Previous Section Back to Table of Contents Lords Hansard Home Page

The Mental Capacity Act has had a positive impact on giving people greater choice to express in advance what they wish at the end of life. A change in the law to allow assisted dying would offer a much clearer framework for the protection of vulnerable people, including those who have lost capacity, those who are depressed and those who might be unduly influenced by others looking to their inheritance, among other things. Such a law would protect doctors. It would make clearer what they could and could not do and would immeasurably improve the trust that patients have in their doctors, knowing that their choices will be respected at the end of life.

3.58 pm

Baroness Knight of Collingtree: Let there be no doubt whatever about the aims of those who are trumpeting this cause today. They have buried it in a whole lot of sensible goals which I cannot recall them ever mentioning before. When has the Voluntary

18 Nov 2008 : Column GC85

Euthanasia Society, which was the previous version of Dignity in Dying, ever funded a hospice? Dame Cicely Saunders has been mentioned; she certainly did not support euthanasia. When has this society ever campaigned for accessing palliative care, more monetary help for carers or demanded that health and social care professionals should be trained to cope with spiritual support for patients?

Never before has there been a squeak of a suggestion that religion should be brought into this arena. Is this the road to Damascus? I do not think so. I do not think that, all of a sudden, the Voluntary Euthanasia Society has changed. It is trying to fool us. It is a bit like slipping a bottle of cyanide into a weekend shopping list and hoping that it will not be noticed among the Daz, eggs and vegetables. What we are actually talking about is encouraging people to kill themselves and, worse, opening the way for relatives to get elderly and sick people out of the way—which can be a boon, especially when they have money or property to leave. Make no mistake, it is very easy to give an old lady or old gentleman the impression that their continued existence leads to great problems and great expense for their sons and daughters. They love their relatives and they do not want to cause problems, either.

We also know that it is very costly and, heaven save us, that hospitals are severely hampered in meeting their all-important government targets when patients linger on in a bed for which there is a waiting list. “For goodness’ sake let us shoo them out of the way and into the graveyard or crematorium”. Terminally ill but mentally competent people will, if the true aims of the Voluntary Euthanasia Society are realised, submit themselves to a lethal injection or a fatal dose, when it is made clear to them in a subtle or direct way that it is time that they shuffled off this mortal coil for the general good. I cannot support this proposal, which worries me very much. This does not apply to every proposal in the paper but it applies the one that we should allow euthanasia.

4.01 pm

Baroness Finlay of Llandaff: This document contains a great deal that I agree with wholeheartedly. The Government worked for two years through various working groups and consulted widely on their excellent strategy for end-of-life care. These same ideas are presented as if they emanate from the voluntary euthanasia lobby, now known as Dignity in Dying. The document before us seems to be an attempt to import a very different additional proposal into the government strategy—that Parliament must give terminally ill, mentally competent people the right to an assisted death. I emphasise the word must because this is the only point in the charter that the voluntary euthanasia movement feels “must” be followed. That word alone shows that it is a key priority, but I cannot sign up to it.

Perhaps I may address the contents of the leaflet with which I agree. Carers and the bereaved need support. The Mental Capacity Act already requires professionals to take account of end-of-life care plans and preferred priorities for care documentation. Awareness of advance decisions is being actively promoted by the

18 Nov 2008 : Column GC86

Government. Indeed, in 2001 I wrote an editorial calling for death plans. They did not, and do not, include euthanasia. Good care does not require the excuse of “double effect” to which the noble Lord, Lord Lester, alluded. Patients die of their disease and deserve good care and support, not shortcuts in care to end life. Good care is hard work.

Those who wrote this so-called charter seem remarkably ignorant of the increased resources that the Government are putting into end-of-life care. They seem unaware that a transparent formula for commissioning services is already being used in Wales; that carers are at the heart of many initiatives; that care and respite by Marie Curie nursing and others is cost-effective; that Dr Bee Wee has been appointed to develop the national training programme; and that communication skills training is already underway.

This charter masquerades behind the many years’ work of all those organisations that it alludes to as being supportive—clever wording indeed on page 6. It creates the impression that the hospice movement supports this charter. It certainly does not support item 5, which is the nub of the charter. Palliative care investment and education have increased around the world—not preferentially in countries that legalised euthanasia and assisted suicides, as has been asserted. In Oregon, one in six of those whose suicides were assisted had their depression missed by those assessing the request. The pro-euthanasia lobby’s approach in this document is reminiscent of Orwell’s 1984 and the Ministry of Truth.

