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Lord Lipsey: My Lords, my first-ever public speech, in the Oxford Union nearly 40 years ago, was in support of euthanasia, an issue about which I have thought again only this summer. Since I made that speech, the argument has moved forward in two significant regards. The first, much remarked on tonight, is the improvement in our care of the dying—
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stronger drugs for pain control, a greater willingness on the part of doctors to prescribe them to those who need them, and the wonderful growth of the hospice movement although it is common ground on all sides of the House that we need to do more to improve palliative care and hospice care.
The other factor, which has not been remarked on, is that the diseases that used to carry people off to a merciful death are now terribly treatable—pneumonia, for example, the old man's friend. People with the most appalling neurological afflictions in particular can linger on and be kept alive by modern medicine for years and years.
Those two arguments point in contrary directions and they are as difficult to weigh today as they were then, although the Select Committee has done a wonderful job in putting the considerations on every side. While I am on balance in favour of change, I am much concerned about the notion that old people will somehow feel obligated to end their lives out of a false sense of the burden which they are imposing on others.
I want to draw one contrast between those who favour a change in the law and those who do not. The noble Lord, Lord Joffe, whose efforts are commended even by those who strongly disagree with him, is a very rare creature. He is a man who changes his mind in response to evidence. I know this because I sat with him on the Royal Commission on Long-Term Care of the Elderly, and he was persuaded there to drop his original predisposition in favour of spending money on better care rather than providing it free to the better-off. He has changed his mind quite a bit on this Bill—I am not sure he is right to have done so—to put in additional safeguards.
I am afraid that the same does not apply to most of the opponents of the Bill. The right reverend Prelates the Bishop of Oxford and the Bishop of London both told us to listen to their arguments. The trouble is that I suspect that, whatever was done to refute or demolish those arguments, they would still hold the same position, which is deeply rooted in their faith. They are entitled to have that opinion, but we should recognise that difference between the proponents and opponents.
I do not therefore have any hope of convincing those fundamental opponents, but I would just make to them two incredibly simple points at the end of a complex and subtle debate.
First, I respect and enormously admire people's willingness to declare for themselves that however ghastly their sufferings at their end—and for all that palliative care can provide, it cannot alleviate every suffering; we have heard from noble Baroness, Lady Noakes, about motor neurone disease—they commit themselves in advance to accepting those sufferings, because that is in accord with their belief. What I cannot respect and admire is their willingness to impose their commitment on others, using to do so the law of the land, a land that is increasingly a secular land that does not share those particular values.
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Secondly, although I am no theologian, it seems to me as a simple soul that to condemn many of your fellow human beings to an agonised, undignified and unchosen end in the name of your abstract principles is a bit unchristian.
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Baroness McFarlane of Llandaff: My Lords, I wish to speak very briefly about the contribution made by nursing and midwifery, because those have been the professions in which I have worked. I came to nursing in 1947, which is a few years ago, and the ways of treating the dying were very different then; but I must have sat for many nights beside the beds of dying patients at Barts, where I trained. Many noble Lords will know that Barts is a monastic foundation, or has one; I feel that I entered into a seamless robe of caring that stretches from 1123 right down to me. I inherited some of those values and seek to emulate them in my life still.
I believe that as nurses and midwives, we have the great privilege of sharing the joys and sorrows of the beginnings and ends of life. I remember the relief that I felt when Dame Cicely Saunders came into view, with her developments in palliative care, which added so much to our ability to care for people. I am indebted to her throughout my professional life.
I want to say how much I feel that voluntary organisations add to care in this whole area. I have had the privilege of serving on the committees and councils of a number of voluntary organisations, such as the Malcolm Sargent Cancer Fund for Children, not to speak of my own hospice, St Anne's Hospice in Cheadle. It has been a great privilege to see how much people who work in organisations of that kind contribute to the values of our society in all that they do. I admire tremendously the role of voluntary organisations in our society. What amused me recently was to find how much job satisfaction there is among the workers at St Anne's Hospice in Cheadle. This year it won the award for the second best place to work in the UK and the first best place to work in England, as listed by the Sunday Times. That is an achievement. When one is doing work of that kind, there is tremendous job satisfaction, which many other organisations might like to emulate.
