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Unfair age discrimination, like any form of discrimination, is unacceptable. It is unacceptable in society, in particular within publicly funded institutions such as the NHS and within social care. There is still a way to go but I think that this debate will help in putting on the record the fact that the Government agree with most of the remarks today. We recognise that there is a problem with discrimination and we want to support services to place the principles of anti-discrimination and equalities at the centre of everything that they do, particularly with regard to this issue.
To ask Her Majesty's Government what consideration they have given to holding an independent inquiry to examine the evidence relating to a change in the law on assisted dying for terminally ill adults.
Lord Tunnicliffe: My Lords, this debate is time-limited to one hour. When the hour is up, the next debate will begin. I therefore urge noble Lords to do their utmost to keep their contributions brief and to consider omitting the usual courtesies so that the Minister has time to respond before the debate is brought to an end. Should there be a Division, the one hour will be extended by the period of the adjournment.
Lord Warner: My Lords, it is a great pleasure to open this debate so close to Sir Terry Pratchett's courageous and-dare I say it?-entertaining Dimbleby lecture. I may not reach the same audience as Sir Terry, but we seem to have pulled in quite a lot of people today. Using humour to cope with huge sadness, anger and despair is a rare gift. The theme of that Dimbleby lecture was shaking hands with death and coming to terms with it in the individual's own way. As Sir Terry said, "My life, my death, my choice".
As death is a personal matter, I do not expect the Government to get involved in telling people how to conduct their affairs when they are dying-quite the reverse. I expect the Government to recognise that we now have a confused legal situation around death and dying that is very threatening to a growing number of people. They have a responsibility to try to facilitate some resolution of the confusion. A responsible Government-this one or another-should not wash their hands of these difficult issues and simply say that it is up to Parliament to sort things out, especially when Parliament has demonstrated that it cannot do that unaided. The theme of my remarks today is why the Government need to bring in some wise and independent help to break the parliamentary gridlock.
Why do we need an independent inquiry or review? First, we have a mounting set of contradictions that produce far too much confusion for many citizens. Most people want to die in their own home with their family around them, and at a time of their choosing. Instead, 60 per cent of people still die in hospital. A growing number of very determined and reasonably well off British people slip over to Switzerland to die at a time and in circumstances of their choosing. More than 700 brave souls have registered with Dignitas to keep their options open. A few have managed to persuade doctors to help them on their way illegally-probably in less than 1 per cent of deaths. Some people just give up and effectively starve themselves to death, sometimes rather painfully, but we do not know how many of those there are.
We have legislation that gives us the right to make living wills to stop doctors treating us, but we have little confidence that healthcare staff will always respect our wishes. Doctors' leaders have satisfied themselves that they have a satisfactory system for giving patients doses of drugs that may kill them, but that that is okay if it is only a secondary consequence of relieving pain. That is what I call the nudge and a wink approach to putting you out of your misery-very British.
With this confused situation, it is hardly surprising that year-on-year, we see a steady flow of mercy killing cases appear in our courts. Some of them look similar in circumstance but end up with different outcomes in decisions to prosecute or in court outcomes. In the recent Gilderdale case, the judge criticised the CPS for prosecuting. That does not bode well for the DPP's new guidelines. Personally, I think that Keir Starmer has done as well as anyone could expect with the poisoned legal chalice passed to him by Parliament and the Supreme Court.
We know that the law in this area is a mess because the Law Commission told us so in its review of murder law in 2006. It recommended that a further review was needed on mercy killings and other connected issues, such as assisted suicide, which would include assisted dying. The Government have declined to take up that recommendation but should, in my view, reconsider their position.
That is a brief summary of the policy and legal confusion, but there is also a lack of symmetry between governed and governing. Survey after survey for a decade or more has shown that the public want some form of change to legalise assisted dying for terminally ill people who are competent to make that decision. The recently published 2010 British social attitudes survey showed that 82 per cent of the public support assisted dying. Parliament-Commons and Lords-lags behind public opinion on this issue but, as in so many areas, the plates are shifting. In 2006, 33 per cent of participating Peers voted in favour of the Bill on assisted dying of the noble Lord, Lord Joffe. In 2009, 42 per cent of Peers who took part in, or listened to, the debate on an amendment to the Coroners and Justice Bill to safeguard those who assist people going to Switzerland to die voted in favour of it. In the Commons, a higher proportion of MPs now seem to support change than in 1997, when Joe Ashton brought forward his Bill on doctor-assisted dying.
