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Lord Layard: My Lords, the opponents of the Bill would like us to believe that the present situation is a logical one and that it puts the preservation of life above all else, but, of course, that is not the reality of the situation.
I would like to give three examples of where people are allowed to die who could have been kept alive. One example is where the doctor himself or herself makes that decisionwhen a person is deeply incapable and suffering and there is no obvious hope, they decide not to keep the person alive any longer. Secondly, there is the case where the person has made a living will which requires that of the doctor. Thirdly, there is the case where, if you are capable, you can insist that you are not resuscitated if you have a heart attack. All those cases break the principle of the preservation of life.
The thing which you cannot do, though, if you are capable and in hospital is deliberately to advance your death, either on your own or with assistance, to speak practically. Of course, if you are not so ill and therefore you are at home, you can do it, and if someone assists you, they will not in fact get more than a reprimand. So we have the situation where it is only if you are ill enough to be under 24-hour medical care that you cannot advance your death. I find that extremely illogical. Certainly, it cannot be defended on the ground that we put the preservation of life above everything else in all that we do. You can, in fact, kill yourself unless you are so ill that you need medical help to do it. The majority of people80 per cent of the electoratedo not agree with that and think that the law should be changed. We should take their opinions very seriously because it is not like an opinion about capital punishment, where you are thinking about what should be done to somebody else; it is an opinion about what you would like to be done to you if you were in a certain situation.
The problem that we haveit is a very serious feature of the position that we are in as a Houseis that the majority of the medical profession are against the Bill. It is extremely easy to understand their feelings because 99.99 per cent of their patients desperately want to go on living, and it is a prime obligation of doctorsit is their prime jobto satisfy the wishes of those people. That leads, of course, to the development of a professional ethic and an instinctive response that that is the overriding drive. But what if a tiny minority want something differentthat is the issueand they are in no position to bring it about on their own? And what if the vast majority of the population think that those people ought to be legally able to have help in bringing about their end? This is a straightforward issue for political philosophy and in my opinion the people have it. I am a passionate
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supporter of the medical profession and I want it to have more power in the NHS, but this is a matter of people's lives and I think that the views of individuals and of the population ought to be paramount.
There is the issue of unintended consequences, which my noble friend Lord Turnberg quite rightly raised. For example, would the measure undermine the trust between doctors and patients? I do not see why it should. I note that in the Netherlands that trust is higher than in any other European country, as shown by surveys. Would mistakes be made? Do doctors misdiagnose people as terminally ill? Of course, occasionally, they do. But if the person is in that situation and has no reason to think that they will not have a horrible death, they are in a state of mental distress, and mental distress is at least as important an issue here as physical distress, particularly if the patient says, "I cannot tolerate this situation". That is in the end the overriding issueshould the choice of the patient be decisive, if the patient is capable? In the NHS that is, of course, always the overriding criterion except in the case that we are discussing. Eighty per cent of the population think that people should have this facility, and so do I.
Lord Kerr of Kinlochard: My Lords, I join those who congratulate the noble Lords, Lord Joffe and Lord Carlile, on the speeches which started the debate. The noble Lord, Lord Carlile, has the advantage over me: it is clear that he finds the issue relatively simple, and the decision that we have to take an easy one. Listening to him I was reminded of the man who said of Lord Macaulay, "I wish I was as sure of anything as Tom Macaulay is of everything".
I myself find it an extremely difficult decision and one not illuminated by the correspondence we have received. I have read all the letters that I have received, but the correspondence clearly reflects public concerns which do not arise naturally from the substance of the Bill as I read it. First, many people clearly have been led to believe that what is at issue here is euthanasia, and it is not. Secondly, the version of the slippery slope argument which seems most understood by the people who have been following this debate is that somehow in this Bill there exists an infernal machine or a mechanism by which the Bill may expand its scope over time and the safeguards be eliminated or reduced over time. That clearly is and could not be the case.
Thirdly, many people clearly believe that if the Bill were to become law, the amount of resources available for palliative care, and the attention given to palliative care, would be reduced. That, plainly, is not the case either. I hope that those reporting this debate will take care to address those issues and discuss the scope of the Bill because two-thirds of the concern I detect in the correspondence that I have received is built on these three factors, none of which applies. All of these three concerns are misconceived.