So I ask the noble Lord whether this is an illusion. Are the people pictured next to the case vignettes the ones described in the document? Why is the euphemism “assisted death” used? Midwives assist at birth and palliative care assists at death; assistance is supportive help, not accelerating death or cutting life short by months or years. Why not be honest? What are the authors of this document frightened of? What they are really proposing is aiding and abetting suicide or giving doctors a therapeutic option of killing their patients. Palliative and other end-of-life care is being used like bubble-wrap around a sharp and dangerous object in an attempt to introduce assisted suicide by the back door.

4.05 pm

Lord Carlile of Berriew: I welcome the opportunity for another debate on this important subject. I also welcome the Government’s strategy.

I want to speak about the suggestion that assisting suicide should become lawful. I disagree fundamentally with my noble friend Lord Lester. His argument is for legalising precisely those hard cases that make bad law and which may indeed have the perverse effect of disadvantaging the very people he wishes to help. It is said that it is inappropriate to retain as an offence the assisting of something that is not unlawful—suicide—but do we not have to look at end of life with a quite different set of ethical values? If you assist a thief, the stolen goods can be returned. If you assist a suicide, only the body can be returned; there is no going back. At the moment we have a law that has a stern face and a kind heart with a discretion not to prosecute exercised

18 Nov 2008 : Column GC87

sensitively. The existing law protects the vulnerable. The proposed law could well not protect the vulnerable in the same way and I believe that it would not.

The sort of legal certainty of a statutory kind espoused by my noble friend would lead to a prescriptive law. We do not have purposes for statutes in this country, we have very precise statutes. The result would be the perverse result of more prosecutions for murder and manslaughter in a situation where Government after Government still set their face against the removal of the mandatory life sentence for murder.

I have two further things to say for the future. The first is that I have read a lot—the noble Lord, Lord Joffe, and I should talk more and exchange fewer letters through the columns of the newspapers—about the influence of religion on this debate. I probably come at this debate from exactly the same point as the noble Lord, Lord Warner, in non-religious terms. However, I do not see the contribution of the right reverend Prelate the Bishop of Exeter, or of someone whom we already miss, the Bishop of St Albans, as being a contribution that has any less validity than that of those of us who are non-religious or humanists. Indeed, I say to those who say that this debate has been taken over by the religious that they are coming close to the sort of religious intolerance that I believe went out 100 years ago.

My final point is on where any Bill should occur. I simply challenge those who would wish to change the law to bring their Bill in the right place—where the law can be changed and where there can be a vote by democratically elected people on whether the law should be changed—and to bring it to your Lordships' House afterwards. This is plainly something that should now be considered, if at all, by a Bill in the House of Commons. It should not start next time in the House of Lords.

4.08 pm

Baroness Emerton: I, too, thank the noble Lord, Lord Warner, for raising this debate. Like others, I agree with a considerable amount in the charter but certainly cannot agree with assisted dying.

The Government’s own strategy document was published at about the same time, following extensive consultation. It is an excellent document. Indeed, I have described the strategy as,

I reiterate that today.

By contrast, this charter from the voluntary euthanasia movement is a short document claiming to champion three,

choice, access and control, which then appear as 10 recommendations for action. One of these, coming as it does from the Voluntary Euthanasia Society, now rebranded as Dignity in Dying, calls on Parliament to legalise euthanasia—or “assisted death”, as it is euphemistically put.

18 Nov 2008 : Column GC88

Yet the so-called principles for dignity at the end of life do not make reference to this—they talk coyly of “how I die” and,

The foreword by the noble Lord, Lord Warner, fails to make any mention whatever of assisted dying. This omission is truly extraordinary. It is hard to escape the impression, as one reads the charter, that there is a veritable elephant in the room—a presence which is obvious to anyone who reads it with a little care but about whose existence there is a good deal of embarrassment and reticence. It is pretty obvious what is going on.

By contrast, the Government’s own end-of-life care strategy takes a wise and statesmanlike approach to the topic. It is a true strategy for improved end-of-life quality of care and enhanced dignity, and it provides a specific and fair assurance on the euthanasia debate. It states:

“The strategy has been developed within the current legal framework. Whilst the debate about changing the law to allow euthanasia and assisted suicide will continue in this country and elsewhere, these issues are beyond the scope of this strategy”.

Indeed, not only is it beyond the scope of an end-of-life strategy but it is not a health issue at all. It is one of justice and human rights—the right to life. None of us can escape death but we must have the right to have healthcare provided free from the risk of coercion to suicide.