I wanted also to dwell on the importance of family and all that family contributes to the care of the terminally ill and dying. I listened to the experiences recounted by the noble Lord, Lord Puttnam, and the noble Baroness, Lady Chapman, and felt how fortunate I have been by contrast. October 10 is a very significant day in the history of my family as it was my mother's birthday. She was born in 1882 and lived to be 108. I learnt a great deal from her about geriatric nursing and making a good death. She was a focus of the family over many years. We gathered on this day round her bed year after year to celebrate her life. It was a life worth celebrating. She kept me in place as regards my nursing skills. I remember one evening struggling to get her rather copious arm into a garment that was clearly not made for her. She turned to me and
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said with some venom, "If that is how you nurse your patients, I am sorry for them". There was I, a professor of nursing. I should have known better, shouldn't I?
As I say, that occasion kept the family together for years. We used to gather on 10 October. Every year we would say, "We had better go this year; it is bound to be the last", and on she would go to 102, 103, 104. I think that Her Majesty was fast running out of congratulatory telegrams. That was a blessed experience which has held us all together ever since. I feel so fortunate that I can rejoice in that. I make those inadequate observations about what it means to be a nurse and to have the tools of palliative care at one's disposal, and about what it means to be a midwife and meet life at its start and revere it. It would be difficult for me to change from that mode of care to handing a deadly mixture to a patient. It is something that is alien to all my professional values.
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Lord Habgood: My Lords, in view of some of the fears that have been expressed I promise not to offer your Lordships the slightest whisper of theology. I speak as a member of the 1994 Select Committee, and as one of those who did not change his mind subsequently. However, I have asked myself how two Select Committees could come to such different conclusions in a matter of a mere 10 or 11 years. I think the answer is that the two committees began from different places. Where you begin frequently determines where you end up. It seems to me that the present report, admirable though it is—I share all that has been said in praise of it and of its chairman—starts from the wrong assumptions and inevitably goes on from there to draw what I believe to be the wrong conclusions.
The 1994 report began with the prohibition of intentional killing, which we saw as the cornerstone of all civil law as well as the basis of trust in the medical profession. Our committee gave much weight to the likely consequences of undermining that prohibition. The new report begins with the concept of personal autonomy, but I believe understands it in a way that fails to give due weight to its potential for being manipulated.
I accept that, on the whole, autonomy is highly desirable and should be respected. But it is important not to forget that the exercise of autonomy is, to a greater or lesser degree, socially conditioned. It takes a very strong-minded person not to be influenced in their perceptions of themselves and of their desires by the way in which other people think about them and by the general social expectations of their culture. In particular, it takes the kind of self-esteem that enables people to struggle against adversity and to want to go on living despite many disadvantages. That self-esteem depends to a considerable extent on the public estimate of their condition. If the general estimate is that they would be better off dead, that is how they themselves are likely to feel.
Let me give an example from a French writer, Emmanuel Hirsch, in a book about accompanying the dying. He wrote:
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"In the field of choice between life and death, resort to the notion of individual autonomy is in part an illusion. A patient whose physical and mental faculties are deteriorating may truly want to die, but this desire is not the fruit of his freedom alone. It may be, and more often is, the translation of the attitude of those around him, if not of society as a whole, which no longer believes in the value of his life and signals this to him in all sorts of ways. Here we have a supreme paradox: someone is cast out of the land of the living, and then thinks that he, personally, wants to die".
The truth is that we are not solitary, autonomous units. What we are and what we do are irreducibly social. Let me relate that to what the report in paragraph 102 calls "the paradigm shift", and what I prefer to call "cultural change". Changes in social practice change our perceptions of ourselves and of other people. That is the most dangerous and most widespread aspect of the slippery slope. It is not just that laws are found to have loopholes, or that their application becomes more casual as vigilance decreases, or that individuals find ways of justifying exceptions in their own case. We are familiar with that kind of slippery slope and can in theory devise all sorts of safeguards against it. The central point is that as new practices become familiar, the culture changes, and that has consequences for the way in which people think about themselves. We may imagine that we are making an autonomous choice, when in fact we are merely responding to changed social expectations; as is all too obvious nowadays in the choices made about abortion.
A few years ago, I watched a very moving documentary film about a Dutch doctor preparing one of his patients for euthanasia and then actually performing it on film. It was all very sensitively and tastefully done, and I marvelled at the amount of time, care and emotional energy expended on this one patient. There was a degree of care that it would be hard to match in this country given our present resources. At the end of the film, the doctor was asked whether he found the whole process too emotionally demanding. "Yes", he said, "but it gets easier as you go on". That is precisely the point, because that is the way the world works. That is why I believe that it would be a profound mistake to follow those who have chosen to go down this road.
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