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The Earl of Glasgow: My Lords, as a latecomer to this continuing debate on the question of whether in certain circumstances we should legalise "assisted suicide" and/or "voluntary euthanasia", I am most impressed by the amount of time, care and detailed research that has already been done on this very
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sensitive subject, particularly in the well considered report from the Select Committee which, in theory at least, we are now considering. I am only sorry that any law that might resolve this issue still seems such a long way away.
As the noble Earl, Lord Ferrers, reminded us, most of us, to a greater or lesser extent, fear death. As we know, it comes to us all sooner or laterperhaps sooner rather than later for the majority of us in this House. But sometimes I wonder whether it is really death itself that we fear or rather the manner of our death. We fear terminal illness, pain, indignity and, for instance, the inability to perform natural functions without the help of others. We fear becoming a permanent burden. We fear losing our minds and no longer being able to express our feelings and anxieties. The reason is that we have all seen these conditions in others, and it is particularly distressing when we see them in the ones we love. But perhaps our greatest fear is our helplessness, the fact that we will have no control over our own death. It is because I believe that we should have the maximum possible say in the manner of our death that I support voluntary euthanasia, whether administered by oneself or by others.
The most usual argument against voluntary euthanasia for the terminally ill is that once it becomes legal, it could be abused for selfish or even criminal ends. Old, infirmed grandmothers are often cited as the likely victims: still with a desire to go on living but encouraged, pressurised or bullied into believing that they have become an intolerable burden on the rest of the family, and eventually agreeing to have themselves put down. But as has already been pointed out by other speakers, and has been demonstrated in countries where conditional euthanasia has been legalised, adequate safeguards have been introduced to protect vulnerable people against such situations. The same will surely happen here.
A much greater threat to the infirmed and terminally ill, and a point mentioned by my noble friend Lady Tonge, is exactly the opposite. It is our desire to keep the ones we love unhappily alive for as long as possible, long after they themselves might have hoped to go. It is for emotional, sentimental, ethical, often self-interested and sometimes religious reasonsnot from any fear of the lawthat most of us are reluctant to hasten the inevitable death of the terminally ill. Surely, whenever practicable or possible, it should be the wish of the dying person, not that of doctors or even the next of kin, that should prevail.
If your Lordships have not already done so, I recommendno, as did the noble Lord, Lord Puttnam, who is not in his place at the moment, I insistthat they see a film called "The Sea Within". It is a Spanish film made by Alejandro Amenábar which came out earlier this year and can now be bought on DVD. It is a dramatised version of the true story of Ramon Sampedro, a quadriplegic paralysed from the neck down who became a Spanish cause célèbre when he embarked on a 30-year battle with the Spanish authorities, requesting that they allow him to die, as he put it, "with dignity". In the event, partly no doubt
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because Spain is a Catholic country, he failed to move them and had to devise a method of having himself put to death in such a way that none of his accomplices could be prosecuted for having assisted him.
It is a beautifully made film, and not morbid or sentimental. In fact it is quite funny in parts and, through the characters, presents all the arguments for and against euthanasia in a very comprehensive way. There is a particularly poignant moment when one of the characters, a girl who is always by Ramon's bedside and professes love for him, is asked by him to assist in the engineering of his own death. Horrified, she says, "Of course not. I love you". He replies, "No. If you really loved me, you would help me do what I really want".
We all know what a complex and delicate issue this question of euthanasia is. Every case is slightly different and our own views are largely coloured by our own personal experiences, particularly by the nature of the deaths and suffering of some of the people that we love. But one set of circumstances still seems to me relatively straightforward: a person with a terminal illness, who is still in full possession of his mental faculties but has lost control of all or some of his physical ones, and is clearly not suffering from any form of clinical depression, who wishes, begs, demands assistance to end his life, and persists in this demand for, say, six months, should be given every assistance to have his wish granted, regardless of the views of the doctors or of his family. This surely should be an automatic human right. It is a mystery to me why so many honourable and caring people believe that it is their duty to keep someone alive as long as possible when that terminally ill person has unambiguously stated that that is not his wish.
I hear that the noble Lord, Lord Joffe, may agree to amend his proposed future Bill to limit assisted dying to those who are not only terminally ill but also suffering unbearable pain. If true, this is an unnecessary limitation and complication. But I will still support all his proposals as a first step in getting the law to accept the important principle of assisted suicide and voluntary euthanasia.
Baroness Murphy: My Lords, we must all be brief today. I want to do no more than indicate my support for the introduction of a very limited Bill to enable those with terminal illness to request help to die.
I have changed my mind over the past 20 years from being actively against such a measure to being a strong supporter. Indeed, my first letter to the British Medical Journal in 1984, on taking up my chair at Guys, was on this very topic. It would have done credit to the noble Baroness, Lady Finlay; she would have been proud of me. But over the past 20 years, I am afraid, my patients and their families have changed my mind and it has now become a moral issue for me that we should respect the diversity of patients' wishes in the last days of life, just as, as doctors, we are beholden professionally to respect their wishes at other times.
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We have said with some force that we do not always respect an individual's autonomy of action where a decision may impact adversely on others. Certainly we all know that a patient's suicide during a depressive illness can have a profound and widespread distressing impact on other family members, even to the next generation. In practice, however, patients with terminal illness are in a very different position and relatives are almost always sympathetic to the wishes of their suffering loved one, even when they do not agree with the course of action they wish.
How do I know this? I worked as a gerontologist and psychiatrist in hospital and community services for most of my working life. In hospital practice we have a category called "no psychiatric disorder". This includes those referred by another hospital consultant with a request to "query depressed suicidal thoughts"; patients near the end of long and wearying illnesses who think the time has come to go and feel trapped inside the business of being and yet no longer have the physical means to end it. Of course, if they do, they make their own decision.
As has already been said, these people are quite distinctive personalities and often not very easy patients. They hate above all the prospect of total dependence on others, detest losing control and are unwilling to sacrifice their individuality to institutional norms. They want to be in charge of their fate and it is the uncertainty about the end that is distressing to an unbearable degree. It is scarcely ever a matter of pain control, although, as we know, there is insufficient expertise in the palliation of pain and the expansion of palliative care services to the very old and those with longer term terminal conditions is long overdue. No, it is not that. What causes their unbearable suffering is remediable not by medicine or psychological supports but by respecting their wishes and supporting them to choose their own time of death. I can think of no greater privilege, as a doctor, than being trusted to help make happen a person's final wish.
I remind noble Lords that this limited Bill proposes that a prescription be given and that the person concerned makes the final decision. Most people will be sufficiently helped to feel in control if they just have it available and can think about it. From what we have heard, only a third or so of such people would ever take it. Of course, there are many others. As a psycho-geriatrician, the majority of people I see have treatable, reversible depressions during terminal illness. Others go through periods of hopelessness after diagnosis or after a particularly gruelling course of treatment and come out of it again. You have to sort out one from the other. That requires strict safeguards, but I believe it is possible to make these distinctions, which I hope to address at greater length in some future debate.
For the moment, I should like to praise the quality of the committee's work, which I found enormously helpful in setting the international scene. Of course those who take the religious view that only God can decide when life begins and ends must always reject the notion of assisted dying. I understand that. But for me
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and for many others, particularly in those parts of the medical profession that are changing their mind, human suffering demands a human response.
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