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Lord Clement-Jones: My Lords, like many noble Lords I took part in the last debate we had on this subject in June 2003. I strongly supported the establishment of the Select Committee although I did not support the Bill. Despite personal experience as a carer, I have tried as dispassionately as I can to test the arguments that I used in that debate against the Bill against the evidence which has been given to the committee.
In our last debate one of my key arguments was that assisted suicide or voluntary euthanasia would crucially alter the duties of and trust in the medical profession. The overseas evidence from Oregon and the Netherlands taken by the committee is therefore I believe absolutely crucial in this debate.
"At the level of the patient doctor relationship I see a growing anxiety among terminally ill patients, as well as, other patients, that they think it is not decent not to ask for euthanasia sometimes, because they feel that they are such a burden to their families or to their carers".
I therefore still have strong concerns that the traditional role of and necessary trust in doctors would be eroded by the Bill. Then, as many of your Lordships said, we come to the relationship with the availability of palliative care. The crucial argument made by overseas witnesses is that there is a case for assisting dying even where excellent and widespread palliative care is available. But it is far from clear that in the Netherlands or Oregon there is actually good palliative care.
In the Netherlands, Dr van Coevorden, a GP and part-time consultant in palliative care, does, I grant, describe an enormous boom in palliative care training and in hospice care. He considers that that has been stimulated by the law on euthanasia and that such provision is now at a high level. But the fact is that other witnesses had a completely contrary view. It appears that the boom in training courses in palliative care was the result not of the legislation but of the prior debate about voluntary euthanasia. The funding for research and training is now in fact diminishing. As we heard from the noble Baroness, Lady Finlay, there are no full-time palliative care posts in the Netherlands at all. Dr van Coevorden himself admitted that if you give proper care, you will see requests for euthanasia fall. Some of those giving evidence alleged that Oregon also has extensive palliative and hospice care and that it has grown substantially, but other evidence, such as that from Professor Katherine Foley of the Sloane-Kettering in New York, completely contradicts that.
So the suspicion remains that palliative care has not been fully developed in either Oregon or the Netherlands. However, as we have heard in the debate today, massive strides in palliative care have been made in this country during the past five years. Even the past year has seen major advances. Surveys show that palliative care doctors themselves are overwhelmingly opposed to the proposals. Should we not, as many noble Lords have said tonight, be concentrating on ensuring that patients have the best palliative care and developing adequate resources in the NHS and in our hospices? As palliative care doctors can testify, all patients have moments of despair, even the most positive, as I can testify from experience.
The burden of proof is on the supporters of the Bill and, after consideration of the evidence taken by the Select Committee, I do not believe that the right to get professional assistance in handling one's own death has been made out. I do not support going forward with the Bill.
Baroness Young of Old Scone: My Lords, it is quite late and I thought that I might just stand up to say that I support the Bill tabled by the noble Lord, Lord Joffe, and sit down again. That would certainly make half of your Lordships very happy for the support and the other half of you very happy for the brevity, but I want to say a little more on this important topic. I am very grateful to the Select Committee for giving us this opportunity to debate it. Like my noble friend Lord Puttnam, I should like to focus on individuals rather than on doctors, nurses or churches: to focus on people.
We all die. Some of us will die better than others and, for painful and difficult deaths, palliative care can help and certainly needs improvement in its quality and distribution in this country. In my previous existence I was involved in the enlargement of palliative care, but I do not believe that it is enough. It is not enough for control freaksthe noble Baroness, Lady David, was very unhappy about being designated in that waywho, after a lifetime of trying to control their lives may find themselves at the end of it unable to control it. I include myself in that category.
The other group of people on whom we have not focused enough is those with long-standing terminal diseases for whom the dread of a terrible death threatens to blight even the comparatively disease-free part of their lives. A few years ago, a group from your Lordships' House was privileged to hear from a young woman with early motor neurone disease. She had experienced her mother's lingering death from the same condition. Despite support and palliative care, it was a horrible death for her mother and for the family. The young girl now faced a long decline in her own health in the same way, with clear knowledge of what lay in store for her in the future. She desperately needed the comfort of knowing that when her time came she could make a choice in order to avoid going through that terrible sort of death. The Bill introduced by the noble Lord, Lord Joffe, would give her that lifelong comfort.
