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Lord Young of Norwood Green: My Lords, I commend the noble Lord, Lord Joffe, for his courage and persistence and offer my support for his Bill. I trust that your Lordships will not accede to the invitation of the noble Lord, Lord Carlile, to apply euthanasia to the Bill, because it is in the tradition of the House to give time and attention to vital issues which merit more scrutiny.

The noble Lord, Lord Carlile, accused the Bill of casuistry, an unwarranted description of both the Bill—which I do not believe is disingenuous—and, by implication, perhaps, even the noble Lord, Lord Joffe. He declared that it would put every doctor at risk and enrich many lawyers. The noble Lord may well have the gift of prescience, but Clause 4 will clearly afford protection if it becomes law. How that law will be interpreted is a matter that no doubt will be decided by learned judges.

The most reverend Primate the Archbishop of Canterbury—who, unfortunately, is not in his place—said that suffering can be helpful. I would not wish to engage in a dispute with him, but that is a matter for individuals to determine in the course of their life. He then went on to say that we would put everyone at risk and that this would be a substitute for palliative care. Time and again we have heard such allegations made in this debate—but they are assumptions; they are not validated. As has also been said time and again, nothing in the Bill precludes us continuing to be a country which is well respected for its attitude towards palliative care.

The right reverend Prelate the Bishop of St Albans—who also is not in his place—made an unfortunate analogy, which seems to presume that all those in favour of the Bill are engaging in some kind of wilful misrepresentation by implying that the words that we use do not really have the meaning that they should have. I reject that. I would not impugn his integrity and I do not understand why he should impugn the integrity of those who support the Bill.

I have a huge respect for the noble Baroness, Lady Chapman—it is unfortunate that she is not in her place—but our society has moved a long way from failing to acknowledge the rights of the disabled and children. This Bill is not a prelude to euthanasia in such circumstances.

The noble Baroness, Lady Emerton, who has just spoken, said that no alternative was offered. It may be that we read Clauses 2 and 3 differently, but they take you through a whole range of alternatives that are put
 
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to the individual. She may not agree with my interpretation, but that does not necessarily mean, with due respect, that her interpretation is right.

At a meeting in this House on 19 April, Professor Raymond Tallis, a geriatrician and former chair of the Royal College of Physicians Ethics Committee, said:

"I am in support of Lord Joffe's Bill in its present form. There are several reasons for this. Firstly, the current law is a bad law with negative effects. There are a significant number of people who need, and seek assisted dying because of unbearable suffering which cannot be alleviated by even the best palliative care. The result is either botched suicides, currently illegal practices or the need to travel abroad for assistance.

Secondly, society recognises that the law is unfair and overwhelmingly supports a change in the law. In this, they are supported by many healthcare professionals.

Thirdly, the proposed Bill has more safeguards than any other legislation of its kind. Lord Joffe's Bill will make the situation safer for both patients and doctors than it is at present where end-of-life decisions are shrouded in medical, legal, and ethical fudge.

My own change of mind about the Bill is, perhaps, instructive. When the Ethics Committee which I chaired at the Royal College of Physicians first considered this Bill, in 2003, we opposed it and I was in support of that opposition. Unfortunately our decision was based on a series of assumptions: that good palliative care would obviate the need for assisted dying; that assisted dying legislation would stunt the development of our current underdeveloped palliative care services; that there would be a slippery slope in which assisted dying would be extended to people who did not want it or could not give informed consent, particularly those vulnerable people who have been my main professional concern; and that it would break down trust between doctors and patients. Every single one of those assumptions has proved to be false in those countries where assisted dying is available. Indeed, the impact of liberalising legislation has proved to be the reverse of what I had assumed.

This, then, was why I changed my mind".

Finally, I agree with the noble Baroness, Lady Williams, that love and respect is what every person deserves. But this can be shown in many ways, and I submit that respecting our loved one's wishes may be difficult but not necessarily wrong. We will all ultimately be faced with the challenge of death and no doubt rage against the dying of the light. This Bill will allow those who so wish to end the struggle, and to do it on their terms. I commend the Bill and I hope that your Lordships will oppose the amendment.

1.18 pm

Lord Carey of Clifton: My Lords, although the noble Lord, Lord Joffe, is not in his place at the moment, I thank him for his courage in pressing his concerns and for the tone in which he opened the debate.

