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Lord Lucas: My Lords, I was very happy to discover that the noble Baroness, Lady Murphy, has covered a lot of what I wanted to say, so I hope that I can be reasonably short. I felt totally in tune with her speech. I have seen this process at first hand a couple of times. Fortunately, they fell into that Hippocratic divide—the double effect—where it was possible for a doctor to treat the people concerned in a way which enabled them to die when they wanted to because of the particular conditions in which they found themselves.

I do not see that as any different from assisted suicide. It looks exactly the same from outside. A patient is offered an alternative, chooses death and dies. I really do not see as relevant the fact that the doctor under those circumstances by some trick salves his or her conscience, or is perhaps happy with the process anyway. In both cases everyone involved—the patients, their families and the more remote people involved—was profoundly grateful that that option was available. Those events happened some while ago now but, looking back on them, I found them a joyful experience. What was achieved was something that everyone felt was right. The goodbyes were said, the suffering was avoided, the end was what the patient wanted and the rest of us understood, consented, went along with it and were part of it.

So the process is there. It is already with us but it is not available to the relations of the noble Lord, Lord Puttnam, because they happen to fall on the wrong side of some line. It would not perhaps be available to the noble Lord, Lord Desai, when he wanted it. Why should he not be able to sit down with his wife at his side and have her assistance to bring about his end, if that is what he wanted and she consented to? In what way does that trouble other people's existence if that becomes possible? We have accepted that people can kill themselves. I suspect that many of us have difficulties with that. Some people do not really like the idea of us having the right or ability to end our lives when we wish. Most of us are conscious of the harm it does to do it out of time. But to do it properly, in a way where everyone is drawn in and there is consent and understanding, is a joyful experience; it is not terrible.

A number of the problems that have been raised relate to the medicalisation of the process. I do not see why doctors should be involved; the Swiss do not involve doctors. I want someone whom I love next to me should I choose that way out; I do not want it done impersonally by a doctor. I would not impose it on a doctor that I know, and I certainly do not want some impersonal doctor. What I require of the medical profession in these controlled days is the means. It is not fair to chuck yourself in front of a bus or train, or even off Beachy Head, or to cut your wrists in the middle of a field. It imposes so much difficulty and inconvenience on other people. To do it in a way where
 
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you do not impact on society requires someone's help to make it possible. I can no longer have a revolver in my drawer; a knife is an extremely messy and uncertain business. Medication is the most sensible way of doing it. If there was a court procedure or if there was some other means of proving that what was being done was right and was not murder, and I just took the relevant prescription along to a chemist and got the dose, why the need to involve a doctor at all?

I very much hope that this debate, if not this Bill, will lead to the facilities that happened to be there for two people I loved being there for me when my time comes.

9.31 pm

Baroness Emerton: My Lords, I, too, pay tribute to the committee so ably chaired by the noble and learned Lord, Lord Mackay, which produced such a balanced report with clarity on such complex and sensitive issues.

I speak as a retired nurse with 53 years of experience in the profession. I have two brief points to make from a nursing perspective. First, there is the nurse-patient relationship. Consistently, research shows that 80 per cent of care delivered to patients is provided by nurses. Given that wealth of experience, it is regrettable that their unique position and expert contribution has been omitted from the draft legislation. That is particularly so in the light of evidence that nurses play a crucially important role in supporting patients and relatives at the end of life, particularly Macmillan, Marie Curie, hospice, hospital and community nurses.

Virginia Henderson, an eminent professor of nursing from the United States, defines nursing thus:

"The unique function of the nurse is to assist the individual, sick or well, in the performance of those activities contributing to health or its recovery or to a peaceful death that he would perform unaided if he had the necessary strength".

I strongly believe that the introduction of a law relating to assisted dying would seriously damage and compromise the nurse-patient relationship, leading to fear of that option at the most vulnerable time in patients' lives. Respect for the intrinsic value of life is central to the nursing profession. Midwives and nurses caring for women undergoing termination of pregnancy have the right to refuse to participate in the procedure on the grounds of conscientious objection. Other nurses do not have, and would not want, that option in these circumstances.