In the debate, we have heard a lot about the sanctity of life and the preciousness of the gift of life. But I believe that life is no longer sanctified or precious if the holder has come to the point where life is no longer seen as a precious commodity. We have heard a great deal about respect. The noble Baroness, Lady Greengross, summed it up when she said that a dying person should not have to beg for his or her wishes to be respected. A dying person should not have to save up his or her drugs surreptitiously and risk an amateur and botched suicide. A dying person should not have to travel abroad to die among strangers. That is not respect.
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The Bill is a very carefully crafted set of proposals. I very much admire the thoughtful way in which the noble Lord, Lord Joffe, has conducted the drafting and his commitment to amend it to best meet the widest possible range of views. It contains multiple safeguards against misuse. It deserves our and, indeed, the Government's support.
Lord May of Oxford: My Lords, I wish to express my appreciation for the Select Committee's report and also to explain why I support the principles set out in the original Bill introduced by my noble friend Lord Joffe. There seem to be, broadly, at least two distinct categories of objection to assisted dying, both of which deserve respect. Quite apart from that, I see the discussion of further investment in improving palliative care as a distraction. Of course we should be doing that as well.
The first category deals with practical issues. There is the worry that the Bill could lead to terminally ill people being coerced into death earlier than desired, which is one aspect of the slippery slope. Another legitimate worry is that medical practitioners could be asked to act in ways contrary to their personal beliefsmy noble friend Lord Lewis referred to the imposition on the medical professionand there are others. I believe that careful crafting of a Bill on assisted dyingindeed, the original Bill offered by my noble friend Lord Joffecan deal effectively with such worries, although, of course, consideration should be given to the further recommendations made in the Select Committee's report.
The second category of objections derives in essence from personal beliefsoften, but not always, religious beliefswhich in their strongest form can equate assisted dying with murder. The most reverend Primate the Archbishop of Canterbury put it with admirable clarity in the Mail at the weekend, when he said that life is a gift from God, with the corollary that it is up to God, not the individual, to decide when to end it.
Essentially, this is an argument about how the rights of the individual are weighed against the rights of the community. Many of the anguished debates in this House are about such weighing of the rights of the individual against the rights of the community, whether the issue is as trivial as fireworks or as large as terrorism. But it is my belief that this is a subject in which primacy should be given to the right of the individual to choose, if she or he so desires, to avoid extreme suffering and to die with dignity.
But my values, shared with many noble Lords, derive from the Enlightenment: plurality, individual liberty of conscience and empirical evidence as the best way to formulate policy. In this latter context I applaud the excellent report from the Select Committee. Some of its facts bear repetition. Studies in the Netherlands and in Oregon show no signs of increasing rates of assisted dying, no slippery slope
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and, indeed, in the Netherlands doctors are if anything interpreting the rules more strictly over time, as reported on page 395 of the Lancet, Volume 362.
Indications in Oregon suggest that hospice referrals and the attendance of doctors at palliative care conferences have increased since 1997. Indeed, there has been a longer time-span in which to observe that than there has been in Holland. Studies in Oregon and the Netherlands suggest that many, perhaps even most, of those obtaining prescriptions for the lethal cocktail do not use it. Quoted in the New Scientist earlier this year, the director of the Netherlands Right to Die Society said, succinctly and tellingly, that,
Finally, even acknowledging the faults of all public opinion polls, it is clear that the principles set out in my noble friend Lord Joffe's original Bill command wideroughly 80 per centpublic support. I hope that I misunderstood the noble Lord, Lord Carter, when he seemed to suggest that the other place is nevertheless unlikely to make time to consider a new Bill from my noble friend in this Parliament. That would be outrageous, given the time the other place has devoted, for example, to concerns for self-determination for foxes.
So I welcome the report of the Select Committee in all its fair-minded complexity. I hope that my noble friend will bring forward a new Bill and that the Government will make time for it in both Houses.
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