The Voluntary Euthanasia Society is trying, in my view, to piggyback the Department of Health’s strategy for care at the end of life as a mule for carrying its single-issue thinking into government policy. The Government should wisely smell a rat and resist that. Further attempts to change the law on assisted dying must be declared before Parliament for what they are. This is far too important an issue for sleight of hand and confusion.

4.11 pm

Lord Dubs: I welcome this debate. I would certainly welcome a full debate in Parliament and a Bill because I support Dignity in Dying for a number of reasons.

Some time ago, I visited a friend of mine who had motor neurone disease. He was still able to communicate by typing. His family was gathered and I wondered why they were all there on that occasion. It turned out that they wanted to raise with me directly the issue that we are debating. They wanted to know what I would do and how I would vote in Parliament. When I asked my friend how he would like me to vote, he said that he would want me to support what Dignity in Dying is saying. The family had gathered there to lobby me. His wife said that, in her view, if a person in her husband’s position had one single thing to live for, they should stay alive. If they did not, they should seek a way out.

At the time, I asked myself what right I had to contradict that view. I thought to myself—as I still do—that I do not have the right to support something that imposes on others something that I would not want for myself. In other words, if I were in that unfortunate position, I would want the choice of ending, or being helped to end, my life. If I want that, what right do I have to deny it to anyone else?

18 Nov 2008 : Column GC89

I know that public opinion is on the side of the argument that I am putting forward, and I think that public opinion must count for something because some of the people, like my friend’s family, are seeing relatives, friends or loved ones move to the end of their life and they want to meet their wishes. Of course, the tragedy with some of these dreadful diseases is that at the point when people can make the choice easily—that is, when they can do something about it themselves—they are too well to want to end their lives, but when it comes to the point when they cannot do it themselves, they need help. Surely one is simply saying, “We don’t want you to have to make a decision against your life too early. If you can wait until nearer the time and you can be helped, then you have the right to end your life in that way”.

Finally, I understand that in the state of Oregon, where the palliative care is excellent, people use it more because they know that they have the option of being assisted in ending their life if that is what they want. Surely that is the way in which we should go forward. It is a human right which I support.

4.14 pm

Baroness Masham of Ilton: I feel the need to say a few words of warning to those people who want to make suicide easier. There are only a few people who want to be assisted to be killed, but there are thousands of vulnerable disabled people who fear that if the law is eased, their lives will be put at risk. Not long ago, a male nurse killed several patients recovering from operations in hospitals in Leeds. Medical and nursing staff have the opportunity to procure dangerous drugs which will kill patients.

I quote from the Independent:

“Some parents report that they avoid taking their disabled children to hospital, for fear that the attempts to resuscitate them that they wish for will not be made”.

It is felt that,

I know personally of young people who had been taken off their antidepressant drugs by their social workers. One threw himself over Beachy Head on a foggy day and the other, a young married woman, drove her car into a train. This subject is complex. The young rugby player, Daniel James, was one of the few who did not want to live, but I can assure your Lordships that, with the help that they need, many members of the Spinal Injuries Association, of which I am president, do splendid things and achieve good lives.

I wholeheartedly agree with the suggestion of better choice and better palliative care. At the moment, like so many aspects of healthcare, it is patchy across the country. My husband would have liked to die at home, but because the Sunday out-of-hours doctors said that they could not or would not set up a drip, he died in an A&E department. I am all for dignity, but not for killing.

4.16 pm

Lord Taverne: The issue today is choice, and on one point we are all agreed: the need for palliative care. It should be available to all who want and need it.

18 Nov 2008 : Column GC90

However, at present, some choices are legally available in the UK and others not. We have the right to choose to have life support withdrawn in certain circumstances and to receive painkillers that hasten death, but no right to receive help to commit suicide.

There is a certain logical inconsistency in the law as it stands. It is not clear, as the courts have pointed out. Many members of the public may find it difficult to understand why some choices are legal and others are not. Why is it morally and legally justified for a doctor to remove a ventilator or switch off a life support machine, but not to provide a lethal drug to a terminally ill person of sound mind?

The first is an act that intentionally and actively ends life. The second is an act that may or may not end life depending on whether the patient takes the drug—in Oregon, one-third of patients do not. The final decision is the patient’s. The reason that the first is moral and legal, and the second is immoral and illegal is not exactly clear.

When a doctor gives a large dose of morphine that will hasten death, it is legal if the intention is to relieve pain. However, the doctor knows that it is likely to cause death. Everyone knows that, in practice—certainly, in a large number of cases—he or she is doing it to ease death. We are all legally responsible for the consequences of our actions, and the doctor knows the consequences of his or her actions. Is there not a distinction without a difference between causing death to relieve pain and relieving pain in a way that will cause death?

