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Baroness Morris of Bolton: My Lords, compassionate care of those facing death has altered the landscape, and palliative care specialists have been advocates of the patient more than any other group. They have argued for stopping futile treatment and keeping people comfortable even if that risks shortening life. It is those specialists above all who have insisted on care that is directed by the patient and at the patient's pace and choice, and all these specialists are clear: they see this Bill as a nightmare.
As we have heard, Britain is a world leader in palliative care, as one might expect from the birthplace of the hospice movement. What is needed is to enable everyone who is dying to receive the care they require and deserve. We should focus NHS resources on care that most of us will need one day, and from which thousands of people stand to benefit.
We should not assist suicide. As we heard in the powerful speech of the noble Baroness, Lady Symons of Vernham Dean, patients are often not in the right frame of mind, and the information to patients may be wrong. Patients with motor neurone disease believe they will choke to death but, as the noble Lord, Lord MacKenzie said, the evidence is that patients do
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not. Even in this disease, prognosis is unpredictable. The prognosis is officially short. Fifty per cent of those diagnosed will die within 14 months, but one in 10 is alive in 10 years10 years within which they and their families will have experienced much happiness. How can a decision to end life be sound if it is based on such uncertainty? We must not forget, as the noble Lord, Lord Alton, said, that one in 32 deaths in Holland is through euthanasia and assisted suicide. That is what happens when society accepts assisted dying, which the Dutch did some years before they introduced their present legislation.
It is not the mark of a civilised society to assist those who wish to end their life before its full course has run, or in any way to add to the fear and pressures of the terminally ill, the disabled, the elderly or the young and depressed. In doing that we surrender to a collective despair. We should kill the suffering, not the patient, and despite the good intentions of the noble Lord, Lord Joffe, we should certainly kill this Bill.
Baroness Wilkins: My Lords, I am totally opposed to this Bill. It is a dangerous Bill. Contrary to the views of my noble friend Lord Hughes of Woodside, it only masquerades as a modest Bill. If it were to succeed, it would remove the cornerstone of our law that protects us when we are at our most vulnerable. If we cross that threshold, society's attitude will inevitably change. It is for that reason that we have all been inundated with pleas from disabled people to reject the Bill. Severely disabled people know vulnerability only too well, subject as we are to the widespread prejudice that the quality and therefore the value of our lives is less than that of non-disabled people. Regardless of the high-profile individual cases such as Dianne Pretty, no disabled people's organisation, national or local, has supported the Bill.
In Committee Room 4 today, a new organisation was launched called Not Dead Yet UK. It comprises a group of influential disabled people who have helped ensure that disabled people's fears have been properly heard for the first time in relation to the campaign of the noble Lord, Lord Joffe. This was no tactic. They fear the Bill not because they have been told to, as my noble friend Lord Hughes suggested, but because their life experiences have taught them to be afraid. They and I believe that legalising assisted dying will inevitably lead to increasingly adverse judgments about the quality of our lives. I say to noble Lords, please do not let that happen; vote against the Bill.
First, I wish to emphasise a point that has been covered by many of your Lordships, and that is the position of the medical profession on this issue. We now have more detail on the reservations felt both by doctors and nurses with regard to the Bill. I realise that
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there is ambiguity given that various people have different views on or interpretations of the evidence before us. However, my belief is that the people who are most concerned with the application of the Bill are not in favour of it. They highlight many difficulties so far as patient interaction is concerned and many see their participation in this operation as a violation of their professional commitments.
Secondly, I feelas clearly do many other Members of your Lordships' Housethat the correct answer to this very difficult problem is the utilisation of palliative care techniques. That has been very ably expressed by the noble Baroness, Lady Finlay. Although we are told that the UK is one of the world leaders in this area, and that there is a well developed palliative care scheme, there are parts of the country where there are clearly problems. Those have been highlighted by various speakers. There is still a great need for investment in people and financial support in this area of medicine. A danger that I fear is that the implementation of this Bill would lead to a decrease in support in this area, as appears to have occurred in Holland when related legislation was passed and the government withdrew considerable support for palliative care. I am very concerned about the remarks made by the noble Lord, Lord Elton, on the financial implications of the possible alternatives that the Bill could present.
Thirdly, like other noble Lords I received an extremely long list of letters. Among those who wrote to me in favour of the Bill, it was clear that there were people who had not recognised the limitations which the noble Lord, Lord Joffe, had written into the Bill and that in certain cases the problem that was being aired could not be solved because of the six-month time limit. I fear that if this Bill were passed, these problems, which are very real, would lead to demands for a more extensive form of legislation and would involve the so-called "slippery slope" effect that a number of us fear.
Undoubtedly, this Bill addresses a very difficult and highly emotive problem. I admit that my initial reactions were in favour of the Bill, but on detailed consideration, for many of the reasons already expressed by noble Lords, I feel that the solution suggested by the Bill provides too many alternative problems. The real answer is greater investment in palliative care. The correct solution is to build up the palliative care service assistance to a level that can then deal with the real problem.
Lord Lipsey: My Lords, some hours ago, the right reverend Prelate the Bishop of St Albans referred to Alice in Wonderland, and as I have sat through this wonderful but gruelling debate, I have felt a bit like the Cheshire Cat's grin; when I looked at my speech it was fading by the moment. I will say a word or two about palliative care, picking up the point that has just been made.
Palliative care has been mentioned in this debate almost as if the supporters of the Bill were against it. I, and I am sure the noble Lord, Lord Joffe, take that
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quite hard. The noble Lord, Lord Joffe, and I signed a minority report to the Royal Commission on Long Term Care for the Elderly. The majority report wanted a large sum of money to be spent on paying for care for the better off, and they had a very good case. The noble Lord, Lord Joffe, and I said, "No, we cannot go along with that, because the priority at the moment is better services for the elderly, not paying for care for the better off". That is a controversial view, but that was the view that we took, and of course we included palliative care in that. I am sure that no one inadvertently will think that we are against palliative care because we are in favour of this Bill.
To me, palliative care and assisted suicide are not alternatives. They are complementary; we need both. We need much more palliative care, so that wherever possible people want to live; and we need assisted suicide for the small minority of cases where people, despite palliative care, are suffering unbearably. If the proponents of palliative care are honest, and I know that they are, they will admit that there are some conditions, particularly neurological conditions, where palliative care really cannot prevent unbearable suffering.
I would go further. Contrary to the view expressed by the noble Lord, Lord Elton, and my noble friend Lord MacKenzie of Culkein, and as someone who has written a great deal on public expenditure, I am absolutely confident that if this Bill goes through we shall get more spent on palliative care by the Government than if it does not. This is for two reasons. First, it would concentrate public attention on end-of-life issues, which most people like to ignore, and therefore create a demand for palliative care and for the Government to pay for it. Secondly, once Parliament has passed such a law, the Government would have to spend more on palliative care, if only to avoid vulnerability to the charge, fatuous though it may be, that they have permitted the change only to save money. The evidence of the improvement in palliative services in Oregon is proof of that pudding in the eating.
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