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Baroness Murphy: My Lords, I support this Bill, and I express my admiration for the courageous persistence of my noble friend Lord Joffe in this matter. As a psychiatrist and geriatrician, I know how diverse and sometimes contrary patients can be. I recognise the differences in how people approach death, and I respect those very few who would want to take advantage of this Bill's provisions. It should be their choice, not ours, and a matter of human rights.

I have three brief points to make. First, I want to talk about palliative care. According to the recent figures from the National Council for Palliative Care, at present about 70 per cent of all cancer sufferers are referred to palliative care services, and under the age of 50 almost everyone is referred. That is not bad coverage, although I entirely accept that we need a massive expansion of palliative care skills, and I heartily agree that we must campaign for that, but it would make very little difference to this very small group of people. It would be brave and right if palliative care specialists championed the rights of their patients to have their wishes respected.

Secondly, there is the issue of undue influence. One of the burdens that older people and those with disabilities face—the noble Lord, Lord Ashley, made this comment—is the often unwanted protective paternalism of those who run their services. Unless they have mental frailty—many older people do have undiagnosed dementia—older people are no more likely to suffer from undue influence from their relatives or carers than younger people. It is a fallacy to think that older people will be persuaded to take their own lives against their better judgment. The paternalistic denial of older people's right to be treated as others are is an ageist idea.

Thirdly, I want to comment on the safeguards in the Bill to prevent hasty decisions being taken by those who have a treatable, reversible depression, which is very common indeed when someone discovers they have a terminal illness, as my noble friend Lady Finlay of Llandaff said, and is usually responsive to timely medication. I was concerned by the earlier drafting of
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the Bill, and I suggested that there should be clearer wording to ensure that any mental disorder that impacts on capacity should be sought, and those individuals excluded. While legally capacity can readily be impaired by emotional disorder, unfortunately many doctors interpret capacity wrongly to include only intellectual capacity. I wanted to ensure that people with disturbed emotional states were clearly excluded from the Bill. I am now satisfied that the current wording in Clause 2(4) would ensure that. This legislation will strengthen patients' confidence that at the end their wishes will be respected. I commend this compassionate Bill to the House.

11.36 am

Lord Turnberg: My Lords, I have thought long and hard since our previous debates on the Bill, but I am sorry to have to say to the noble Lord, Lord Joffe, for whom I have enormous respect and whose motives I admire enormously, that I cannot support the Bill.

I say that not because I am against the principle that we should do all we can as a society in general, and as doctors in particular, to relieve a patient's suffering, especially the type of heart-rending cases that we have heard about today. Where they are terminally ill, I am not against easing their passage from this life as best we can by palliative care; how could I, as an ex-practising physician, not support that principle? All my feelings and emotions are in favour of those who speak for the Bill. I am not against the Bill because of the religious convictions that I may have, because I do not wish to inflict those convictions on others who do not hold them. I am against the Bill for entirely practical reasons—the unintended consequences of acceding to one patient's desire for assisted suicide when the risks entailed for others seem, to my mind, too great. The probability of a risk to the aged, the disabled and the depressed, who will feel a burden to others despite the safeguards in the Bill, seem to me too high. The finality of that risk, the termination of a person's life, is too severe. When mistakes are made they will be fatal, and mistakes seem inevitable. Some mistakes, such as a wrong diagnosis or a misdiagnosis of depression, will go undetected.

I have tried hard to see whether it would be possible to amend the Bill to the extent that my anxieties could be allayed. Perhaps we could better define terminal illness, or change "unbearable" suffering to "unrelievable" or "intractable" suffering. Perhaps we could relieve doctors of this responsibility, as the majority of doctors seem to wish to be relieved, and give it to some other professionals to pursue. But I am afraid that none of those types of amendment would get around my concerns, and for those reasons I cannot support the Bill.

Having said that, I would be sorry if the noble Lord, Lord Carlile, were to press his amendment. Such a controversial Bill, which raises such high feelings, does deserve to be debated in Committee.
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11.39 am

Lord Prior: My Lords, I am a very diffident speaker, and I am very rarely able to attend your Lordships' House, but on this issue one should stand up and be counted, and I wish to be counted as a supporter of the noble Lord, Lord Joffe. I admire enormously the courage that he has shown in introducing this highly controversial and difficult Bill. For me, it is not a moral issue, because already we know that a number of people are helped to die by one means or another, and that issue is irrelevant. I am surprised that so many people turn a blind eye to that, yet make such a fuss about a comparatively small number of people who could be helped by the Bill.

The Bill deals essentially with a small number of people who are highly intelligent, but are struck down by a physical illness that leaves their mental capacity intact but destroys their physical ability to lead a dignified and normal life. Surely any Christian doctrine has to accept that there are people who suffer deeply, for whom the Lord would take the view that they should be helped, and that there is no point in causing people to suffer the indignities that go with such diseases and which have nothing to do with the sanctity of life. For me, these are the issues that really count.

It would be a great shame if your Lordships did not give this Bill a Second Reading. That would enable some of the other issues to be brought out and we could, perhaps, get the Bill into an acceptable form. If it comes in an acceptable form, there is a chance that it could get through the Commons, perhaps next Session. To kill the Bill at this stage would be a tragedy for all those who think that there should be some change, but would also deny your Lordships a chance to put right anything that needs to be put right.

11.41 am

Lord Clement-Jones: My Lords, the more we debate it, the more ethical difficulties I see in the Bill, because my objections to it are only partly borne from personal experience as the carer of a terminally ill spouse, from problems I have with the language of the Bill—words such as,

and "unbearable suffering"—and from the failure to implement all the Select Committee's recommendations. Principally, my objections are founded on similar grounds to views expressed by the Royal College of Physicians, which recently produced an impressive and definitive briefing. It considers that assisted suicide is incompatible with the doctor's role of trying to prevent death by effective treatment. It would lead to erosion of trust in the medical profession and adversely affect people's willingness to accept treatment for relief.

The RCP also outlines the huge issues surrounding the assessment of capacity in making a decision on assisted suicide and the impact of conditions such as depression, which can require specialist diagnosis and are treatable. The RCP correctly states that:
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I am still convinced that the way forward is through the development of high-quality palliative care, pioneered by the hospice movement in this country, in which we are now world leaders. We should not extend patient autonomy for a few by a dramatic change in medical ethics and practice, which could be detrimental to the many.

We are told by those who want the law changed that doctors in the UK are already illegally helping people to die and that it would be better to recognise that and regulate it by law. But the report by Professor Clive Seale shows that illegal actions by doctors to end the lives of patients were estimated to occur in about 0.5 per cent of all deaths. The argument that in Britain there is widespread euthanasia or assisted suicide that needs to be regulated cannot be sustained.

Annual reports from the Oregon Department of Human Services give figures for assisted suicides. Every report states also that the numbers given,

The operation of Oregon law on assisted suicide is based entirely on a voluntary reporting system. We have a paradox—we are not being warned about illegal assisted dying in Oregon, where the responsible government department clearly thinks that it might be happening, but we are being warned that illegal assisted dying is widespread in Britain when there is a report that says the practice is extremely rare. That demonstrates the dangers of new legislation and the lack of necessity and desirability for it here in Britain. I support the amendment of the noble Lord, Lord Carlile.

11.45 am

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