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7.15 pm
First, the amendment contains a reference to approbation being given by two medical practitioners. From 1989 to 1999, I was a lay member of the General Medical Council. I sat on its conduct committee and its health committee. We heard processions of medical practitioners before those committees who had done outrageous things. We heard of private clinics, some of them in highly regarded streets of London, Manchester and Liverpool, that set themselves up to provide bogus cosmetic surgery, for example, from which to make money. I see absolutely nothing in this amendment that begins to approach the protection that the public need in this life or death situation. We have heard mention of Dr Shipman, but-and I am sorry to say this to the noble Lords who are doctors in this House, who are all extremely distinguished-there are many, many rogues in the medical profession. I had better say that I am sure that there are in the legal profession too.
Then we have the phrase "independent of each other". What on earth does that mean? Where did it come from? Does it mean that they work from different premises, or does it mean that two members of the Royal College of Physicians would not be allowed to give opinions in the same case? It is so broad as to flash up the twos and blues of danger in its drafting. I am astonished that the proposed new clause has reached this point without that kind of problem being addressed.
Then there is the phrase, "in good faith", used about the doctors. That really gives the game away, does it not? I do not know why it is there, as it is one of the most tautologous phrases that I have ever seen in a piece of statutory drafting, unless its purpose is to confirm in our minds that, among two entirely independent practitioners there will be some of bad faith. Well, amen to that-I am afraid that I agree.
Then there is the question of the independent witness, chosen by the person who wishes to die. People in that position can be so easily persuaded that a person who is not really independent is to be seen as independent. Subsection (3) of the proposed new clause says:
'Independent witness' means a person who is not ... likely to obtain any benefit from the death of T".
That does not mean that they can obtain no benefit, which raises the prospect that independent witnesses may indeed turn out to be beneficiaries from the death of the person concerned. Excluded from independent witnesses are a "close relative or friend" of the person concerned, but that does not exclude the partners of the close relative or friend.
I give those as examples of a clause that really does not bear serious legal or ethical examination. My final conclusion is, as was said by the noble Baroness, Lady Emerton, that if we are to address this issue in a serious way, it has to be as a piece of whole legislation. Furthermore, it has to be considered as a piece of whole legislation starting its life in the elected House of this Parliament and going through the democratic
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Lord Neill of Bladen: I want to flag up a legal point. What do we know about this individual called D who appears in subsection (1)? Is he a friend or relative? The noble and learned Lord, Lord Falconer, plainly thinks that we are talking about a loved one. I ask what is no doubt an improper question. Can the loved one benefit from the death? Are there any words that rule out the loved one benefiting?
Benefits take different forms. It could be a financial benefit or relief from the endless burden of caring and visiting, and that aspect of life. There is nothing to exclude benefit from coming to D. Is that why subsection (1)(a) of the proposed new clause states that,
What is the adverb "principally" doing unless it opens the door to some other motivation, which could be financial?
At the end of the day, what is the likely tendency of this amendment if carried? I agree with those who say that the likely tendency is a green light for a view about what is acceptable in respect of suicide. Suicide can be assisted. At the moment we have one route, which involves travelling abroad. But it will become an acceptable concept once it has been passed in the Lords and, let us suppose, adopted in the Commons.
I want to put this consideration to your Lordships. What do we know from what we read, the people we meet and the world we have moved in for many years about the quality of family care and support in this country? We have all visited countries where disabled people live in the family and are not sent off to homes. We have a rather different attitude from the Victorian age. Many people live alone. Their families do not support them. My perception is that families are broken up here compared with many other countries in the world. What can we expect families to do? What is the probability over the vast range of the population 10 years from today if we have an enactment like this? To my mind, it is inevitable that people will be pressurised into signing up for death.
The argument that I used with the Bill introduced by the noble Lord, Lord Joffe, which I still believe to be true, is that elderly people can take a hint. It costs a lot of money to keep people in a home and pay the weekly or monthly bills. It costs a lot of money to have a carer at home. Meanwhile, daughters, sons, grandsons and granddaughters cannot afford university fees and cannot pay the mortgage, and there is granny carrying on a useless life in some home or hospice. I fear that this new clause will be used to pressurise people into signing up to an unwanted death.
