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Baroness Williams of Crosby: My Lords, in the past three days I have received 124 letters, of which 123 have been against this Bill and one in favour. They have not been in any sense propagandistic. They have been written by the individual person concerned and have clearly expressed a deep sense on the part of that person.
I want to make three points. The first is that, particularly in a society that has a National Health Service, intrinsic to the success of that service is the profound trust between a physician and his or her patients. Many of the letters I have received raise the issue of whether that trust would be maintained in a situation where it might be thought that the intrinsic and profound value of human life was in any way questioned by the physician.
My second point is that there is indeed a very powerful "slippery slope" argument. It does not only link to Holland, where, as my noble friend Lord Carlile said, there is already discussion about the possibility of legally ending the lives of children with learning difficulties or other handicaps such as Down's syndrome. Like noble Lords elsewhere in this House, I have close friends who have had a great deal of joy from their Down's syndrome child and would never wish to see that child in any way sacrificed.
In addition to that, I have a letter from a distinguished nursewho points out, incidentally, that today is the international day in celebration of nursingsaying that already under the terms of the Mental Capacity Act there has been a notable slip towards bringing the lives of some patients to an end. She writes from the hospital where she has worked for many years:
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She goes on to say that she has been forbidden by consultants from sustaining life on the part of patients who have not asked to die. This is the slippery slope in practice, and is something we have to consider extremely seriously.
My final point is about palliative care. I believe that the most reverend Primate the Archbishop of Canterbury is right in suggesting that if this alternative is open to us, the pressures on the Administration to bring more palliative care to bear will be much less than they ought to be. Palliative care has been one of the huge and celebrated achievements of this country and it has been extended to the world.
Dame Cicely Saunders, the distinguished founder of the palliative care movement, made the powerful point that it is not just medicine that people in the last stages of life need but also, to be put it bluntly, love and respect. They are to be found in the marvellous hospices that now exist in this country, in a way that cannot be found anywhere else.
Baroness Finlay of Llandaff: My Lords, why does this Bill ignore the majority of the essential changes recommended by the Select Committee report when we as a Select Committee looked at the previous Bill? Several so-called safeguards have been weakened, despite the committee recommending that they needed to be tightened up.
The Bill is not called "Assisted Suicide" for good reason, because that takes us to the very brink of euthanasia in one fell swoop. Doctors could supply a lethal overdose, which is assisted suicide in the Oregon law. But what are the alternate means, undefined in this Bill, by which those drugs could be taken? The doctor is not required to be present, so who knows whether the patient actually took the drugs themselves or was euphemistically "helped" by someone else? How could malpractice be proven if the principal witnesses were dead or would not come forward?
The Bill ignores the recommendation that the doctor's actions be clearly set out. As I listen today, there is still no clarity about precisely what "assisting to die" is. Even the proposed amendment does not clarify what alternative means to ingest can be provided, nor the circumstances in which an intravenous dose could be used.
The test for mental competence is weakened. The applicant should not "lack capacity", yet the Mental Capacity Act was designed for different purposes and errs towards preserving life, not committing suicide. The Bill has dropped protecting those whose judgment is impaired through fear, misinformation or depression, despite the committee's recommendation
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that all applicants should have a psychiatric assessment. Dutch research shows that undiagnosed depression is eightfold more common in those seeking assisted dying than in those who do not.
No clinician can accurately predict prognosis beyond eight to 12 weeks at most. The committee recommended that a definition of terminal illness should "reflect the realities of clinical practice", but it has been slackened to cover anyone considered to have six months to live. Now any progressive disease that cannot be reversed by treatment is included, rather than just those whose effects cannot be reversed. How does the doctor judge that you are or are not suffering enough, if you refuse attempts for your "unbearable suffering" to be relieved?
I am Professor of Palliative Medicine at Cardiff University and Groningen University in the Netherlands. There are failures and complications, even when doctors assist suicide or inject a lethal overdose. The public need to know that 94 per cent of palliative medicine specialists in the UK oppose this Bill. It is we who work day in, day out to give dignity to the dying; know the pressures and fears behind the statement, "I wish I were dead"; and know how often time and care that enhances dignity prove everyone wrong. Across all hospital doctors, over 71 per cent oppose this Bill, a figure proven by validation using the very question put to the profession by the noble Lord, Lord Joffe.
Palliative care in Oregon does not fulfil the quality specialist criteria of the UK. It is domiciliary primary care or in-patient care at the end of life. I was not impressed by what I saw when I went to Oregon as a member of the Select Committee. Our palliative care has led the world, and the world is watching this debate. In letting this Bill proceed, we would be giving a message to the rest of the world that we will abandon the vulnerable and treat suffering by ending the sufferer's life. Let us get on with working for patients to live as well as possible until a natural dignified death and teaching others how to do it, not be taken up in becoming complicit in suicide.
I was chairman of an organisation called Exit, a possibly politically incorrect name these days. I took over the post when the doctors who were then running it, although in favour of the principles of this Bill, were not prepared to publish a pamphlet of advice on the subject and thereby risk prosecution. I became chairman and, with the support of my committee, published the pamphlet and was not prosecuted, although I did spend a night in the cellsone of the only two occasions on which I have made the front page of the Evening Standard. I salute the noble Lord, Lord Joffe, for the fact that he has been prepared to endure.
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The reason for my support for this Bill is simple. The country slowly becomes more sensible, and the sheer lunacy of having a law that made suicide a crime has, thank God, vanished. I hope I never have even to contemplate suicide myself, but if I do, I wish to be able to rely on my nearest and dearest to help me to perform this legal but disagreeable action without fear of prosecution. And what I desire for myselfI hope that this is a principle which your Lordships accept for all your legislative actionsI would not deny to others.
As a keen readerlike most clergymenof crime fiction, I am aware of the dangers and temptations involved. I therefore welcome the safeguards, even though some of them go further than I would personally want.
Finally, I am, as most of your Lordships know, a priest of the Church of England, currently licensed to a regular ministry in the parish in which I live. In addition to my crime fiction, I keep up my theological reading and I have found no theological or ethical objection to the Bill which I consider holds water. I will therefore vote for it and I urge your Lordships to do likewise.
Baroness David: My Lords, I speak to support the Bill of the noble Lord, Lord Joffe, and to speak against the, in my view, ill judged amendment of the noble Lord, Lord Carlile. I still hope that he may withdraw it.
All the Bill provides for is an option. The safeguards are very strong. In a review of the safeguards and qualifying conditions, Professor MacLean says that the Bill offers far more protection than the current situation, both for those who want this option and those who do not. I have one reservation about Clause 3 on determination of lack of capacity. Here, if, in the opinion of either the attending or consulting physician, a patient who wishes to make a declaration may lack capacity, the attending physician shall refer the patient to a consultant psychiatrist or psychologist, who shall be independent of the attending physician, for an opinion on the patient's capacity. I think I should resent that, and I wish it were not in the Bill.
I strongly believe in personal autonomy and the right of individuals to decide when and how they die. As a 92 year-old, and I think probably the oldest person speaking in this debate today, I think it is patronising for opponents of the Bill to suggest that elderly people are unable to make informed decisions about their lives. If I were terminally ill, I believe that I would be the only person with the right to decide how I died and whether I preferred palliative care to assisted dying. It would provide me with an additional option on how to end my life, which I would find tremendously reassuring, whichever choice I made. With all the hurdles to get over before it is possible to decide on the assisted dying option, I hope I would have the courage and determination to make that choice. I think I should.
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