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The Earl of Arran: My Lords, as an enormously privileged member of the Select Committee, I am immensely grateful for the time that we have spent in considering how to meet the wishes of some terminally ill adults who are suffering unbearably. Like all those in today's debate who are supportive of the Bill, I would of course prefer that their wishes could be met in some other way. But, as the committee unanimously noted, these people are,

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While taking evidence we visited the state of Oregon in the USA. I, among others, was most impressed with the way that the Oregon Death with Dignity Act 1997 compassionately responds to the request to die with assistance. As noble Lords may be aware, the Bill introduced by the noble Lord, Lord Joffe, is closely modelled on that Act, which a majority of my fellow committee members have confirmed that they support.

There has been considerable confusion in this country about how the Act is working there. Perhaps I may briefly remind your Lordships of some of our experiences there. We held 10 evidence sessions in Oregon, in nine of which witnesses largely agreed that the Act was working well and without abuse. Representatives of the Oregon Hospice Association, the Oregon Medical Association, the Oregon Board of Medical Examiners, the Oregon State Board of Nurses and Oregon's equivalent of the Department of Health, among others, all expressed satisfaction with the Act.

One set of witnesses, however, comprising a small group of doctors belonging to Physicians for Compassionate Care—PCC—tried to persuade us otherwise. However, the evidence that we received from the Oregon Medical Association strongly suggested that these individuals oppose the Act primarily because of their deeply held religious beliefs. This group's view of the Act was in stark contrast to the other nine groups. This group told us that Oregon's end-of-life care is of poor quality and has deteriorated since the Act was passed. Indeed, that message has been widely repeated. But some of your Lordships will have attended or read the notes of last month's presentation from Ann Jackson, CEO of the Oregon Hospice Association, at which she confirmed that the quality of end-of-life care in Oregon has improved and has not been compromised since the passing of the Act. Oregon is a leader in this area and was last year named the best place to die in America. The number of people dying in hospice care has doubled since the Act was passed, and every Oregonian now has access to hospice care, even those in the most remote areas.

One member of this group, Dr Kenneth Stevens, has suggested that Oregonian doctors now take less care of their terminally ill patients because they have the easy option of offering an assisted death instead. There is absolutely no evidence to substantiate that claim. In contrast, independent research has found that since the Act was passed, 70 per cent to 80 per cent of doctors have sought to improve their knowledge and skills in the care of the dying. So, Oregon legislation has had no adverse effect on hospice care; nor have the dire consequences that were predicted by groups such as PCC prevailed.

Unfortunately, such predictions are now being made in this country. Out of the 240,000 deaths in Oregon, 246 people have used the Act in the eight years since its passing; not—I repeat, not—the thousands that were anticipated by the Act's critics. The annual Oregon state reports show that, contrary to the predictions, these individuals are not very elderly; not disabled; not uneducated; not motivated by financial
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concerns, inadequate pain control or psychiatric illness; not uneducated and not disproportionately members of ethnic minorities.

In Oregon, we heard again and again that these individuals valued being in control and making their own decisions and could not tolerate the way in which illness had robbed them of their dignity. They were motivated by a desire to remain in control of their lives and avoid this loss of dignity and autonomy. Most importantly, more than 90 per cent of them were enrolled in hospice care at the time that they received their prescription: so dying Oregonians do not have to choose between palliative care and assisted dying.

I do not support these proposals blindly. Like others, I weigh the positive benefits to the great many terminally ill adults who would be reassured by these proposals and the small but significant number who would use them against the possibility of abuse. There is compelling evidence that the Oregon Act works well. In addition to this, the noble Lord, Lord Joffe, has included even more safeguards than existed in the Oregon legislation.

Whatever happens today, I make one prediction. Like homosexual reform—which Bill, incidentally, was introduced by my father and took four attempts to get through your Lordships' House—and the abortion Bill, and despite the similar controversy over this Bill and what the Churches and some doctors may say, eventually the clamour from society as a whole for legislation such as this will prevail, and, in doing so, society will be giving some relief to those suffering from intractable distress.