Baroness Flather: I would like to go back to the beginning. Only 115 people have gone to Switzerland: that is not a huge flood of people. I would imagine
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We heard about Dr Anne Turner. I watched that film and I hope that your Lordships also watched it. One had to keep a box of tissues by one's side when watching that film. There was no way that there was any problem of pressure; in fact the pressure, as has been stated, went the other way. The children did not want their mother to go. The older two children accepted it more easily, but the youngest one was distraught. However, they went with their mother because she was a doctor and she could tell them what was in store for her.
She is not alone: there are many people who know-and their doctors know-what is in store for them. It is not about being hastened to slip away. We have heard that death diminishes us and all the rest, but every one of us here is going to die. I do not believe that all of us are so sanguine about lingering for months and years and not being able to do anything. Even if we were in one of the hospices of the noble Baroness, Lady Finlay, we would still be lingering. Is that what we want? I would not like that. I speak only for myself. If any of your Lordships would like to spend your last months or a year in a hospice, that is your choice. My choice is not to do that. I would like to give effect to my choice. I am an individual and I should have control over my death as I have control over my life.
Medicine has made such huge strides. A lot of medical people like to keep everybody alive much longer than they used to. Now we are being told that they are killing people off, but they are letting people die a natural death instead of putting them on antibiotics when they cannot do anything. Their hearts keep beating and they do not have infection so they keep going. There are so many cases like that. I do not think that that is the future we want.
I have to say a word about disability. As time has gone on, disability has become a much more important issue for society. We can judge our society reasonably well by the way we now think about and care for disabled people. I do not think any one of us would ever want the disabled to be counted with people who take such decisions for themselves. This is a question for me. I am thinking of myself. I could be in a situation where I was going to die and linger in a half life. We have heard that pain can be controlled, but what sort of state are you in when you are getting a cocktail of painkillers?-not a particularly wonderful one. We are also told that there is no double effect and that doctors can tell whether you are given too much or too little, but there is not much point in that for me.
That is how I feel. I want the right to be able to go to Switzerland and consult my family and friends. If two doctors told me that I was going to die badly from whatever I had-not just old age-what would be wrong about going to Switzerland? That is the way I feel, and I am sure that other people in this Committee think about these things carefully, because this is what is in store for all of us.
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Lord Joffe: I support this humane amendment because it is about preventing suffering-not the suffering of the terminally ill patient who goes to be assisted to die; this new clause seeks to prevent the suffering of their loved ones. The loved ones go to Switzerland or wherever because they love the terminally ill person. It is against their instincts to help their father, wife or mother to die, but they believe that they cannot let them die alone and they go with them to a country where it is lawful. That is what the amendment seeks to achieve. It is, as has been said, a very narrow amendment. It talks only about clarifying the law and protecting some of the terminally ill people who might otherwise have gone overseas to be assisted in dying. It is not about the decriminalisation of assisted dying. So much has been said about that in the debate, which has focused in many ways on assisted dying, that I would like to touch on some of the points that have been made against it. I do so not to promote the Bill that I originally introduced, but to deal just with errors of fact and approach that have emerged during the debate.
7.30 pm
It is naturally impossible for the opponents of the amendment to provide direct evidence of the dangers of a slippery slope, which they allege the amendment would pose. Accordingly, they must rely on conjecture, speculation and, in some cases, their own experience of what they are totally confident will happen. However, because there is no direct evidence, surely it makes good sense to go to a country where assisted dying has been legal for 10 years, and to explore what is happening there. Is there indeed a slippery slope? Let me tell noble Lords the facts of the latest annual report of the Oregon public health department, which relates to the years 1998 to 2008. It shows that in 2008 there were 50 assisted deaths in Oregon, representing 0.2 per cent of total deaths. The previous year there were 49 deaths, and 48 deaths the year before. The year before that there were 47-hardly a slippery slope. The report also states that the Oregon medical board found no violation of good faith compliance with the Act. There is clearly no evidence whatever of a slippery slope in Oregon, so the question that the opponents of the amendment need to answer is: why should it be different in England and Wales? The noble Lord, Lord Carlile, says that there are scoundrels among the medical profession in this country. That may be so, but presumably there are scoundrels in all professions everywhere and this has not led to slippery slopes.
