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Lord Haskel: My Lords, the topic of assisted dying provokes the whole range of human responses—ethical, personal, physical, political, legal, emotional and spiritual—and the advantage of speaking late, as I do, is that I have had the enormous benefit of all those responses this evening.
Like most people, in my life as these important matters arise, I deal with them through ideology and principle. I have spent most of my life in the world of business and industry, and you certainly need ideology and principle to survive successfully in that world. But as time moves on and circumstances change, even ideology and principle have to be reassessed—the noble Baroness, Lady Murphy, spoke of that—otherwise we would never have change and progress.
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I recognise and respect that, through faith or professional ethics, people can be against assisted dying. Several noble Lords have spoken about that. Like other noble Lords, I respect their ideology and principle, but change and progress is made through a careful re-examination of those ideologies and principles. From this debate, it seems that assisted dying, when subject to proper safeguards, need not violate those established principles. As we have heard, it can be a blessing.
Of course I recognise that, in order to safeguard our principles, there needs to be an exhaustive examination of those safeguards, and your Lordships' committee has been most diligent in that. The noble and learned Lord, Lord Mackay, and others told us about the visits to Oregon, the Netherlands and Switzerland. They have read the submissions of several hundred witnesses and listened to the oral evidence of 150 witnesses. To give you a measure of the amount of work put into this by the noble Lord, Lord Joffe, I quote him directly:
"Such was the complexity and passionate interest in the Bill and the Select Committee, that it has probably required more sustained work by me than the nine month trial in which I defended Nelson Mandela and the leadership of the African National Congress in 1963".
It seems that the committee, in examining the safeguards, has been both exhaustive and exhausting.
I shall be brief. After reading the report and listening to this debate, I am satisfied and convinced that adequate safeguards can be put in place to protect my principles. This is not the start of the slippery slope. It is a matter not of hard cases making bad law but of relieving the suffering of the hard cases. In view of that, I would strongly support any future Bill, and I congratulate the committee and the noble Lord, Lord Joffe, on their diligence.
10.58 pm
Lord Moser: My Lords, we have had a remarkable debate, and for that all of us are grateful to the noble Lord, Lord Joffe, and the excellent report before us. In view of the late hour, I shall confine myself to just one point in the report.
The report dealt with evidence from many experts and professional groups, but also public opinion. Public opinion has been mentioned by a number of noble Lords. It is obviously important for the subject. There is enormous interest out there. Ultimate decisions on the matter will rest with Parliament and so, if for no other reason, with public opinion. What do we know about what people think?
The committee did not have time to commission its own opinion research, so it asked an organisation called Market Research Services to assess survey evidence over the past two decades. To my mind—this is very much my own field—the assessment by that organisation was far too dismissive of the weight of opinion and the enormous excellence of some of the surveys. They were criticised as being too quantitative, which is not a criticism in my view, and too simple for such a complex topic. In fact surveys, when technically sound, can be helpful indicators of public opinion,
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even on complex issues. But the assessors were right in giving more positive weight to the work of the National Centre for Social Research, which is generally regarded as the best of this country's—and perhaps Europe's—survey organisations. I declare my interest as a trustee from that organisation's early days. The centre carries out so-called basic social attitude surveys, which have been extremely valuable and for a decade have covered the subject of our debate. Incidentally they were the only surveys that were conducted neutrally without any connection with vested interests—pro or con.
The results have been clear. Support for voluntary euthanasia and assisted dying rose from some 75 per cent in the mid 1970s to some 82 per cent in the mid 1990s—much the same picture as emerged from all the other random surveys of the general population that have been referred to. I would not wish to suggest, nor does the Select Committee report, that this strong public opinion in favour of a change in the law makes the issue decisive for our conclusions. But, equally, it would be wrong to regard it as marginal. The state of public opinion, which is shifting all the time in favour of a change in the law—and some new surveys are being carried out—must play a part in our considerations and leads me to conclude that the steps before us today, a formal Second Reading followed by the Committee stage, would be overwhelmingly in accord with public opinion. My simple point is that public opinion on this matter is not marginal.
