelate the Bishop of London and my noble friend Lady Cumberlege. Of course, comparisons with other countries and cultures have enormous value, but they also have serious limitations. I would make the point that, whereas consistent threads run through palliative care as practised in British hospices, the GP-driven model as practised in
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the Netherlands is striking for its difference rather than its similarity. I have no doubt that it works for the Dutch, but we are not legislating for the Dutch or the people of Oregon; we are contemplating a major Bill that affects British people. The committee was of course right to go to Holland and elsewhere; but it would have been better still if it had seen at first hand palliative care as practised here.

The Select Committee makes the point that however good palliative care is in Britain, its provision is uneven and therefore inequitable. A major contributory reason for that state of affairs which I offer to your Lordships, in case the Minister forgets to, dates back to the wretched and nakedly political action on the part of the Government when they first came to power in 1997 of removing the financial weighting that enabled rural areas to match in quality the services offered by their urban counterparts. That has caused untold harm and difficulty to providers of public service and it is high time it was revoked. I am struck by how little the Minister, who is not in his place at the moment, has to answer today, but perhaps, with his customary helpfulness, he can give me some reassurance when he comes to reply.

The people covered by this Bill endure the most extreme forms of suffering. It was suggested to the Select Committee that between 3 and 7 per cent of deaths fell into such a category. The experience at St Mary's, the hospice with which I am involved, shows that such extreme distress, which can manifest itself in suffering other than physical pain, is present in about 1 per cent of deaths that occur with us. That is lower than it used to be. The trend is for it to fall still further.

A combination of increased skills and experience, newer and improved drugs, and an increased confidence on the part of patients and their families that they will not be abandoned—which is a very important phrase—gives me grounds to believe that the suffering that this Bill addresses can in time be removed through the agency of palliative care as practised here in Britain.

It is claimed by some that doctors and health professionals regularly break the law or at least interpret it liberally in order to relieve suffering. I am sceptical. One reason for my scepticism of such claims is that there has never been to my knowledge even the smallest suggestion by any of our staff that a change in the law would improve our care. On the contrary, it is the unambiguous opinion of our medical director that the accepted definition of patient autonomy has stood the test of time and is not in need of improvement. I sometimes wonder whether the noble Baroness, Lady Tonge, has been in a hospice, because autonomy is central to our philosophy. We consult first and foremost the patient.

Many noble Lords asked why not have both palliative care and assisted suicide. This debate, which has attracted wide media coverage, is already causing unintended consequences. There is a substantial and increasing incidence of patients arriving at our hospice in varying degrees of agitation. Nothing saddens us more than when they ask anxiously if we are planning
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to terminate or shorten their lives. It usually takes between 24 and 48 hours before an acceptable level of trust can be restored. After that, usually, no more is heard in that vein. But, in some contexts, 24 hours of fear-induced distress is like a lifetime. Most of our in-patients admitted for terminal care have, on arrival, a life expectancy of up to 14 days. During that time, in an overwhelming majority of cases, the patient and his or her family and loved ones will find safety and comfort. The patient's pain will be controlled and pleasures will be experienced. There will be laughter and a newly won peace of mind is often powerfully evident.

However well meaning the Bill—and I have no doubt of that—it casts yet another shadow among vulnerable people whose lives have already been shattered by debilitating illness, pain and fear. It has undermined the trust that we so critically need at the moment when desperately ill people turn to us for safe haven. And that is not all. If and when this Bill passes into law, I have forebodings about what might become the culture of the future. Already we talk of an "ageing population". It is possible to picture a new generation, oppressed by a mix of global instability and economic failure, turning on the ageing population whose patrimony we have squandered and whose liability they inherit. In this nightmarish future age, it will become the duty of the old, the ill and the frail to die once they have outlived their economic usefulness. I regret to say that this Bill paves the way for such a future, bereft of all humanity. If that is thought to be fanciful, I suggest noble Lords talk in depth with those who live at the rock-face of palliative care. The truth is that they will find that what I am suggesting is already beginning to happen.

Echoing the speech of the noble Lord, Lord Carlile, the stark statistics coming from the Netherlands in respect of large numbers of euthanasia deaths occurring without consent, and the alarmingly small proportion of such deaths being reported as Dutch law requires, hardly inspires confidence. Even if these departures from good practice can be explained away, it illustrates vividly how difficult it is to legislate on such sensitive matters and perhaps explains why wiser generations in the past have shown caution. Many noble Lords have spoken about the importance of safeguards. The trouble is that safeguards are at the heart of this matter and, as the noble Lord, Lord Phillips of Sudbury, said, they are elusive.

I hope that we, too, will tread with caution and divert the entirely benign commitment to relieve human suffering into the field of palliative care, which I believe stands on the threshold of its greatest achievements.

9 pm

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