Some may argue that the doctor cannot be sure that a very large dose of medicine will cause death, only that it is likely. But nor can a doctor who supplies the patient with a lethal drug be sure that it will cause death, because a patient may decide not to take it.

I hope that, whatever else our differences, we can all face the issues rationally, and avoid making distinctions which are confusing to the public and seem to have a basis neither in morality nor in common sense.

4.19 pm

Baroness Greengross: I want to add only a few words; I agree completely with much of what has been said.

I have worked with elderly people for slightly longer than 32 years. I know that, as they get older, many people think about how they are going to die and that many are very worried about the process of dying. They want to know where and how they are going to die; they want reassurance. I am afraid we also know that in this country there is widespread abuse of older people. It is tragic but we have to accept that it happens.

This charter and the Government’s strategy are extremely welcome. A huge amount in both is to be praised and taken up with enthusiasm. We have to insist on an acceptably high standard of care for people at the very end of life. This must mean that everyone dies well and that people of sound mind have their preferences taken into account. People want to die with dignity. At the moment, most people do not

18 Nov 2008 : Column GC91

die where they want to die. I hope that the Government strategy and this charter will reverse that and make sure that they do.

I shall make only two more points. First, those who want to see, in exceptional circumstances, people openly being able to be helped to die are not seeking premature death for anyone; it should happen only at the very last stage of life when people are in intolerable pain. We are talking about extending the double effect to something which is clear and acceptable to everyone with all the safety measures built in—otherwise I would certainly have terrible doubts about ever introducing any legislation.

Secondly, we have to understand that we will be judged as a society on our ability to reassure and clarify for people what will happen to them if they find themselves in intolerable pain and losing their dignity at the end of life. As a society, we will be judged on that. I hope the Committee will consider carefully how this can best be done, taking into account the arguments about autonomy and control wherever that is appropriate and necessary for adults of competent mind.

4.22 pm

Baroness Jones of Whitchurch: Like other Members of the Committee, I welcome the Government’s end-of-life care strategy, addressing as it does one of the most difficult and sensitive issues of medical care. My interest in this issue stems from my involvement for many years as a UNISON official, which took me into a number of care homes and hospitals. During that time, I witnessed a wide variety of care, often delivered by committed health professionals working under considerable pressure. However, today I am not seeking to claim that I represent their collective views or interests; my comments come much more from a concerned observer with a massive respect for the profession but with a knowledge of how far we are from delivering the model of a good death that the strategy promotes.

It goes without saying that health and social care professionals are crucial to delivering high-quality care and greater choice at the end of life. However, it is also true that during the development of the end-of-life care strategy many people identified a lack of open discussion between staff and those approaching the end of life as one of the key barriers to the delivery of good end-of-life care. It is a sad fact that health and social care staff often find it hard to initiate discussions with people about the fact that they are nearing the end of their life. This makes it difficult or impossible to elicit people’s needs and preferences for care.

This lack of open discussion is particularly problematic in care homes, often due to inadequate training of care home staff, but poor communication regarding end-of-life issues between patients, family and staff is also a huge problem in acute hospitals. For example, the Healthcare Commission found that 54 per cent of all hospital complaints received in 2007 were regarding end-of-life care, and these complaints often related to poor communication.

18 Nov 2008 : Column GC92

So what needs to be done to improve the contribution of staff to end-of-life care? The new strategy rightly acknowledges that there are major deficiencies in the knowledge, skills, attitudes and behaviours of staff groups in frequent contact with those nearing the end of their lives. But before we focus in on the staff, we have to address the overriding issue that, as a society, we do not talk openly about death and dying. There will need to be a cultural and behavioural shift in attitudes if we are to deliver the open and honest discussion which will underpin an effective end-of-life care plan. This needs to be addressed by improving training and education for professional staff to help them to overcome those barriers. That is why I welcome Dignity in Dying’s charter, which calls for adequate training on end-of-life issues for health and social care professionals, including communications skills training.

Finally, and crucially, for health professionals to carry out their new responsibilities effectively, they must be given the tools to enable the terminally ill to exercise real choice over their care plan. This might include a wish not to have their life unnecessary prolonged and, in some cases, it may include a wish to be assisted to die. Regrettably, at the current time, staff embarking on these difficult and sensitive discussions risk leaving the patient feeling less, not more, empowered if they have to explain that some of those personal choices and preferences are simply not open to them.

Next Section Back to Table of Contents Lords Hansard Home Page