11.2 pm
Baroness Howells of St Davids: My Lords, I, too, add my congratulations to the noble and learned Lord, Lord Mackay, for his balanced report. I intend to place on record why I am deeply unhappy with the Bill that the noble Lord, Lord Joffe, intends to present. Those reasons are such that I am unlikely to support any future Bill on this subject, because I envisage the negative fallout on the poor and on the black community in particular. Will this Bill be used later as a form of ethnic cleansing?
There is one certainty in life and that is death. It is final. There is no turning back. I urge the House to support the old-fashioned notion to let nature take its course. One of the most striking features of any assisted dying Bill is its lack of contact with the real world. It depicts people who are wholly rational, who have thought long and hard about ending their lives and who have access to good palliative care. But that is not the real world. Most people who receive a terminal prognosis are at a very irrational stage of their lives. Most have not thought about ending them at all. Why should they have done so? Many of them do not have access to the best palliative care and, above all, they are frightened and confused. It is all very well for any Bill to talk about referring people for psychiatric assessment if there appears to be a psychiatric disorder or offering them a palliative care assessment. But anyone who knows anything about the matter will tell you that in a multiracial society doctors often cannot
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spot depression and internalised pressures and that hearing about good palliative care is a world away from experiencing it.
There is another way in which the Bill falls short of reality. My attention was caught by a statement made to the committee by one of its witnesses—Professor Irene Higginson of King's College, London. Professor Higginson, who specialises in palliative care, told the committee:
"There are certain under-privileged communities which have lower access to palliative care services".
"Work that we have done in the south London area has shown a mixed experience in advanced cancer, for example, among the local black Caribbean community".
And reports showed, said Professor Higginson,
"a trend towards a greater number of unmet needs and also reports of less satisfactory care . . . compared to a local white UK-born population".
Noble Lords may ask what this has to do with euthanasia. The answer is simply this: the more disadvantaged that people are in accessing palliative care services, the greater the push for them to access assistance with suicide or euthanasia. Let us look at what the Select Committee was told when it visited Oregon to inquire into the working of the so-called Death with Dignity Act. The Oregon health department, which collected data on the numbers and characteristics of people who opt for medical assistance with suicide, told the committee:
to take lethal drugs supplied by a doctor to help them out of their confusion.
I want to look at another aspect of this matter, and I am glad to see that the committee flagged this up clearly in its report. Society does everything possible—and rightly so—to prevent or frustrate suicides, yet here we are considering whether one group of people—the terminally ill—should be aided and abetted in killing themselves.
I have long been concerned about suicides among prisoners—especially among black prisoners—and about the watch that is kept on them to prevent tragic and ill considered actions. What kind of signal will it send to prisoners who are suffering—and many of them are, in the words of the Bill of the noble Lord, Lord Joffe, "suffering unbearably"—if we decide that such suffering is a key criterion for being helped to end one's life rather than being discouraged from doing so? Not only is there a complete inconsistency here, with society facing in opposite directions, but in my view there is a risk that over time this will translate, however subtly, into less rigorous oversight of suffering prisoners. It is no good to say that we are talking here only about the terminally ill; a Rubicon will have been crossed, and it would be less than realistic to expect there to be no impact on other situations of unbearable suffering.
Finally, what about nurses, of whom mention has already been made? The report says much about the problems of doctors but precious little about the effect
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on nurses. Community nurses see dying people all the time. They could not withdraw from participating in this law without withdrawing from the nursing profession. It is all very well to say that there will be a conscience clause but, in reality, many nurses will fear for their jobs if they are seen to be unco-operative, and the likelihood is that they will either find jobs other than nursing or take their skills abroad. The Royal College of Nursing pointed to the high proportion of trained nurses in the UK who come from cultures which are hostile to euthanasia, and predicted a haemorrhage of trained staff if a Bill like this were to become law. I ask the House: is this really what we want in the UK?
11.10 pm
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