Talking about Oregon, I come to some of the facts. The noble and learned Lord, Lord Mackay, says that the amendment is unworkable. I was with him and the Select Committee in Oregon. The law there, on which the amendment is to some extent modelled, worked perfectly well. I think nine groups testified to the Select Committee, including the nursing association, the hospice association-a medical association that was neutral on the issue-the government department and the hospitals. Seven or eight groups out of nine felt that the law was working satisfactorily. The noble Baroness, Lady Finlay, talked about doctor shopping in Oregon and told us about the extraordinary number of prescriptions issued by particular doctors. If you
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The noble Lord, Lord Walton, spoke about his Select Committee finding that it was totally against euthanasia and assisted dying. There was an intervening Select Committee, which heard evidence from everywhere in the world where assisted dying and euthanasia were legal, and did not come to the same conclusion. We have heard much about safeguards. There were many safeguards in the several Bills that I have introduced. Those were Bills with a much wider remit than the present very modest amendment, and where opponents would argue that the safeguards were insufficient. I would go away and come back with new safeguards, only to be told that these new ones were insufficient, and so on. Then I posed the question of which safeguards would the opponents suggest including. The answer, I was told, was that no safeguards would ever be sufficient-clear evidence of a very open mind.
The noble Baroness, Lady Kennedy, talked about a cultural shift in the law. For hundreds of years, there was strong opposition to decriminalising suicide as its criminalisation was considered to be an essential law. In 1963, after all that opposition over so many years, the law was changed. If the message would be sent out to disabled people that their lives are not valued, as has been said by many Peers, why was suicide decriminalised? Surely that sent out the same message as that which, it is alleged, is now being sent out by legislation on assisted dying and, indeed, by this amendment. There is no intention to treat disabled people in such a way as to breach their human rights, or suggest that they are less worthy of care and attention than anyone else. The noble Baroness, Lady Campbell, said that I told her that I wanted to help disabled people. That is only part of what I said. I said that I wanted to help all people, and that I thought disabled people should have the same right to make decisions about their lives as every person who is able-bodied. I always understood that the battle for the rights of disabled people is for them to have equal rights.
I listened with great respect to everyone who spoke against the amendment. My name was mentioned several times, so I am entitled to raise the points that I wish to make. I come back to safeguards. The noble Lord, Lord Walton, gave evidence to the Select Committee. He was asked what further safeguards he thought could be inserted in the Bill. His answer was that he could think of no further safeguards. We have a simple amendment before us concerned with the prevention of suffering. The Committee should focus on the fact that we are talking only about people who are acting out of love and affection for the people whom they are
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The noble Lord, Lord Elystan-Morgan, said that he was sure that, if this amendment were passed, assisted dying would inevitably be legalised. I say to him with respect that whether the amendment is passed or not is not relevant to the final decision that will be taken. In a democratic country, where 80 per cent of the population support assisted dying, it will eventually be decriminalised.
Lord Alton of Liverpool: I will be brief because I suspect that the feeling of the Committee is that we should now move quickly to a decision. The noble Lord, Lord Joffe, was right to remind us that we had a full Select Committee inquiry looking at assisted dying. In fact, there were 246 Hansard columns and two volumes of 744 pages and 116 pages respectively, 15 oral sessions, 48 groups or individuals giving evidence, with 88 giving written evidence, 2,460 questions asked and the committee receiving 14,000 letters. Under the distinguished chairmanship of the noble and learned Lord, Lord Mackay of Clashfern, that committee delivered a report to your Lordships' House. When we voted three years ago by a majority of 48, with 100 votes to 148 votes, the House decided against permitting assisted dying. It decided against taking what the noble Lord, Lord Joffe, described as the first step. I urge the Committee again tonight to have at the heart of this debate something that the noble Lord, Lord Carlile, identified during that previous debate-public safety and protection. It seems to me that above all the other considerations that many of us will have, such as resources, spiritual questions and so on, public protection and safety are crucial.
I welcomed this Bill at Second Reading-I set out then my substantive arguments against assisted dying and euthanasia and I have no intention of repeating them-because of what it does to reform the coroners service in the light of the 226 patients who were killed by Dr Harold Shipman. As my noble friend Lady Finlay said, those death certificates were signed by second doctors-the very point that we are being urged to consider today. I know that many noble Lords do not agree with me on some of the beginning-of-life issues-I would not expect them to-but we should think back to the 1967 debates. The noble Lord, Lord St John of Fawsley, is present. He spoke in another place during those debates, as did the noble Baroness, Lady Knight, who was present earlier. During those debates many warnings were given about how we could end up with doctors simply stamping certificates in order to agree things. That is precisely what happens today. Seven million abortions later, surely no one can doubt that that early decision, which was taken without due and proper consideration, has led to unimaginable consequences. Therefore, I simply urge that, before we take an enormously important decision of this kind, we give it proper thought and reflection. Indeed, the Director of Public Prosecutions, Sir Kenneth Macdonald, whom the noble and learned Lord, Lord Falconer, quoted in his introductory remarks, said precisely that-that there should be a profound debate and widespread public consultation before any change is made in the law.
