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Lord Brennan: My Lords, this debate should not be afflicted either by religious extremism towards the secular thinker or secular bigotry towards the religious believer. It is important—is it not?—that we attach to this problem disciplined thinking and clear analysis. After the rather ironic comments suggesting that a secular contribution is the expression of an opinion but that that coming from a religious believer seeks to impose an opinion, I am gratified that my noble friend Lord Plant, a good Christian man, in his reasoned analysis supports the Bill. I will seek to emulate him as a Christian by opposing it by a reasoned analysis.

The present law forbids euthanasia because it is thought that that state of the law protects the common good. The Bill will damage the common good in the following ways. First, patient autonomy cannot prevail against the common good. There is no right to assisted dying. To assert that assisted dying is a private matter is an abuse of language. It occurs because you need a doctor or a nurse to effect the conclusion. To say that a doctor who refuses to do that is playing God I find incomprehensible. If his duty is to preserve life and he wishes to have no part in causing death, the concept of playing God becomes bizarre.

The state exists to protect people against intentional private killing. It is completely illogical to suggest that laws directed at preventing it or allowing it are not public but private. If it is allowed, it will damage the common good. First, it will produce a divided profession. The noble Lord, Lord Patel, tells us that medicine is divided on the issue—we do not know in what proportions. If it is divided, what happens to the medical ethos? There are those who wish to preserve life—within reason—and those who will be ready to end it on request. That is a fundamental difference of ethos, so described by the BMA in spring last year.

What of the example of the hospice patient, as the noble Lord, Lord Cavendish, described? Is the fear and apprehension that is created in the common good? How many patients are we talking about? Are we talking about the 350 or 360 that the noble Earl, Lord Arran, mentioned, or the 650 which the noble Lord, Lord Joffe, mentioned on the radio this morning? Are we talking about the intelligent, clear-thinking, controlling minds or are we talking about everyone? I have found the presentation of the debate thus far by its proponents to be extremely confused.

If assisted dying is only for the intelligent clear thinker, why so? Why discriminate against those with a marginally less intelligent analysis but who have the same emotional desire? These are all serious questions. Who is to perform the act? Is it to be by prescription through the doctor and not by dispatch from the doctor? If it is not dispatched by the doctor, who is going to do it? The patient will receive it from
 
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someone. How do we control it? To put it bluntly, do we have some kind of "Ofdead" regulatory system in this field of life and death? It seems astonishing.

I shall make two further, short points. When the disabled people we care for seek our help for their needs, are we to patronise them when they express to us their fears? What will happen in the future if quality of life is a factor in the giving or withholding of treatment? Is it sensibly to be argued that some doctors will not take into account the economic factor in determining whether to end a patient's life at their request, or even advise them in a way that is directed at the economic well-being of other patients who need treatment? It is too idealistic to think that that will not be the fact.

As regards the slippery slope, looking at this issue with intellectual discipline, I find it surprising that, from Oregon, the Netherlands and Switzerland, a system of self-reporting by doctors should be regarded as a proper analytical basis for considered action of this gravity. Would we do it in any other walk of life? Of course, we would not.

My final point is on the position of the medical profession. If the common good wants trust in doctors, doctors should tell society what they want to give society through medical care. The BMA maintained its position for 30 years. It has changed it in a rather tawdry exercise in procedural stratagems. It did so with an 11-vote majority on a vote of 175 from a membership of more than 100,000. Let us compare that with the Royal College of General Practitioners. When its executive sought to be neutral, it insisted on its members' opinion being taken and the majority clearly went against euthanasia. That has not happened yet with the BMA.

This report is surely the occasion for informed debate by the public. Paragraph 232 and Appendix 7 categorically warn against the present state of public opinion being thought to be reliable. It clearly states that we need further work. I conclude with one short remark. No one who values liberty should want to reduce the ending of life itself to just another lifestyle choice. Is that the society in which we live.

9.19 pm

Lord Neill of Bladen: My Lords, I begin with an apology. Regrettably, I had duties to perform in a court of law and could not be here at the start. To some extent, I had the compensation of having heard the noble Lord, Lord Joffe, on the "Today" programme, so I got some of the highlights from him then—and, of course, we have debated this matter before. The other thing to say at the outset is to declare my total absence of any qualification for speaking on this subject; only the fact that I have lived entitles me to speak.

I hope that the noble and learned Lord, Lord Mackay of Clashfern, will not be embarrassed if I add my voice to what is now a chorus of eulogy for the excellent quality of the report, the manifest skill with which he must have conducted the committee—as one
 
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can read between the lines—and also for assembling such a massive body of excellent and very interesting evidence. The only way in which to set the House ablaze at this hour would be if I were to say that I did not think that it was a good report; I would be the first person to say that and it would be an absurd opinion to enunciate.