I think the debate has given lie to the claim in some papers that this is a clash between two world views—the Christian religious world and a secular one. In the debate we have seen convinced Christians speak for the Bill, and Peers not noted for their religious fervour speaking against it. Therefore, although Members of your Lordships' House are divided, I believe we are united in our concern for those with terminal illnesses and in our desire that suffering people should enjoy the best quality of life until they pass away. It is the phrase "quality of life", introduced by my noble friend Lord Laing of Dunphail, which seems to me to be central to our concerns.
 
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It was my privilege many years ago to meet Dame Cicely Saunders, who founded the hospice movement, and to get to know her and her work very well indeed. Her vision was to create places where people with terminal illnesses are treated until they die. There are now 231 hospices in the country and many hundreds abroad. They, together with many other palliative care units in hospitals, are experts in pain control.

From the many letters I have received about today's debate, I have noticed the emphasis that so many of the writers have placed on palliative care. One experienced doctor from the midlands wrote:

"It is my observation that good terminal care can usually achieve adequate pain control and that the concept of unbearable pain is mainly a mental one".

I am against the Bill for a number of reasons, not least because it would alter the precious relationship between doctors and patients and because assisted suicides could, before a few years are out, be treated as casually as abortion is today. It is interesting that, in its most recent pronouncement on the Bill, the BMA said that the unevenness of good-quality palliative care was a matter of extreme concern to doctors. That is why I join the noble Lord, Lord Wilson, and others in believing that this is where our energies should focus. If this debate leads to significant investment in those services that provide end-of-life care, our time here will be well spent. For myself, I shall vote for the amendment of the noble Lord, Lord Carlile.

1.20 pm

Lord Brennan: My Lords, the Bill calls into question a serious issue of the law-making powers of this House. Dr Johnson put it clearly when he said that laws are not made for particular cases—they are made for all mankind. Let us keep those words in mind while I look at four reasons why the Bill fails that constitutional test.

First, the Bill legalises assisted suicide. That is presently a crime because we have always thought we should protect life, safeguard the vulnerable and preserve the ethos of the medical profession, and all that for the benefit of all society. I cannot accept that the common good of millions, protected by those foundations, should be put at risk because of the personal autonomy of the very few who are very determined. It is simply disproportionate, and it is dangerous.

Secondly, the Bill cannot work without the use of the medical profession. Doctors and nurses are against it, for two main reasons—their concern for the vulnerable and their deep commitment to what they think to be the correct ethos of the medical profession, which is to look after life, not to deal out death. If the Bill comes into law, a conscience clause is not only necessary but essential in order for there to be created—which there will be—a group of doctors who will carry out the legislative intent. We will be faced with the macabre prospect, in Britain tomorrow, of doctor-shopping and death clinics.

Thirdly, the Bill involves the creation of not only concerns but fear. The vulnerable, who feel exposed, will feel fear. The disabled do feel fear. I know of no
 
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organisation for the disabled that supports the Bill. Why? Because despite the intellectual reassurance which many noble Lords give the disabled, they are not confident that they will be protected in the future. Disabled people will live in fear. I cannot allow myself the luxury of listening to disabled people when they tell me about their physical needs and ignoring them when they tell me about their profound fears.

Fourthly, the Bill is wholly defective. There are at least 17 areas of criticism to be made: the borderline with euthanasia; the inadequacy of the safeguards; and the ineffectiveness of monitoring. In Committee, the Bill would need not revision but the impossible task of wholesale reconstruction.

I have a final and critical point. This is a Private Member's Bill. That is a right that we should value. It carries two responsibilities: first, such a Bill should represent the consensus of society; secondly, it should represent a division reached at the end of prolonged, profound and reasonably informed public debate. This Bill fails both those requirements.

I cannot foresee any intellectual discipline telling us, when the Select Committee told us otherwise in paragraph 232 and appendix 7, that the present state of public opinion is unreliable. I accept that. If Oregon is self-monitoring, I do not regard that as adequate data.

Parliament and this House are the proper places for debating controversial issues where no Bill is involved. But when a Bill is involved, this is not a legislative laboratory designed to test the ethical and social limits of a highly controversial piece of legislation. The noble Lord, Lord Carlile, requires us to face these realities. The Bill is wrong in principle, unworkable in practice and should be rejected now.

1.26 pm

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