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One question put to me was whether medical practitioners were suitable people. Well, I do not think that they are. If a person is to have the comfort, guidance and opportunity to come to a free and settled conclusion and to have a judgment made as to whether they had been put under pressure or whether it has been free and settled, someone in a judicial office is the right person to do it-preferably someone whose approach is inquisitorial rather than adversarial. That is why I proposed that it should be coroners, because they are used to trying to find out the truth of what is going on rather than what is simply the point of law. A perfectly legitimate argument could be made that someone other than a coroner should be doing this, and I entirely accept that. However, there is a requirement for someone who understands the law, is used to trying to find out the truth of what is going on and is sensitive to people and their families and the understanding of things and who has, by nature of their office, the facility to call people, give reports, explore the question and try to come to a reasonable conclusion. That would be someone who could call a specialist to say, "Is this an incurable disorder, or a progressive disorder?". They could call a psychiatrist-or more than one-to ask, "Is this person suffering from a depressive illness which, if treated, would resolve, and they would no longer have the wish to bring their life to a close? Or is this someone who is not suffering from a mental illness but has come to a clear, settled and thought-through wish to take this action but is not able to do so by nature of their disability?".
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That is the chain of thoughts. Someone finds himself in this circumstance, wishes to do something, is unable to do so-and the protection is that it is not his own physician or even an independent physician who makes the judgment. It is someone who is legally and by experience qualified to explore these questions. Then, if they certify that this is the case and that the person has come to a free and settled view, they can provide a certificate, which would ensure that anyone who rendered assistance-although that does not mean that assistance has to be rendered-would not be breaking the law. Then we would not have what we are frankly in danger of having, which is an Irish solution to the problem. The Irish solution to the abortion problem is that you pass it on to somebody else and then feel justified; you are glad that somebody else is dealing with the problem. Sometimes we actually need to face the problems, struggle with them and try to come to a reasonable conclusion.
In such questions, it is often thought that one should maintain a conservative approach to such matters, and not change because if you do so you jeopardise things and move into danger. That is a serious misjudgment. There was a time when the majority of the medical profession believed that it was ethically wrong to provide chloroform to relieve the suffering of women in labour. That was theologically justified because, of course, a woman was to bring forth her children in pain. That was the view of society and the view of many doctors, although not all, thankfully. Now, we would not only regard that is not appropriate, we would regard it as not a moral position. It was the same with suicide. There was a time when it was regarded as a crime. Now, we do not see it in that way. We try to come to an understanding of it. These positions that we take are not immutable. Indeed, sometimes we come to a view later that is radically different from the one that we had earlier on.
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Lord McColl of Dulwich: Which doctors objected to chloroform under those circumstances? I know that there were a few ministers of some churches, but I have never heard of a doctor objecting.
Lord Alderdice: If the noble Lord expects me to provide chapter and verse, either medically or theologically, I am not prepared to do that.
Lord McColl of Dulwich: Why not? The noble Lord made an assertion.
Lord Alderdice: If the noble Lord maintains that doctors and the medical profession have always been justified in their ethical and moral stance and have never had to change it, that is a position to which I would not hold, nor do I believe that he would. I offer it as an example, and we could look to providing the chapter and verse that he wishes, but that is not the issue. The issue is whether one is actually concerned to address the real pain and suffering in another person, or justify one's own present position and fears and concerns about changes that might take place. Or should one struggle with the difficult question of
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I present this as a real problem, which is a matter of debate in our community and legal services. I invite the House, if it has other thoughts about how this matter might be addressed, to provide those for further consideration and thought, not necessarily in this Bill, but in future when, without any doubt, this will come back again and again and, I hope, with more light than heat, which is the contribution that I trust we make.
Baroness Butler-Sloss: I would like to speak first on this, because although there are fundamental issues involved in this amendment, there are also some practical issues. The coroners were not consulted. They would have been pleased to have had the opportunity to discuss the amendment with the noble Lord, Lord Alderdice, but they were not given that opportunity. I have from the Coroners' Society of England and Wales a number of very practical objections, not of a fundamental nature, but of a nature that would make it very difficult for coroners to undertake this particular task-if indeed the House thinks that it is appropriate for it to be undertaken by anyone.
