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This amendment, however, has a narrow purpose. It is highly focused on the position that we are in now with the law, which is that there is uncertainty. The general public who are neither lawyers nor doctors do not fully understand what is meant when the Director of Public Prosecutions says that it would not be in the public interest to prosecute. Why would it not be? If assisted suicide is wrong anywhere and if it is wrong in principle, he might argue that it would be in the public interest. We need more clarity about the reasons for which no prosecutions have been made and we need to have that clarity soon.
I want to make two other brief points. First, I have a deep interest in the well-being of the disabled at any stage of their lives and there is no doubt that they need protection still more when they reach the end of their lives, whenever that may be. However, I think that there is confusion if we run the disabled as a class of people, members of society, into another class of people, the terminally ill, although they may overlap. There are two different concepts and we should not bring them together under the general heading of the vulnerable about whom we hear, in my experience, all too much. Being vulnerable is a judgment made by somebody about another person; in my experience, it is not a judgment that one ever makes about oneself. To be classified as vulnerable is to be regarded from a great height by lawyers or doctors, above all, or nurses. They deem one to be vulnerable. There is a very small category of people, of whom we have heard today, to which belong some of those people who have gone to Switzerland to commit suicide, who do not want to be categorised as vulnerable. They therefore make their own decision.
Secondly, we have heard a great deal today about predatory, selfish relations who want to bump people off, but there is another class of relations-children, perhaps-who have been very difficult to persuade to help their parent or loved one to go to Switzerland. I
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Lord Quirk: I think that we can all accept that the arguments that have been made opposing this amendment have been powerful, cogent and persuasive. However, it has struck me that some of them tend to bypass the present situation. We have legalised suicide; we have people going to Switzerland or wherever-if they can afford it, they go to Oregon. It seems to me that the question before the Committee is whether the amendment tabled by the noble and learned Lord, Lord Falconer, et al improves the position of those who want to go and have made up their mind to go to Switzerland. In my view, the lot of the unhappy is improved by this amendment.
Lord Low of Dalston: I put my name to this amendment in the belief, which has been endorsed by others, that it is a comparatively narrow, targeted amendment. It is designed to remedy the lack of clarity about the current law and practice that gives rise to considerable anguish. I also believe that the safeguards in the amendment are by no means negligible. I say to the noble Baroness, Lady Finlay, and others who have questioned the robustness of the safeguards that the framers of the amendment would be more than happy to look at them further to see whether we can bring back something that would be more acceptable to noble Lords.
The main way in which I feel I can help the Committee is by making a different point. From the representations that we have received from people who have written to us in this House and from what we have heard at various times during the debate, it would be easy to gain the impression that disabled people are completely against the kind of legislation contained in this amendment. No doubt many noble Lords have received a letter from RADAR stating that many disabled people have expressed real fears that the amendment could open the door to people being coerced into
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As has been made abundantly clear, the amendment is confined to those who two doctors are prepared to say are terminally ill, who have provided written evidence that this is the course that they wish to follow and that they know what they are doing and whose consent has been independently witnessed by someone who has no stake or vested interest in the patient's death. There is no way in which this amendment gives the slightest encouragement to anyone thinking of coercing the generality of disabled people into going abroad for an assisted death. It is a major act to go abroad in order to die with dignity. It is implausible to suggest that people can easily be conned into doing it. Tony Benn once told the story of somebody who wanted to go to Switzerland to be assisted to die with dignity, but in the end changed his mind because he could not abide the thought of being killed in an air crash. That illustrates that it takes a certain amount of courage to undertake this course and it is not something that people can be easily bamboozled into.