The noble Lord, Lord Walton of Detchant, is with us; I have found his earlier report greatly fascinating to go back to. He, too, assembled some great evidence. The House of Lords can be really rather proud of the written record of the testimony that has been established in this field. I have not done the research, but I would guess that it is without parallel anywhere else, as it is really magnificent material.

I spoke to an earlier version of the Bill, which is recorded in Hansard. My concern was in particular with the vulnerable, and I have not been persuaded that that issue has disappeared or has been taken care of. I want to make a few observations on one or two points.

It is funny how words can appear on the scene and then assume an extraordinary dominance, as has happened with the word "autonomy". We have been talking about patient autonomy—but I wonder whether I have autonomy as a non-patient. I find that I have not, as I am controlled in everything I do by law and morality, in my profession by an ethical code, and in private life by all the bonds that we all have of love and affection. As for oaths, we have the astonishing Clause 10(3), to which noble Baroness, Lady Cumberlege, drew attention, which means that what is now a breach of an oath will be deemed not to be so. One might ask oneself what Parliament is doing in encouraging people to be false to oaths that they gave on entering a profession. That is very strange—but no doubt a point of detail.

As I do not believe in non-patient autonomy, naturally I do not find patient autonomy a very convincing idea. It seems to elevate a personal choice in some agonising and heartbreaking cases, such as the noble Lord, Lord Puttnam, described. One could not hear about those cases without thinking that they were absolutely terrible and that it would be marvellous if somebody removed that person from the Earth. But one is balancing that against the widespread effects of introducing a Bill, which may subsequently be an Act, along the lines proposed.

Four areas concern me. First, we know that a lot of the medical profession are strongly opposed to the proposals. What would be the practical effect? Imagine an appointments committee looking for a registrar, perhaps, in a hospital. Would it be legitimate for that committee to ask, "Would you mind telling us how you stand on the assisted dying question? We have had a number of those cases lately. Of course, it is a difficult choice, but this is a very strong field of competition". One can imagine such a situation.

Secondly, the proponents of palliative care and the hospice movement have given their evidence. There is the evidence from the National Council for Palliative
 
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Care in volume two of the report, on page 151—but I need not go into that; if one goes to the fons et origo, Dame Cicely Saunders, one finds:

"We believe that euthanasia or assisted suicide is socially dangerous and a negative answer to a problem that should be tackled by other means".

That is a quotation from volume two, on page 101. There is unanimous opposition from the hospices, and this evening we have had the advantage of hearing the direct and compelling evidence from the noble Lord, Lord Cavendish of Furness, who spoke about a particular hospice.

With regard to the nursing profession, I believe that it is unfortunate that there has been some challenge to the evidence given by the Royal College of Nursing—but nevertheless it seems to be the case that a significant body of nurses want to have nothing to do with the Bill or the ideas underlying it. An interesting sub-issue was raised as part of the nursing evidence, as a very substantial percentage of the nursing profession comes from overseas, and a large number of those come from Catholic countries. So very severe problems might be encountered with the nursing profession in that respect.

I turn to my fourth category of people whom I am worried about—people whom I then called "the vulnerable". I was rather surprised to see that the people subject to hidden pressures are classified as a sub-head of the slippery slope. As far as I am concerned, they are not on any slippery slope; they are bang on the level with the whole of the proposals. They are an integral part of what is proposed. We have a lot of evidence that people will feel—I am not talking of a Balzac scene of a family persuading an old person that it would be better to sign his or her death warrant—that they should not be here and that they are taking resources from the family. Paragraph 97 of the report states that Dr Jim Gilbert raised the concern,

"that some patients, while not opting for ending their lives, would feel themselves to be presented, if the law were to be changed, with an ongoing choice to be made".

"Ongoing choice" are brilliant words—the matter would not go away. A person would be thinking about it six months or nine months later, depending on his or her condition.

Finally, I am troubled about the safeguards. The very first safeguard at Clause 2(2)(a) states:

"The attending physician shall have been informed by the patient that the patient wishes to be assisted to die".

However, the noble Lord, Lord Joffe, said that his intention was that the patient must initiate the request. However, the report points out in paragraph 24 that,

"nothing in the Bill . . . prohibits a doctor or nurse suggesting assisted suicide or voluntary euthanasia to a patient".

So the first condition is really a non-condition—simply that the patient says, "Doctor, I have a bit of paper for you. I would like to die", but you do not investigate the prior conversations.

Like the noble Baroness, Lady Finlay of Llandaff, I was greatly struck by the evidence of the woman reported in volume three who for 10 years, according to her testimony, said that she wanted to die and tried
 
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to commit suicide but finally, over the past nine years, has turned into a campaigner for the disabled both in this country and in India. That was a remarkable testimony. If the Bill had been in place, she would have been dead many years ago.

9.27 pm

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