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Lord Wilson of Dinton: My Lords, I follow the noble Earl with respect, but I am afraid that I cannot follow him in supporting the Bill. I believe that killing and assisted killing is wrong and that this Bill would be a serious breach of principle. I want to make just two points in the short time available. I respect the noble Lord, Lord Joffe, for his courage in introducing the Bill, his intentions and his compassion.

I was Permanent Secretary of the Home Office for 10 years in the mid-1990s. The Home Office is a place where all the worst aspects of society go through your in-tray every day. You learn more things about the disagreeable sides of society than you ever wanted to learn. If you legislate in a way that relaxes principle, you will find that you have to look at it through the prism of the worst things that people will do with it. You have to assume that human frailty, running the whole gamut from wickedness to weakness, will search out the weaknesses in the Bill. If you permit killing to take place you have to assume that there will be abuse and have to look at it without a rosy view of human nature. I offer that thought on the slippery slope.

My view is that it is much better to put effort into palliative care, which is a very positive approach to the end of life, rather than bring forward death. I am proud to be a trustee of the Cicely Saunders Foundation. I was delighted when the noble Baroness,
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Lady Williams, paid a tribute to Dame Cicely Saunders who I believe was one of the truly great figures of the age in which we live. We miss her very much. I learnt from her that whatever one's route of illness at the end of life—whether cancer or some other progressive disease—the symptoms are very similar, whether they are breathlessness, fatigue, pain or any of the other terrible things that can happen to people at the end of their life. The main issue is how those symptoms can be relieved and how people can be enabled to die with dignity.

It is curious in the age in which we live that while huge amounts of money are spent on prevention and treatment of progressive illness, we turn our backs on the whole against spending money on research into relieving the symptoms in order to allow people to die with dignity. For every £500 we spend on research into cancer, less than £1 is devoted to symptom relief and end-of-life care. Those figures come from the National Cancer Research Institute. It is very odd that we are blind in that way. The gross imbalance is probably worse for other progressive or terminal conditions than for cancer. I would much prefer it if we could unite in this House to put effort into improving palliative care, which is a positive approach to the end of life with huge public support, rather than to put effort into assisted suicide, which I find to be inherently negative as an approach to death.

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Lord Haskel: My Lords, I congratulate the noble Lord, Lord Joffe, on the careful, dignified, courageous and determined way in which he has promoted his Bill. He and his colleagues travelled far and wide to take evidence so that all of us could become wiser and better informed, and I thank him and the members of the committee for their hard work. I want to make three points, in the main gently to remind noble Lords about our role as parliamentarians.

First, we are here to serve the public as a whole. We legislate to enhance and preserve people's rights and freedoms. Let us remember that Parliament was equally divided not only over abortion and homosexuality, but on cloning and assisted fertility. But in the end Parliament produced careful regulations to safeguard and control these activities which respect people's concerns and beliefs while preserving their freedom of choice. I think we must do the same here.

Secondly, I turn to the slippery slope argument. This House delayed the abolition of capital punishment for years using that argument, one which claimed that abolition would turn this country into a murderers' paradise. It was wrong then and, when applied to this Bill, it is probably wrong now. I think we should learn the lesson.

Thirdly, like it or not, this issue has become a matter of great public concern and controversy. Noble Lords have all spoken of the number of letters they have received and the many broadcasts about it. The Motion moved by the noble Lord, Lord Carlile, to kick it into the long grass would, I fear, expose us to
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criticism and perhaps ridicule. People would ask: what are we here for? The noble Lord, Lord Carlile, said that he sees no way of amending the Bill to make it acceptable. Well, that may be his opinion, but fortunately we have procedures to see whether a way can be found to make a Bill acceptable by amendment, by compromise and by scrutiny. That is why I hope your Lordships will allow this Bill to continue its passage.

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