As I said, it would be easy to gain the impression that disabled people are completely against this kind of legislation, but that is not the case. Disabled people do not speak with one voice on this issue and there are numerous opinion polls showing steady support for legislative change. Eighty-two per cent of the general public surveyed in a 1996 British Social Attitudes Survey thought that they should have the right to ask a doctor to end their life if suffering from an incurable and painful disease. Disabled people were just as likely to be supportive as the rest of the population. Younger people who had a disability were indeed more likely to support assisted dying than non-disabled people of all ages. The survey stated that those with a disability were more pro-euthanasia than those who were able-bodied. A possible explanation for that is that disabled people were more inclined to sympathise with those in pain or suffering, or with those wholly dependent on others who wished to end their own lives. However, the survey said that that disability effect applied only among the young. It said that, among older respondents, there was no significant link with attitudes towards euthanasia. By that it meant that disabled people were neither more nor less likely than the general public to support euthanasia.
In case noble Lords think that this evidence is too dated, a 2004 YouGov poll showed that, of disabled respondents, 80 per cent supported assisted dying legislation and 82 per cent believed that the current law discriminated against disabled people who wished to end their lives but could not do so without assistance. Seventy-six per cent felt that such legislation would have a positive impact or no impact on society's view of disabled people and 84 per cent said that they would trust their doctor the same amount or more.
I am afraid of being terminally ill, as I imagine most of us are. If I were, I think that I would hope to
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Lord Waldegrave of North Hill: It may be appropriate to have two or three sentences from someone who once held the huge and wonderful office of Secretary of State for Health. I want to associate myself warmly, which was not always the case when I was Secretary of State, with the views of the BMA, as so eloquently expressed by the noble Baroness, Lady Finlay.
We have to be realistic. We have heard the phrase "predatory families"; there are also such things as predatory bureaucracies. The noble Lord, Lord Turnberg, said most exactly what worries me. This would open the way to a shift in perception across the board, and it would begin to shift the perception within the appalling decisions that have to be made about resource allocation within health services. It would open another front. The health service bureaucracy has to be able to rule out that kind of resource allocation by saying that that is not something that we will consider.
We have heard wonderful examples today from patients, doctors, nurses and lawyers. All the individuals who work within these bureaucracies are of course sanctified, particularly when they are in your Lordships' House. But bureaucracies do not have souls, and given broad signals, they can move quite quickly in ways that individuals looking at hard cases had originally not envisaged. I urge noble Lords to keep this light on red, as the noble Baroness, Lady Campbell, put it so eloquently.
Lord Warner: I support what we must remember is a narrow and focused amendment. This is not the day to have a wide debate on assisted dying, although I would welcome that in the not-too-distant future. This is a narrow, focused amendment that would rectify deficiencies in the legislation as presently presented. It represents a humane clarification and improvement on the current law, with appropriate safeguards to protect vulnerable people. It is much more in line with the 21st-century reality of a growing number of Britons who go abroad to end their lives, whether we like it or not. That is what is happening, and the law is inadequate to deal with it. It puts a great deal of responsibility on the Director of Public Prosecutions, so that is the reality of the issue in this amendment.
A number of noble Lords have raised issues that relate to the wider debate on assisted dying, and I want to correct one or two of them. I am no great fan of BMA polls, but the recent one shows that the majority of doctors are against assisted dying. About 45 per cent are actually in favour of the amendment, so medical opinion is mixed. It is not uniform, and not
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On the issue of palliative care, no one is more supportive than me. I will march shoulder to shoulder with the noble Baroness, Lady Finlay, in support of more resources for palliative care but, on reaching a certain point, a minority of people-I include myself-want to make their own decision about when they die. They cannot always rely on the health and social care professionals providing the palliative care to respect their views and wishes. That is a sad fact of life. That is not to diminish the work that such people do, but it will keep us focused on the fact that a minority of people strongly believe that it is their decision to choose the time when they leave this world. We have to respect their views as well as those of vulnerable people who are disabled. We are trying to craft legislation that meets a diverse group of needs. We are not trying to change the world on assisted dying today, but are trying to focus on a humane amendment that would improve the lot of a small number of people, with adequate safeguards for disabled people.
Baroness Masham of Ilton: With pressures on our National Health Service, many people who are seriously disabled feel vulnerable now, but should this amendment be passed, they will feel even more vulnerable. All of us on the mobile Bench here today in your Lordships' House fall into the definition explained by the noble and learned Lord, Lord Falconer. It is quite possible that the legislation might open the door to doctors and nurses to feel that people who become disabled are not worth keeping alive. Legislation so often allows things to happen that were not thought about, or meant to happen. That could happen with this amendment, should it be passed today.
