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Lord Dholakia: My Lords, 75 noble Lords have already spoken and there are more to come. I do not think I can add to the arguments already advanced by the noble Lord, Lord Joffe. However, I wish to put on record my support for the Bill. I promise I shall be brief.

My reasons are very personal. I lost a family member in tragic circumstances, and the more I think about it the more convinced I am that his death lacked that dignity which he so craved for all his life. I have compassion for those in despair and tolerance for others' wishes even though they may not hold with my own moral or religious views. I want fairness for those who currently cannot receive the treatment they want; justice for those who so often do not have the strength to battle for their rights; respect for individual choices; and dignity for patients at the end of their lives.

The Bill is controversial and has generated a great deal of public emotion. I have spoken about this matter publicly and I have received abusive letters. No, I do not throw them away; I file them under fan mail.

The reason I have decided to speak is that I cannot see any justification for dividing this House at Second Reading. I accept that there is nothing procedurally or constitutionally wrong with doing so—I agree on that point with my noble friend Lord Carlile of Berriew—but society expects to decide complex issues through its legislators in Parliament. A Committee stage and a Report stage would give us the opportunity to tease out all the arguments that have been advanced. Denying that opportunity for this complex legislation downgrades our democracy and, more importantly, our democratic institutions.
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3.32 pm

Lord Hylton: My Lords, I wonder whether my noble friend Lord Joffe really understands the strength of the opposition he has aroused. The great faiths are united against the Bill, more so even than was shown by the letter to the Times today. The new organisation, Care NOT Killing, received 10,000 signatures petitioning against the Bill. Surely this is a record for a Private Member's Bill.

The medical professions are fairly solidly against the proposals. The Royal College of Physicians, with 23,000 members, states:

I hope that that will satisfy the many agnostics. In fact, no royal college favours changing the law.

My noble friend Lord Joffe said that more than 70 per cent of public opinion, as measured by polls, supports a change. I suggest that that turns very much on how the questions are put. CommunicateResearch, in a recent poll, found that 65 per cent agreed that the Bill would put pressure on vulnerable people to opt for suicide; 73 per cent thought it would become harder to detect rogue doctors, as in the case of the late Dr Shipman; 75 per cent thought that people with treatable illnesses, such as severe depression, would prematurely wish to end their lives. These are very serious matters.

The Bill risks destroying the remaining trust between old and sick patients and their doctors and carers. Here I agree with the noble Lord, Lord Turnberg, about the practical and unintended consequences, such as improper pressures.

I urge my noble friend to withdraw this divisive Bill, though he has moved it from the highest motives. Otherwise, I must vote against it.

3.34 pm

Lord MacKenzie of Culkein: My Lords, I declare an interest: I am a nurse. I know that some nurses, whose opinions I very much respect, support the Bill and even seek to do so from an ethical standpoint, but I cannot agree with them. I cannot support any legislation which will, in my opinion at least, jeopardise the future of the nurse/patient relationship. I am therefore pleased to note that the collective voice of nursing is very much opposed to the Bill.

The Bill clearly sees the involvement of nurses in the process of assisting death. We have heard much today about choice and autonomy, but you cannot exercise choice and autonomy without involving doctors and nurses. It is not something you can do on your own. Although there is a clause dealing with conscientious objection, I am of the view that it cannot really work in all the care settings where end-of-life care is delivered. The prospect of encountering a patient wishing to take advantage of physician-assisted suicide
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will not be restricted to those working in palliative care. I feel very strongly that it is not part of their practice for any palliative care nurse to be involved in any process whatever of obtaining assisted dying.

We have already heard about the slippery slope, not least about the cultural shift in the UK since the introduction of the Abortion Act 1967. The situation is self-evidently very different today from that envisaged by the noble Lord, Lord Steel of Aikwood. I make no complaint about that because I firmly believe that women have a right to control their own fertility. Some noble Lords have said that there will not be a slippery slope yet, but I am not so confident. I think that there is bound to be a demand for further legislation to legalise euthanasia. The noble Lord, Lord Joffe, said today that he has changed his mind about the legislation going forward in incremental stages. I greatly respect and welcome his revised position. But others will surely not be so content if the Bill is enacted—they will want to take the matter further.

I do not believe that this is what the values of the nursing profession are about. I also believe that if the Bill ever becomes an Act, it will severely damage the development and continuation of palliative care, not least if that inevitable cultural shift takes place and the population becomes conditioned to a cheaper option of physician-assisted dying or euthanasia. The noble Lord, Lord Elton, said that money drives policy. That is fairly hard-nosed, but he is right. We know that that is what happens in the real world.

It goes without saying that, wherever possible, death should be pain-free and dignified. If there was universal—I emphasise that word—availability of hospice care, not just for malignancies but for diseases such as motor neurone disease, if there was hospice care at home and good symptom and pain control, a lot of the fear that engenders the demand to be allowed to choose assisted dying might be removed. The lessening of that fear would be materially assisted if there were less media hysteria and misinformation—for example, that people living with motor neurone disease choke to death. That simply is not true.

I do not want to damage in any way the trust of patients in nurses and physicians or the terminally ill in their relatives and carers. I do not believe that the Bill provides sufficient safeguard where someone who appears to be terminally ill feels that they are a burden on their family and carers and where—this is the real world, after all—there might be greed and malice aforethought.

The prescribing doctor will not be present when the lethal cocktail is taken. Who is to know who administers the drugs? For me, any doctor or nurse who sets up an intravenous line or nasogastric tube where there is an inability to swallow must come very close indeed to practising euthanasia. For all these reasons, and many others which time does not permit me to give, I will support the amendment in the name of the noble Lord, Lord Carlile of Berriew.
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3.39 pm

Lord Maginnis of Drumglass: My Lords, the noble Lord, Lord Joffe, said that his last Bill was,

I assume that the same principle of personal autonomy underlines this Bill. Yet surely he agrees that society must have laws restraining us from doing those things that may harm others. On that basis alone, his "personal autonomy" justification fails.

Unhappily people do attempt to commit suicide, and one does everything possible to prevent them succeeding, including trying to resuscitate them. Society views that as its duty. Although the individual is probably, in the words of the Bill, "suffering unbearably", society makes clear, in the time-worn words of successive coroners, that suicide indicates that the balance of the mind is disturbed, so society promptly suspends the suicidal individual's personal autonomy. Yet this Bill would make it lawful to assist suicide for the terminally ill seemingly because, the moment one is told one is going to die shortly of natural causes, it is no longer to be considered a sign of mental imbalance that one should want to accelerate one's death. In the case of the terminally ill, the Bill presumes mental capacity where, if the motivating trauma was different, that presumption would be the exact opposite. That just does not make sense.

There, due to time constraints, I rest my case. I have received hundreds of letters, many of them laboriously hand-written, and hundreds of personal e-mails. None was abusive. Only one that was written to me was in support of this Bill, and I believe that reflects the will of the vast majority. I urge your Lordships to reject the Bill.

3.42 pm

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