I do not expect the Government to bring forward legislation, but they should try harder to bring some greater order to the increasingly chaotic policy and legal situation. The position continues to change in other countries. We now have the experience of the Netherlands, Luxembourg, Oregon and Washington state to draw upon, with Montana likely to join them soon. The DPP's guidelines are unlikely to produce stability. The Government's own end of life strategy is incomplete in this area and will continue to cause the issue to be raised.
Now Sir Terry Pratchett has suggested a practical way forward for helping doctors out of the quandary in which they find themselves: a medical legal tribunal to which people who want assisted dying can apply. That is not much different from the situation now, where applications can be made to the High Court to switch off a brain-dead patient's ventilator. Of course, we still have the Law Commission's recommendation lying on the table.
There is a lot of material for an independent review to get its teeth into. There is a raft of medical, legal, ethical and other knots to untangle, as I have indicated. This is territory that in an earlier time we would have handed over to a royal commission. I do not much mind what one calls such an inquiry, provided its terms of reference are wide enough and its membership carries public confidence and avoids sectarian capture.
I have made no attack on those who have different views from mine. I hope that other noble Lords can be dispassionate, support this approach on a non-judgmental basis and encourage my noble friend the Minister to get his colleagues to consider seriously the idea of an independent inquiry.
The Earl of Arran: My Lords, it is clear that people increasingly want the choice of an assisted death. Two very recent polls suggest overwhelming support: one put it at 75 per cent; the other at 82 per cent. In fact, all polls on assisted dying show that an overwhelming majority of people wish a change in the law. Opponents argue that the questions put to the public are biased but, given how many polls have been conducted, all with differing questions, surely one by now would have shown a result other than overwhelming support, but there is not one.
You cannot just ignore opinion polls. Some argue that the public do not understand the complexity of the issue. I would advise against patronising the electorate, who understand suffering all too well. I would also advise against paternalism, no matter how well intentioned. Parliament must wake up; assisted death will happen at some point in the near future, hastened on by the clamour of society at large. More importantly than that, it has to happen in order to relieve the suffering of those who can no longer endure intractable distress.
Lord Goodhart: My Lords, I have no idea what my reaction will be if I find myself facing a terminal illness with only a few weeks to live. Will I want care at home or care in a hospice or help with suicide? What I
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There are people who claim that legalising assisted suicide is the beginning of a slippery slope. The evidence from places where assisted suicide is lawful does not support that claim. We do not need an inquiry. Public reaction to the deeply moving Dimbleby Lecture of Sir Terry Pratchett and to the acquittal of Kay Gilderdale on the charge of attempted murder of her daughter show that the time for change has come. Let us get on with it.
Baroness Butler-Sloss: My Lords, the sad stories of trips to Dignitas in Switzerland, together with the two recent cases of mothers and daughters, have been taken up by the media and supported by well known personalities. They undoubtedly make a case for change, but these cases and this publicity have obscured real and cogent arguments to the contrary, which will be made during this debate. My main concern is the position of elderly and vulnerable people who already feel that they are a drag on their family and friends, and that they should die even if, deep down, they may not actually wish to do so. They may feel impelled to agree to die. I am also concerned about the tip of the iceberg. Once legislation is in place, it can that much more easily be extended. The issues and arguments are clear; it is unnecessary to have a further inquiry.
Baroness Campbell of Surbiton: My Lords, how ironic that Sir Terry Pratchett was given such a platform this week-a man whose views are purely from an individual perspective. It is a view so at odds with that of thousands of other terminally ill and disabled people, who want Parliament to concentrate on better support to live, not to die.