The Lord Bishop of Chichester: Several noble Lords have suggested that this is a narrow amendment. It is not a narrow amendment: it is about assisted dying. We heard this clearly from the noble Lord, Lord Low, a moment ago; he expressed with some passion what he hoped might be his options were he to become seriously and terminally ill. We heard this from a number of other noble Lords as well. This is clearly a question about what this country should be providing through its legal system; that is what is motivating the amendment.
The law may be unclear at the moment and some problems may need to be addressed, but there are many areas which are not clear in the amendment too. Attention has already been drawn to the lack of clarity about what terminal illness means, to the qualifications and nature of the doctors who have to provide the certification, and so on. If the law is unclear, tidying it up is not a reason for turning a major moral traffic light from red to green, to use the striking imagery that has been used. This is a stalking horse for a more fundamental moral question that we need to deal with head on in open and frank debates rather than in a way that almost makes that inevitable but in a hidden and stealthy way.
Baroness Williams of Crosby: The right reverend Prelate has pointed to a deep ambivalence running through the debate. That deep ambivalence is about whether the debate is fundamentally, as the noble Baronesses, Lady Warnock and Lady Jay, suggested, about a relatively narrow change in the law; one that would clarify where people stand when they attend with a beloved relative to take part in a ritual of assisted dying. It is also and has clearly been shown to be, as the right reverend Prelate says, a debate about assisted dying in a much broader sense. I will say one word about the argument that this is a relatively narrow proposal to deal with people who are trying to travel with a beloved friend or relative to a country that agrees to assisted dying. If that is correct, there should have been much deeper discussion in this debate about the major institution that has been involved. The noble Lord, Lord Walton of Detchant, pointed in his own remarks to the disturbing record of Dignitas, which has been the major provider of assisted dying, well known outside its own country.
We know that nearly a third of those who have died at the hands of Dignitas since 2002 who are British citizens did not have any form of fatal illness. We know that no psychiatric or palliative recommendation was required before the decision was taken to allow them to die. We know that Dignitas has been accused, wrongly or rightly, of being much more a private company in its ethics and incentives than a public body concerned with bringing to an end the lives of people who wish to die. In other words, it is in many ways an unsatisfactory institution to be given the kind of support that this amendment would give.
If we are arguing about the wider issue, I want to make a brief point that relates to what the noble Lord, Lord Waldegrave, had to say. There is inevitably, at a time of straitened public expenditure, a battle to raise enough money for palliative care. Those members of the Committee who are distinguished proponents of palliative care would make it clear that there are some areas of the country in which such funding is desperately short and others where it is adequate. Deciding what to do in one's own case depends a great deal on the situation. The United Kingdom has been a pioneer of palliative care. I have visited a number of hospices and one of the most prominent was in my own constituency of Crosby in Merseyside when I was a Member of Parliament. It is amazing what has been achieved-a mood of happiness and contentment reigns in many of them.
One of the people who corresponded with me who for 23 years was a palliative care doctor, and, given the choice between entering a hospice or choosing to die-choices that were equally weighted because both were present and possible-many people would decide to choose a hospice. One of my correspondents who had also been a palliative care medical practitioner in the north of Scotland for 23 years used the phrase, "It is easy for the right to die to turn into a duty to die". That is what lies at the heart of many of the objections that some of us want to raise.
Like many of my noble friends and many noble Lords in other parts of the House, I oppose this amendment. It has not been sufficiently thought through
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Baroness Emerton: I rise not as a lawyer but as a nurse. I wish to say a few things that have not been said this evening. First, I find it strange that we are faced with these amendments in the midst of this complex Bill. It is even stranger since the Government's action in the Bill strengthens their suicide prevention strategy by dealing with the predatory internet sites, which has already been mentioned.