First, the coroners make the point that they are concerned with post-mortem investigations, not ante-mortem investigations. Their jurisdiction is derived from the presence of a dead body. The amendment would introduce an entirely new and, they consider, alien duty for coroners to provide an investigation before death. It would make the coroners potentially witnesses to facts, which is not their position as judicial officers. Unlike in Northern Ireland, there is no single national coroner service, nor under this Bill will there be, because each coroner will maintain his own separate records and would not have access to any national central register or database. Every "cross-jurisdictional border" inquiry, as it is known, generates its own series of letters and e-mails, so if the proposals were implemented there would have to be some arrangement for information to be provided across these borders.
It is thought that there would be a significant number of coroners who would, as a matter of personal conscience, have objections and refuse to carry through this function. There would therefore have to be a conscience clause, permitting individual coroners or their officers to refuse to participate in the ante-mortem inquiry and certification process. The other point, which is of some importance to the Government and the main opposition parties, is that there would be very serious cost and other resource implications in an already overstretched and underfunded service.
I hope that noble Lords will take those very practical points into account. In particular, if the noble Lord is going to propose that a particular service should take on a totally new duty, the very least courtesy, I suggest, is to ask it first.
Baroness Campbell of Surbiton: My Lords, it is late; I will be very brief. The amendment yet again singles out sick and disabled people with progressive conditions for special treatment under the Coroners and Justice
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Report stage is not the time for lengthy expositions of why this amendment would most definitely afford a lesser standard of protection under the law, especially for those who may feel under pressure to end their lives. I am grateful for the assurance that noble Lords will not press this amendment to a vote, because this is neither the time nor the appropriate approach for tackling such a deeply ethical and complex area. If we support this amendment today, we say that terminally ill and severely disabled people do not deserve the very best forum and process to deliberate their life and death choices. The amendment has profound, far-reaching consequences, which strike fear-I am afraid it is fear-and apprehension into the lives of those who struggle to make society recognise that their lives have value and should be supported. We must treat this arena with the greatest respect, care and thorough understanding towards all sides of the spectrum. This is not the place, and it is not the time.
Lord Patten: My Lords, I have three things to say. I will not indulge in any generalities, my distaste for assisted suicide having been well enough advertised in earlier debates. We had a wide-ranging general debate earlier that, with respect, I should have thought might have pre-empted the debate that we are having tonight. I thought that the debate was going to be about an amendment, as was advertised by the noble Lord, Lord Alderdice, but it is actually a debate of a very general sort-so we are back to where we were a while ago.
I wish to say three things. First, the amendment singles out sick people for special treatment under the Coroners and Justice Bill and proposes, in effect, that they be more eligible for assistance with suicide than the rest of us who are fit, well and healthy. It is very discriminatory in that sense, and that surprises me. The provision under the noble Lord's proposed clause may possibly suit a small number of highly resolute sick people who want assistance to end their lives, but it would afford a lesser standard of protection under the law to others who may feel under pressure to end their lives, whether from others or from within themselves. As such, I regard this provision as both discriminatory and highly dangerous, as the noble Baroness, Lady Campbell, has just said so clearly. It is axiomatic that the law must afford equal protection to all citizens regardless of their age, sex, ethnic origin, religion and, indeed, state of health. That is why I regard this suggestion from the noble Lord, Lord Alderdice, as essentially highly discriminatory.
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Secondly, and here I am a mere echo to the noble and learned Baroness, Lady Butler-Sloss, the task of assessing applications for would-be suicides' assistants' licences is manifestly not a job for a coroner. The noble and learned Baroness has clearly explained to the House that the role of the coroner is to investigate and record causes of death, not to hand out licences to those who wish to help death to occur.
Thirdly-and I am deeply shocked to learn from the noble and learned Baroness that the coroners themselves have not been consulted; I thought that that happened automatically in the practices of your Lordships' House-to the best of my knowledge, coroners do not generally have the professional skills that would be necessary properly to investigate whether an apparent wish for assistance with suicide did indeed, represent,
with all the medical, psychiatric or psychological training that that demands.