Baroness Wilkins: I will continue to read my noble friend's speech on her behalf. That he articulated the majority view of the population is not disputed. However, he did not speak for disabled and terminally ill people. Not a single organisation of or for disabled and terminally ill people supports a change in the law. Does it not seem strange that those identified as beneficiaries of assisted dying are not insisting that their organisations campaign for a change in the law? The Multiple Sclerosis Society, the Motor Neurone Disease Association and the Alzheimer's Society are all silent on the issue, and RADAR has come out in opposition.
When we campaigned for equality we used the slogan, "Nothing about us, without us". Now we feel that we are on the receiving end of a campaign waged by people fearful of disability and terminal illness. With the exception of a few individuals, it is a campaign wholly without us. Today's Motion calls for the examination of,
What about evidence supporting the current law? Does this relentless pressing for a change in the law help the
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The Lord Bishop of Durham: My Lords, where a matter has already been debated, to call for an independent inquiry looks like the old business of holding the referendum again and again until people give the right answer. Parliament is there not to bend to every media-manipulated public whim, but to take the larger and longer view. We do not see in the press the old lady who last summer told me several times that she just wanted to go to sleep and not wake up, but who eventually made a full recovery and celebrated her 63rd wedding anniversary last month and greeted her sixth great-grandchild last week. Had we been in Holland or Oregon, someone might have "compassionately" given her a paper to sign and the deed would have been done. I declare an interest: the lady in question is my mother.
Last summer I sympathised with her view-her desire to die-but I shuddered at the thought of speeding her on her way. That would not have been compassion but, rather, collusion with distorted desire. The assisted suicide lobby does not have a monopoly on compassion. I believe that it distorts the notion radically. The genuinely compassionate course includes the remarkable work of palliative care, in which we in this country are field leaders, particularly through the hospice movement. We do not need a further independent inquiry.
Baroness O'Loan: My Lords, when one contemplates issues of this kind, it is important not to be swept along by a tide of uninformed public opinion, stimulated by selective reporting of very difficult cases. It is important that our response to the lot of those who suffer from terminal illness or progressive disability is not to contemplate assisted dying as the final or only solution. If you have lived in close proximity to suicide or life-limiting illness, you will know that these matters are not simple. There is huge grief and emotion and pain; those are not the foundations on which we should build.
The protection and preservation of life is the most fundamental and important duty of the state under the law. To live with life-limiting illness is to live with uncertainty. Today the law protects individuals from mercy killing-for that, ultimately, is what assisted suicide is. They know that if someone determines that their life is no longer of value and takes steps to end that life, the law will intervene. They know, at least,
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The BMA, like the many organisations referred to by the noble Baroness, Lady Campbell, does not want a change in the law. Let us seek, rather, to maximise the processes and funding for the care of those whose lives are in some way constrained and limited. Life is sacred. We, as legislators, have a profound duty to protect it.
Lord Dubs: My Lords, a call for an inquiry is not a rush generated by media hysteria: it is a balanced way of saying, "Let us look at all the issues and arguments and proceed sensibly and slowly". Public opinion is on our side; it wants a change and the pressure is there. We in Parliament ought to be very careful before we say that public opinion has no right to have its voice heard in this House.
Of course an inquiry must look hard at the safeguards; of course it must look, in the words of the MS Society, at all "choice in death" issues, including the relationship of palliative care to other aspects. I would not wish to deny to others something that I would want for myself. I believe that very strongly. Some time ago, someone I knew who had motor neurone disease, begged me to support a change in the law.
Lord Alton of Liverpool: My Lords on every occasion that proposals to change the law have been put before your Lordships' House they have been defeated by significant majorities. If there is to be further debate, it should be properly conducted in the House of Commons.
To disregard that belief would fundamentally alter the relationship of a doctor with their patient, which is the why the BMA and the royal colleges continue to oppose a change in the law. It would also endanger public safety and put disabled people at risk. The right to die would rapidly become the duty to die.
and he called for "euthanasia booths" on street corners. Others have said that people with dementia represent a terrible economic burden to society. What a chilling and bleak future that is. Surely a civilised society can do better than that.