Secondly, if patients believe that they have no other choice or option but to ask the clinical professions for help in committing suicide, those professions and society have failed them. Palliative care in this country, as we have heard this afternoon, is the envy of the world. We have become skilled in the management of pain and in symptom control, particularly for those with cancer, but we cannot be complacent. We need to continue our research to find new ways to relieve distressing symptoms, particularly for those with neurological conditions.
 
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It is also important to recognise that palliative care is not just pain control by drugs. "Palliative" derives from the Greek word pallios, meaning "shield". As well as physical care by drug therapy, the psychological, emotional, spiritual or even financial impact of a diagnosis or suspected diagnosis of a disease that might be life-threatening is very much an area where highly trained and skilled palliative nurses can assist a patient through the darkest times with care and compassion towards a peaceful and dignified death, as opposed to the indignity of an unnatural death. Certainly, I can testify to nursing, as a member of a healthcare professional team, many patients under the shield of palliative care, delivering clinical, psychological, emotional and spiritual support within the banner of holistic care. There are of course regrettable circumstances, as described by the noble Lord, Lord Puttnam, but that demonstrates the urgent need for resources for providing high-quality care for the dying.

The Royal College of Nursing, which represents 370,000 nurses as a professional organisation, opposes the legalising of assisted dying. The noble Viscount, Lord Craigavon, questioned how accurately it represents the total number of nurses. It would be impossible to consult 370,000 nurses and come out with a unanimous answer. It is a majority answer. Certainly, some nurses choose to support voluntary euthanasia.

The pathway to death is one that we each have to travel. The key to achieving improvements in the care and treatment of dying people is, as a priority, further investment of resources in training for existing and new doctors, nurses and other healthcare professionals, as well as the development of hospice and palliative care, not the introduction of the Assisted Dying for the Terminally Ill Bill.

9.37 pm

Lord Sheldon: My Lords, I also express my great appreciation for the report and the detailed and voluminous evidence that it contains. It was rather surprising when one received the amount of information available; it was well beyond what one might have expected for such a committee. The noble Lord, Lord Joffe, has undertaken a valuable campaign to give those who have been subjected to great suffering and indignity the right to bring to an end a life that has become unbearable.

Time is on the noble Lord's side. He came into the area rather unexpectedly but, as time has gone on, more and more people have been impressed with the arguments that he puts, and he has created a number of people who have a contrary view. He has brought the matter right into the forefront of political life in a way in which I had never suspected that it might be in my time.

I fully support the proposed Bill, but am concerned about one consequence, which I would like to receive further consideration. The problem is that, in some cases, death can be a release for not only the patient but for some of the family. There could be pressure
 
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from the family, expressed or not, in connection with the financial consequences of a lingering death. There is also the burden of attending to the needs and wishes of the patient.

The patient's life may be very limited in time, but in some cases it may linger for a greater period. During that time, the financial position of the patient may decline rapidly, and the family's expectation of financial inheritance may affect their attitude. Besides that, there are problems of visiting and attention to the affairs of the patient. All of that may consciously or not be transmitted to the patient and encourage and prompt a decision to seek an early end to an unwelcome and lingering life.

The role of the hospice movement has been a great help against that. The Tameside hospice in my previous constituency has had an impressive effect on bringing in palliative care and great consideration for the limited life of the patient. I appreciate the value of the work that has been undertaken there. But, as the noble Baroness, Lady Hayman, said earlier, not all suffering can be relieved. Palliative medicine is undoubtedly limited. It may improve with time; it would be surprising if it dealt with more extreme cases. Some people find similar kinds of pain greater than others. There is a great distinction in the way that people perceive such matters.

Fundamentally, however, although we do not choose to come into this world, most people have found their lifetime's experience satisfactory and, to many, happy. But we must have the right to bring it to an end in those cases where the disadvantages of life have become so much greater than the benefits that they have previously enjoyed.

9.41 pm

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