I am extremely surprised that the noble Lord should have brought forward these suggestions in a way that has obviously caused great offence and concern to those who work as coroners to help us, let alone set them within a framework that is so discriminatory in its design.
Lord Low of Dalston: My Lords, I have some sympathy with the noble Lord, but perhaps I might just make these remarks. Having had a full debate in Committee, I imagine that the House will prefer to be spared a surfeit of impassioned pleas at this stage in the Bill's passage and at this hour. At the end of the debate on the amendment of the noble and learned Lord, Lord Falconer, the Minister suggested that an amendment to the Coroners and Justice Bill was not the best way of dealing with the matter, and that the best way of pursuing it further would be through a Private Member's Bill. The noble Lord may feel that that would be the best way of pursuing his amendment also; indeed, from the way that he moved it today, it seems that that may well be so. We will shortly have the guidance from the Director of Public Prosecutions, and the noble Lord may feel that it would be best to wait to see what effect that has before further stirring this particular pot.
At the same time, given the obvious concern that exists about this issue across the House, it might assist our further consideration of these matters if the Government initiated an impartial inquiry into the whole question of helping another person to die. This would be in keeping with the noble Lord's desire that the issue should be approached in the round, not simply in an antagonistic fashion. The Minister said, in response to a Question from the noble Lord, Lord Warner, in this House on 20 October, that he would take away the suggestion of an impartial inquiry. I strongly support the noble Lord's request and very much hope that the Government can be induced to respond positively to it.
10.15 pm
Baroness Finlay of Llandaff: My Lords, the amendment is not about assisted suicide, but rather euthanasia. If a person cannot commit suicide, then the assistance is
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The Dutch experience has shown that a considerable number of people do not feel psychologically able to commit suicide themselves but find the passive role of holding out their arm somewhat easier. We have evidence from Seale's work that there is no physician-assisted suicide in this country. The only thing I can commend in the speech of the noble Lord, Lord Alderdice, is that he did not see this function as being part of a medical practitioner's role. I agree. I was horrified that he did not stress that the role of medical practitioners is to relieve patients' distress.
The amendment covers most medical conditions from childhood onwards. Disabling and incurable illness is anything from arthritis to diabetes. There is not even a requirement here that the disease is particularly advanced. There is no requirement that the person has capacity. How long should their so-called "free and settled wish" persist? Does the certificate ever expire before the patient? Can parents get a certificate for their child? I could go on but I will not bore the House.
The concern of the coroners has to be listened to very carefully. This is alien to their remit. If such a service were set up, it would be inundated. Oregon's physician-assisted suicide prescriptions, which have been rising year on year, are an indicator. If we extrapolated those on a population basis, we would have about 1,400 requests. If we took the Dutch figures, which include euthanasia and would fit with the wording of the amendment, we would have around 12,000 requests. That would be a considerable workload for a coronial service which is already working hard. Coroners' certificates would need monitoring; otherwise, we might find fakes offered for sale on the internet, just as we do for ID.
This is Report stage. The amendment is so flawed that it seems to be euthanasia on demand masquerading behind a sanitising cloak of assisted suicide, without clear safeguards or monitoring, and we have already clearly rejected assisted suicide on two occasions. I fear that this amendment would sabotage the clause that was clearly drafted to ban internet suicide promotions. Such a ban is much needed.
Baroness O'Cathain: My Lords, looking at the amendment, I am struck by its dismal wording. It states,
- "if assistance is given to a person to commit suicide who is suffering from a confirmed, incurable and disabling illness which prevents them from carrying through their own wish to bring their life to a close".
In other words, the noble Lord, Lord Alderdice, believes there is only one option if one is suffering from a confirmed, incurable and disabling illness; namely, the wish to bring one's life to a close by suicide. This is not the only option. Not only is it not the only option but I submit that those who indicate or imply that this is the only option are causing huge distress to those who have received the bad news that their illness is incurable.
I go off on a tangent for a moment in asserting that doctors are not infallible. They can, and do, make a misdiagnosis. They certainly can, and do, make a
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The previous two debates on assisted suicide that we have had in this House on the Bill of the noble Lord, Lord Joffe, and the amendment of the noble and learned Lord, Lord Falconer, have shown without peradventure that this House has little appetite for the issue. Nobody is thinking about the devastating effect these debates have had on those who have had the ghastly diagnosis that their illness is terminal. The publicity about Dignitas, the court cases and the endless press comments make all of us think, but what do they do to those who have had this diagnosis?
