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One aspect makes policing the Bill almost doomed to fail; post-event reporting. The monitoring commissions are to review after the eventthe deaththe decisions of doctors from documentation supplied by them. In other words, has the doctor ticked all the boxes on the form? Oregon's health department figures carry the caveat that it cannot detect illegal prescriptions.
The second opinion is ill defined. The Netherlands at least has a system of registered second-consultation doctors rather than relying on a doctor just asking a friendly colleague to "do the forms", a little like cremation forms are done. We all know how that system did not detect Dr Shipman.
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In Oregon in 2005, 39 physicians wrote 64 prescriptions for lethal medication, which represents one half of one per cent of all Oregon's doctorsI repeat, one half of one per cent Interestingly, of the 39 physicians, 29 wrote one prescription, but one wrote eight, which must raise serious questions. It seems that more than two-thirds of recorded lethal prescriptions are issued by doctors who have had little knowledge of the patient beyond his or her case notes. Given that few doctors want to participate, doctor shopping seems to occur, helped by the pro-euthanasia organisation there. To cite Oregon in support of the Bill seems to be pretty desperate and misleading.
Autonomy does not mean that we get what we want. It means that we must consider the autonomy of others around us. This Bill asks those in palliative care to do what they find abhorrent. Only 3 per cent of specialists in palliative medicine are willing to participate. Those who work in palliative care support patients stopping treatments that they do not want. They care during dying. They see the dangers of cutting life shortthey have no crystal ball to predict how long an individual patient will or will not live. If the Bill goes ahead, we are likely to change the air of the society that we breathe.
We must balance a very few peopleas the Bill's proponents tell uswho have to live a few days, weeks or months longer, against those who will opt for assisted suicide inappropriately early and who could have lived well for years. I hope your Lordships will reject the Bill.
Lord Mackay of Clashfern: My Lords, I begin by declaring my interests as the president of the Scottish Bible Society, a patron of the Lawyers' Christian Fellowship and a supporter of a number of Christian and welfare groups.
As your Lordships will know, I was the chairman of the Select Committee set up to examine a previous Bill in this field, brought forward by the noble Lord, Lord Joffe. At the committee's first meeting, it was apparent to me that its members held strong views for and against the Bill. I felt that a report stating that so many were for and so many were against that Bill was not likely to be of use to your Lordships in further consideration of such matters. Therefore, I felt that, if we could, we should try to assemble a factual report on the matters relating to the Bill and that we should engage together in a thorough examination of those factual and weighty issues that might assist your Lordships to reach mature judgments on themissues of life and death.
In order to do that, I determined to embrace a strictly neutral stance at all stages of the committee's work and I have tried to follow that decision until now. The work of the committee has now concluded with publication of its report and a Take Note debate on it in your Lordships' House. I hope that noble Lords will agree that it is appropriate for me now to express my own point of view.
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Before doing so, I wish to mention a recommendation of the committee, to which the noble Lord, Lord Joffe, referred: that there had already been a Second Reading on a very similar Bill, followed by a Second Reading while the Select Committee was still engaged on its remit, in order for a renewal of its mandate. With a full report with the evidence that we had taken and a Take Note debate, it seemed appropriate that after a further formal Second Reading, a further Bill on the same basis should be remitted to a Committee of the Whole House. Of course, we appreciated that if the House wished to have a Second Reading debate, that would happen and our recommendation could be rejected.
A strong factor in that recommendationat least so far as I was concerned, and I think my view may have been sharedwas that the previous Bill had included provisions whereby a patient could be given a substance which he or she could take and, if the patient was incapable of doing so, the doctor could take action to bring the patient's life to an end. So there were two distinct sets of provisions in that Bill, and the noble Baroness, Lady Hayman, had different views about their validity.
Obviously, when there are two such distinct provisions in principle, a Second Reading debate would not be able to resolve the issues. A Second Reading debate can deal only with a Bill as a whole and therefore two distinct provisions cannot be dealt with separately. On the other hand, in formulating this Bill and having no doubt considered the views of members of the committee that were known to him, as well as the evidence relating to the Netherlands, as he mentioned this morning, the noble Lord, Lord Joffe, decided to produce a Bill containing only the main provision: that of the doctor assisting by providing the necessary prescription. The precise basis for that recommendation from the committee has been somewhat altered by the provisions that the noble Lord, Lord Joffe, has adopted in this Bill.
It is clear from the evidence that we took in Oregon that only a small number of prescriptions had been issued over the years since the legislation there came into effect and that a high proportionperhaps something of the order of 50 per cent or even morehad not been used. Prescriptions were issued by doctors after patients had determined that they wished to die but then quite a high proportion of those patients did not take up the prescription. That is an indication that, even if it appears definitive, a decision to embrace assisted suicide may be provisional.
As my noble friend Lord Arran has already said, the evidence indicated that people who used the prescriptions were those who had been in the habit of exercising very strong control in their own lives and who found it impossible to accept the prospect of losing that control as a result of a terminal illness. They were not necessarily in severe physical pain in the sense that I understand it but in what has been called "existential" pain or mental anguish. The evidence showed that the number of such people was relatively
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small. That fact has been emphasised by the noble Lord, Lord Joffe, today and it is supported, for example, by my noble friend Lord Arran.
We took evidence from a great number of people. Among the witnesses were severely disabled people who expressed anxiety about the Bill. However, I felt that they may have misunderstood it and I said to one particular person, whom I remember very well, that this Billof course, when I spoke of "this Bill", I was talking about the previous Bill introduced by the noble Lord, Lord Joffedid not contain any threat to her or her colleagues because it dealt only with terminal illness. Terminal illness was defined in that Bill as being of a limited time but it was expressed a little more ambiguously than in the present Bill, where the time limit is defined as six months.
I tried to understand why the lady felt that the Bill was a threat. I hope that I summarise fairly when I say that she took the view that, if doctors could properly help to end a heavily burdened life in the circumstances described in the Bill, that involved a judgment on the value of a heavily burdened life. She felt that she was in the category of having a heavily burdened life, which accentuated the burden.
There are many more disabled peoplesome of them heavily disabledin this country than there are likely to be beneficiaries of this Bill, if the evidence from Oregon on which it is founded is to be relied on. I feel strongly that I do not wish to add to the burden of heavily burdened lives lived by those who may be disabled. I do not wish to add to their burdens while they live a heavily burdened but successful and challenging life, which challenges all of us in what they can achieve in the face of their disabilities. We have had the privilege in this debate of hearing from people who are disabled. The message from them seems to be rather the same as that which I took from the evidence of the disabled lady.
The question is whether the Bill should be allowed to proceed or whether it should be postponed, as proposed by the amendment of the noble Lord, Lord Carlile. If the Bill in principle were acceptable or were capable of being put into an acceptable form by amendments in Committee, it would be right that it should proceed. For my part, in the light of my conclusion to which I have just referred, I do not think that that is so. I will support the amendment tabled by the noble Lord, Lord Carlile, if it is moved.
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