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Lord Elton: My Lords, in a debate in which allegations of religious prejudice have been flying around, I should begin with a declaration of an interest as a licensed lay minister in the diocese of Oxford—or, rather, I am allowed to so describe myself by application every two years, following my 70th birthday, to the right reverend Prelate the Bishop of Oxford.

So much has been said, it is difficult not to repeat, but it seems to me that at the centre of this debate is the value of human life. Dying is an essential part of living. Getting it right, therefore, is a precious necessity. The value of life lies in the power to love and be loved; to love our neighbours as ourselves; to act as social animals; and to put others before ourselves.

The whole of society is a criss-cross of loving relationships, marred by relationships of hate and by circumstances that prevent the exercise of love. What is the function of the state in preserving the best for its citizens? Surely is it to preserve the most effective and freest expression of love between its members? One way to do that is to ease the path of someone out of suffering, and, if we put that question, of course the answer is yes. If we consider the circumstances surrounding the issue, however, the question is not so simple.

The noble Lord, Lord Puttnam, made a speech quite different from any other. It seemed to me that most of us were talking from divisional or brigade headquarters, while he was talking from a foxhole on the front line. He had actually been in the room where these events were happening. That has the advantage that he can speak with passion and absolute knowledge, but it is not the place from which you can see how these events can be altered. For that, you have to be further away.

I join my noble friend Lord Cavendish in asking the Government to come clean on their attitude to this Bill. Eventually, if time is given to it in the other place by the Government—and that is the only way it will
 
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get on the statute book—it will be a government Bill in all but name, and the state will have said, "This is how we value human life".

If the state says that the ultimate decision must be to let people out of suffering at their own request, under certain limited provisions, it has said something about human life that has not been said before by any government in this country. That will change the attitude of our society to life, and it will do so at a time when the ratio of our population between those under 65 and those over is rapidly changing. There is a danger, therefore, as my noble friend has said, that the younger generation will see the older generations—of which most of us, I remind your Lordships, are members, although we should not argue from self-interest—as surplus to requirements and non-productive, and will say "Do help the old dears off this planet".

That will completely change the view that the younger generation has about life and what it is for. I am convinced that we are here to learn what love is and how to express it. If I may venture into realms that will offend those who do not like religious prejudice, we are being prepared to express love in a more perfect way after the event of death has taken place. If we curtail that, as is suggested, moving scenes of enormous value, such as that described by the noble Baroness, Lady Chapman, an hour or two ago, simply would not take place. I have seen enough of elderly people who are already concerned that they are a burden to society, to their friends or to their families when they are still able to get around on two sticks. That feeling of guilt ought not to be encouraged. They should be defended from it.

I ask the Government whether they are going to do that by allowing a Bill that will allow people to commit suicide by one name or another, or are they going to do it by addressing the scandalous imbalance in the provision of the palliative care that we are capable of providing but are not providing in equal amounts throughout the country? That is a crisis and should be treated as such—I am reassured to see the jocularly waving head of the noble Lord who is to answer. This must be a matter of concern to the Government because it will touch us all in this generation and it will touch many more in the next.

Lord Warner: My Lords, before the noble Lord sits down, I make clear that I think this is a serious subject and I was nodding in jocular form at his remark about ""scandalous".

10 pm

Lord Lewis of Newnham: My Lords, much of what I wanted to say tonight has already been said far more eloquently than I could hope to do. First, I also commend the noble and learned Lord, Lord Mackay, and the committee on the report, which I found places this very difficult problem in perspective. It is an excellent report and I spent a large amount of my summer reading it and the written submissions.
 
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I shall briefly discuss two aspects of the report; one is medical and the other concerns palliative care. I was initially favourably inclined towards the Bill. However, having read the report and the evidence that has been given, I now have serious doubts, many of which have been discussed this evening. One of my main worries and concerns is the imposition on the medical community that the Bill will make. Although I have talked to only a limited number of doctors, by far the majority appear to be opposed to any form of assisted dying and worry about the effect it may have on doctor/patient relationships.

In considering the view of the medical profession, I was particularly impressed by the evidence given to the committee by my noble friend Lord Walton, who has vast experience in medical matters. However, I was somewhat disturbed by what appeared to be a change of attitude on the part of the medical professional bodies in taking a neutral position on this problem—I am not clear what a neutral position to a problem like this can be, but let us carry on. The position was somewhat clarified by the reply that the noble Lord, Lord Walton, made to a question put to him by the committee. He said that in discussions with the president of the Royal College of Physicians it appeared that the procedure necessary to produce a reply would have involved an extensive inquiry. The college felt that it did not have the time to consult its members and so declared a neutral position. I find this perturbing.

Subsequently, there appeared to be some doubt about the assessment of the opinions of at least one of the other societies concerned; namely, the BMA. I am sure all noble Lords have had a letter about this. Last month, as has already been said by a number of noble Lords, the Royal College of General Practitioners issued a statement indicating that it does not agree with a change in the legislation. I genuinely believe that before any decision is taken on this topic we must have the considered opinion of the medical profession. If time is necessary, time must be given for that opinion to be obtained. It was interesting to compare this evidence with that of the Royal College of Nursing. It appeared, in contrast, to be against the proposal, although I am slightly concerned now with the remarks of the noble Baroness, Lady Thomas of Walliswood, who appears to contest that remark.

Perhaps I may turn to palliative care. One of the most important points that appears to me to arise is the role of palliative care. The general point made by many of the groups is that with adequate opportunity for palliative treatment, the possibility of near or even complete relief from pain can be achieved. If that is correct, the main point of the Bill appears to be answered.

A point made by the National Council for Hospices and Specialist Palliative Care Services is that in many cases the delivery of palliative care to patients is performed by general clinicians where the quality of care can be variable. That, it states, leads to bad deaths
 
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and unnecessary suffering, a situation that has been noted by those in favour of euthanasia. I think that that illustrates a very important point.

Although it appears that the UK is in the forefront of countries providing and working in this area, some of the statistics provided in the Department of Health's submission are alarming. These are points which have already been referred to. There are 172 palliative care hospices, of which 75 per cent are in the voluntary sector. They have approximately 2,600 beds. Considering the size of the problem of the number of potential patients in need of such care, this does not seem an adequate set of figures.

In addition, Professor Higginson from the Department of Medical Law and Ethics at King's College said that,

"research in the UK into ways to understand patients' wishes about, or to find ways to improve, care at the end of life has been relatively neglected".

In fact she made the point that less than 0.2 per cent of cancer research money is devoted to that particular area. Clearly funding is essential if we want to carry out this sort of work. Any Bill of the kind we are discussing today is bound to put available resources in other directions; and it has even been suggested that the finances that would be required to implement this Bill could better be utilised in improving the position of palliative care within the community.

I turn finally to the position that seems to apply to the case for Holland. We have had a lot of discussion about Holland this evening. It is true that with the introduction of assisted dying funding for palliative care initially rose, but my understanding is that it has now dropped and is in a very poor situation. That reflects a very serious matter for concern. The funding of palliative care in this country requires more attention. There is little doubt that there is a need to deal with the problem of pain and death. However, I feel that the proposed Bill reflects the poor position that there is for the correct solution to this problem—a realistic provision of palliative care facilities for those who need the treatment.

10.8 pm

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