Government policy is being rapidly implemented to address inequity of end-of-life care across England and Wales, so that everyone, irrespective of diagnosis, can access specialist support. Yet the focus of publicity has been around the plight of a small number of patients, several of whom were not terminally ill, wishing to foreshorten their life by assisted suicide in Switzerland. We have already heard noble Lords' opinions of Dignitas.
We have to look at whether this is a suitable place for this proposal to be in the law. As a nurse, it is with great sadness that I admit that the care of dying patients has not always been gold standard. Here we are in 2009, with the report of the noble Lord, Lord Darzi, and end-of-life care strategy and qualify markers being introduced. Competencies required for all doctors and nurses are clearly set out. To support the amendment suggests that we are sending more people to Switzerland because the care that we give here is inadequate, and that does the people who live in this country no justice. The House of Lords should have a responsibility for the citizens of this country. The Government have taken steps to move steadily to correct the inadequate distribution of good end-of-life care and we should support that.
I suggest that those who advocate assisted suicide with loved ones accompanying should have the courage to bring a Bill to the elected House. It is irresponsible in my view to introduce such a measure into this Bill. I end with the words of the late Dame Cicely Saunders, which is that how people die remains in the memory of those who live on. We live on but the memory of how people die remains with us.
Lord Carlile of Berriew: I start with something that has not been said as yet. As someone who is opposed to the noble and learned Lord's amendment I thank him for the measured way in which he spoke to it, as this can be a highly emotionally charged argument. However, I reject utterly two of his arguments. First, I suggest with great respect that the noble and learned Lord is deceiving himself if he believes that this is not part of a slippery slope situation. It is, and he must recognise that; the reasons were given eloquently by the noble Lord, Lord Elystan-Morgan, and I can certainly do no better than he. If the amendment is passed it will be seen as an approbation of Dignitas in Switzerland. I reject that point out of hand.
I want to talk more substantially about the noble and learned Lord's assertion, and the assertion of others, including the noble Lord, Lord Warner, that the present law lacks clarity. I suggest that the present
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The only area of uncertainty is in the consequences of the exercise of personal responsibility. My view, as a Member of this House and a former Member of another place, is that the exercise of personal responsibility is actually rather important, and that we should leave an element of personal responsibility to be exercised by the citizen and not try as a state to legislate for it. I offer your Lordships an entirely non-religious but, I hope, ethical judgment, that it is better to leave a decision of this kind in the sphere of personal responsibility than in an opaque-and, I have to say to the noble and learned Lord, and I shall return to it-pragmatic and poorly drafted criminal defence. In so saying, I offer this: we underestimate in this country, and sometimes we underestimate at our peril, that in our unwritten constitution, one of the greatest protections against arbitrariness and oppression is the discretion of the Attorney-General and the Director of Public Prosecutions to prosecute, or not to prosecute, on the application of the CPS code test, including the question whether it is in the public interest. It has proved to be sound under the stewardship of a number of noble Lords in this House over a very long period, and I prefer it to the amendment on offer today.
I say with respect to the noble Lord, Lord Low, that for me a place of greater safety is with the law that we have and the protection that I have described, rather than relying on this drafting or opinion polls, which by and large have been taken after a number of highly publicised cases. I say, too, that this is not any passing amendment; it has been prepared in a blaze of publicity. Everybody who knows anything about this issue, which is practically everybody in your Lordships' House-I hope everybody knows-knows that there has been assistance on offer, drafting on offer and, believe it or not, even free lawyers on offer to enable a good amendment to be brought before this House. The noble and learned Lord is a former Lord Chancellor; we are entitled to expect in this House that when a former Lord Chancellor places before the House an amendment on a matter of this importance, it will be well considered, well honed and usable. I am sure that the noble and learned Lord would not have presented it if he did not think that.
We heard from the noble Lord, Lord Low, that noble Lords who put their names to this amendment would be willing to amend it, if it was thought that it could be made more practicable and useful. I am sure that that is the case-and I take that in the honourable spirit in which it was said. But the starting point is very important, given what we are dealing with. I shall not go through the amendment sentence by sentence,
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