That said, I do not know whether the noble Lord, Lord Joffe, has his Bill right. What I am pretty sure about is that the existing situationthe law as it
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standscannot be right. It cannot be right that a compassionate act, whatever the circumstances, and in response to repeated requests, must always be a criminal one. We all knowmany of us from our own family experiencesthat there are many more cases of assisted dying than are prosecuted. We can make an estimatethe noble Lord, Lord Joffe, mentioned 650of how many cases a year might arise in which people use the procedures set out in his Bill. But we cannot say whether, if the Bill became law, there would be more or less assisted dying than there is today. I suspect that there might be less because the clarification of the law through the specification of the safeguards might actually prove restrictive in its effect, though that is speculation. What seems to me to be not speculation but observable fact is that a rarely enforced law, which leaves a shadow of criminality hanging over those who commit the crime of responding compassionately to a repeated request, must be wrong.
The present situation is not satisfactory. I do not know whether the Bill of the noble Lord, Lord Joffe, is right, but it seems to me very difficult to accept that the question of whether there should be a permitted procedure, how it should be defined and what safeguards should be built in is not even worth discussing. That is why, having listened to the quality of this debate, I hope that the noble Lord, Lord Carlile, will take the same view and will not press his amendment.
Lord Winston: My Lords, I must declare a conflict of interests in speaking in this debate. I am an orthodox Jew and I believe in the basic principle of pikuach nefesh, which is essentially the sanctity of human life. But we live in a pluralistic society and it is very important that when we make legislation and talk about these issues, while our personal background may influence, help and illuminate our opinion, it must be very important and clear to us that we do not expect our opinion necessarily to dominate those of other people. So I will set aside completely my religious views and speak from a purely secular point of view.
A number of noble Lords have spoken about public opinion: the noble Viscount, Lord Craigavon, the noble Baroness, Lady Thomas, and the noble Lord, Lord Layard. The fact of the matter is that if there is some public opinion, what your Lordships have clearly seen over the past months is an overwhelming response from the publicnot from Christian or other religious organisations necessarilyin opposition to this Bill. If we are to test public opinion, we should test it by a different kind of Bill; not by a Private Member's Bill, but by a Bill that is introduced on the basis of some kind of manifesto. I briefly want to argue two points about this Bill.
Five times in my life I have seen people who are dying who have clearly wanted to die and have expressed that wish repeatedly to me, often over several months. On one occasion, I even filmed that, very controversially, in "The Human Body". A man called Herbie in Ireland, who suffered from
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mesothelioma, clearly said to the camera, "I want to die; I wish somebody could end my life". Herbie lasted for almost 20 months after that time, and in the last six months of his life he said, "I am so pleased that I was not taken at my word". I have seen that four other times with patients.
I will tell noble Lords something very personal, which I have not even discussed with my family. My mother is 93; she slips in and out of a pre-dementia situation when she is not entirely with us, and sometimes she is not with us at all. At other times she is quite lucid. Some months ago, she said to me, "I have really reached the end". That was during a lucid period, which is a point to be noted. She then became very confused and aggressive, and she did not know where she was. As recently as last week, suddenly she has found that she is enjoying life again. We cannot predict how people may feel about the future, and to take that view is ultimately the most presumptuous thing that we can do.
I have one other point. There is the question of old people. I was surprised to hear my friend, the noble Baroness, Lady Greengross, talking about old people in this situation; I must take a different view. The problem is that it is nothing to do with the slippery slope. When old people enter hospital they are often confused, angry and disoriented and they do not know where they are. There are three problems. First, there is the attitude to them. I know that my noble friend the Minister of State is on the Front Bench, and I mean absolutely no disrespect to him or to the health service, but he knows as well as I do that geriatric wards and old people's care are constantly under pressure in our very good health service. It is inevitable that it will be so. You see it in many wards, and I have seen it myself with my mother's care. People are left soiled, they are called by their first name, and they are not treated with dignity. They lose themselves, and as they become angry and disoriented they cease to be people. First, they have the attitude of devaluing themselves; secondly, they may be devalued by other people, and we ourselves may devalue them. Recently with my mother, I have sometimes wondered privately if it would not be better to end it. That is the problem, because this week she is sapient, conscious and able to hold an intelligent discussion. We need to respect the hoary head, in this House above all. I urge noble Lords to reject the Bill.
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