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7.45 pm
As regards public protection, I refer your Lordships to a report in the Guardian on 21 June, which stated that the Guardian had obtained a list drawn up by Dignitas revealing the medical conditions that had driven 114 Britons to end their lives at the centre for euthanasia in Switzerland. Professor Steve Field, chairman of the Royal College of General Practitioners, said:
"I'm horrified by this list ... I'm concerned because I know that many of the conditions outlined are conditions patients live with and can live with for many years and continue to have productive and meaningful lives".
Dr John Saunders, chair of the Royal College of Physicians ethics committee, said:
"The list does suggest that Dignitas is cavalier in arranging for people to end their lives".
As recently as last week at its annual conference in Liverpool, the BMA voted against any change in the law, putting it in line with all the royal colleges, which are opposed to any change in the law. Dr Tony Calland, chairman of the ethics committee of the BMA, said:
"This list raises considerable concern ... To go off and commit suicide simply on the basis of these conditions would be premature and unreasonable".
I refer your Lordships to the statement issued this morning by Professor Ian Gilmore, president of the Royal College of Physicians, and several other distinguished physicians. It states:
"The amendment as drafted provides insufficient guidance to doctors who might be asked to assess applicants for assisted suicide. It does not define terminal illness or capacity with any precision and the requirements prescribed for assessment are insufficiently rigorous to protect vulnerable patients seeking assistance with suicide".
I stress "insufficiently rigorous"-the point that the noble Lord, Lord Carlile, made earlier.
As my noble friend Lord Walton of Detchant said, in 1994 the Select Committee of your Lordships' House reported that,
- "dying is not only a personal or individual affair. The death of a person affects the lives of others, often in ways and to an extent which cannot be foreseen. We believe that the issue of euthanasia is one in which the interest of the individual cannot be separated from the interest of society as a whole".
We heard from my noble friend Lady Campbell of Surbiton and the noble Baroness, Lady Masham, about the position of disabled people. I think of my childhood experience when an uncle who had returned from the Second World War in a state of deep depression took his own life. Consequences have followed within the family in all the generations since then. These are not just individual decisions; they affect many others. We would do well to think much harder before agreeing to incorporate this amendment in the Bill. I urge your Lordships to reject it.
Lord Thomas of Gresford: I rise merely to say that we on these Benches will vote individually. It will not surprise your Lordships to hear that. The noble Lord, Lord Alton, referred to his experiences. Each of us has lifetime experiences that I am sure will greatly influence the way in which we will vote tonight. I shall vote against the amendment but I will not weary your Lordships with my personal experiences.
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Lord Henley: I, too, will speak briefly from these Benches. I merely echo what the noble Lord, Lord Thomas of Gresford, has said-namely, that I will make my own decision. I will vote against the amendment if the noble and learned Lord wants to press it to a vote. It is for each Member on these Benches to make up their mind as they so wish.
The Parliamentary Under-Secretary of State, Ministry of Justice (Lord Bach): The Committee has been fortunate to have been able to listen to an outstanding debate on a matter of the highest importance. The debate and amendment raised complex and profound issues. This afternoon we have heard, to our advantage, passionately held views on all sides. For this, I congratulate my noble and learned friend on tabling this amendment. However, as I indicated at Second Reading, it is the Government's view that the Coroners and Justice Bill is not the appropriate vehicle to liberalise the criminal law as it applies to assisted suicide. I note from their letter in the Daily Telegraph on 29 June that the most reverend Primate the Archbishop of Canterbury, together with the Archbishop of Westminster and the Chief Rabbi, share that view. That said, my noble and learned friend Lord Falconer of Thoroton and his supporters are absolutely entitled to table this amendment and to ask the Committee's view on it if they choose to do so. It falls to me to briefly set out the Government's position.
As I indicated in the debate on the previous group-in fact, I did not, because the amendment was not moved-the provisions in Clause 49 do not change the scope of the current law. Our aim is to simplify the law by bringing together two existing offences and to modernise the language to add clarity and understanding. Assisting or attempting to assist suicide would remain illegal. In contrast, it is our view that this amendment seeks to make a decisive shift in the law.
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