Let me tell you about my first-hand experience. In March, one of my dearest friends of 42 years was diagnosed with motor neurone disease. We were extremely close friends, to the extent that our husbands were involved in our friendship. We spent Christmases and went on holidays together. On the day of the diagnosis, I spoke to my friend within one hour. She asked only one question: "Can you help me get to Switzerland?". I had to say no, which was very difficult. I felt truly responsible to come up with an alternative. My immediate reactions were, first, to remind her of her total belief in her saviour Jesus Christ and, secondly, that I had to look frantically for help. I turned to two wonderful colleagues in this House, who I will not name.
Then began an amazing and encouraging period of experiencing the wonderful, caring and supporting characteristics of the services that are available. They included the local authority services of making adjustments to the home and the NHS in its instant response to whatever emergency arose. Above all, the hospice movement offered love, respite and the experience of feeling safe. Let us face it, the nearest and dearest of people who face this diagnosis are not necessarily the people who can deal with it best. The demands on them in emotional terms are absolutely awful, which I know from family experience.
My friend was registered with the hospice through the NHS. Every four weeks she had a week of respite for her, the ill person, and her husband, who was the main carer. Once a week, an ambulance was provided by the NHS. It took her to the hospice for a day of physio, occupational therapy, a bath and a hair wash, all of which were extremely important to her. As my dear friend explained, being with people who were much worse off than her made her feel truly humble and added a dimension to the end of her life that she had never experienced in 69 years. She felt safe in the hospice and, most of all, she was overwhelmed by the total dedication of the loving, caring and encouraging hospice workers.
My dear friend died less than six months after the prognosis of 18 months-again, it was a misprognosis. She died peacefully and accepted that she was going to meet her Maker. If she had gone to Switzerland, would she have had that loving, caring end? I do not need to answer that. There is an option to suicide and
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Baroness Murphy: My Lords, before this debate, I had sought out the noble Lord, Lord Alderdice, and told him that I would not be supporting this amendment, rather on the lines outlined by the noble Lord, Lord Low. I had hoped that we would be moving towards a commission of inquiry into care at the end of life, which includes the way in which we help people to die. However, I have to say that, while I have listened to the illogical and vituperative messages from other Members of the House, I do not think that any of those noble Lords has listened to the arguments being put forward by the noble Lord, Lord Alderdice.
Let us forget the coroners for the minute; I do not think that anyone would see them as particularly appropriate people to do this. The noble Lord was pointing out that at the moment people with profound disabilities and severe illnesses, particularly those who are at the end of their life, are disbarred from making a decision that the able-bodied among us can make if we feel like it without the need for assistance. In this House, we generally support strongly the rights of people with a disability to access goods, services and care and to call forth special circumstances of assistance that are appropriate to individual needs. That is all that this amendment seeks to do in respect of a personal wish to end one's life. It is a wish that the rest of us are prevented from carrying out only if we have a mental disorder within the meaning of the Mental Health Act, although I accept for the moment that most people who wish to end their lives may have a mental disorder within the meaning of the Mental Health Act and do not therefore have a "free and settled wish", as it is rather unusually expressed in the amendment.
The amendment, on the face of it, presses for equality for people with disabilities and serious illnesses, which I applaud. However, for all the reasons that were set out by the noble Lord, Lord Low, I do not support the amendment as it is-and, of course, as we have said, this is not the time and the place. We need a further debate and, to look at all the issues, we probably need a further Private Member's Bill to come forward. However, I am amazed that people should have failed to listen to what the noble Lord, Lord Alderdice, was actually saying.
Lord Tebbit: My Lords, this amendment is about life and death, and there are not many matters of greater import. We have to look at it a little broadly. The law provides that we, as individuals, have no right to take life except in self-defence. It provides that the state, in acting for society, may take life or license the taking of life only in defence of the state or society itself. In short, the right or obligation to take life, or to license the taking of life, is strictly fettered and confined, and I believe that it should be so.
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