Viscount Craigavon: My Lords, in my brief contribution, perhaps I may mention what is happening internationally in this field. We do not want to copy in every last detail the laws that have been passed by
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As well as in Oregon, in the United States the system has been largely adopted by the neighbouring state of Washington. In a vote at the same time as the recent presidential elections, 58 per cent of Washington voters approved the change in the law, which is now in force. The noble Lord, Lord Warner, mentioned stirrings on this subject in Montana.
In the face of all these continuing changes and the publicised cases and opinion polls in this country, I am astonished that we still have some absolute fundamentalist opinion trying to put back the lid on the box of this issue. Such people would be much better served by acknowledging the inevitable changes that are bound to come and working to make that change the best for everyone.
Lord Carlile of Berriew: My Lords, the timing of this debate is surprising, to say the least; the noble Lord should surely have awaited the DPP's guidelines in their final form. On that subject, he should be careful in his criticism on the case of Gilderdale, in which the judge held that there was a case to answer on a charge not of assisted suicide but of attempted murder.
My second point is about the impracticability of what is behind the proposal for an inquiry. The fact that a speech containing such a proposal is made by someone who is rightly regarded as a national treasure, a wonderful author speaking from the heart and using fine language, does not make him right. The fact is that the Pratchett proposals are at least as weak as the proposals made earlier by the noble and learned Lord, Lord Falconer, and heavily defeated in this House.
My third point is that we have already had the inquiry. No one has mentioned the name of the noble and learned Lord, Lord Mackay, so far in this debate, but some of us, including myself and some who have spoken already, were on that committee. I wonder if some noble Lords who have spoken today have taken the trouble to read the report, which contains every fact on both sides of this argument. It enables the decision-makers to make up their minds-and the decision-maker is Parliament.
I therefore regret the timing and the principle behind this Motion, which surely is, as the right reverend Prelate said, an attempt to ask the question so many times that eventually you get the answer you want.
Lord Elystan-Morgan: My Lords, the onus of proof in this grave and weighty matter lies on those who seek to bring about assisted suicide. It is not a matter for public opinion any more than is the death penalty, and the case of those who seek the legitimisation of assisted suicide is riddled with fallacies.
The first is the fallacy that the DPP is in some way in a neutral position. He is not. Under the Suicide Act 1961, he is obliged to give his consent to any prosecution. That does not mean that he is entitled, nor indeed obliged, to seek to change the law, but that is practically what he is now almost invited to do.
The next fallacy is that one can proceed down the path of legitimising assisted suicide but not eventually lead to the issue of euthanasia, whether that be voluntary or involuntary. The noble Lord, Lord Carlile, has already referred to the ravings of Martin Amis in this connection.
The final fallacy is that you can in some way determine this matter by a public inquiry. We have had a surfeit of public inquiries and all the facts are well known. If you set up a royal commission to deal with the ethical and moral matters, you are then in even greater difficulty; you might as well set up a royal commission to determine doctrinal theology.
Lord Joffe: My Lords, the last time that there was a serious parliamentary investigation into assisted dying, it was published in the 2005 Select Committee report of this House, which unanimously recommended the referral of the issue to Committee for detailed debate. That detailed debate was prevented by a cunning tactical ploy by the noble Lord, Lord Carlile. It astonishes me that he refers with such confidence to that Select Committee because, as it happens, I have established that although no vote was taken in the committee, a majority of seven of its 13 members ended up by supporting assisted dying.
Surely, against that background, the 80 per cent of society in our democracy who consistently support assisted dying are entitled to the inquiry proposed by my noble friend Lord Warner, at which the issue can be calmly and objectively considered, based on research and evidence, rather than on conjecture and speculation about what might happen by those who hope that it will not.
Baroness Emerton: My Lords, I see no reason for another inquiry, having been aware of the six-month Select Committee and the detailed debates that have followed. The press has recently highlighted a small number of assisted suicide cases, and an inquiry, if it took place, could lead to a change in the law. Enabling laws have a habit of encouraging the acts that they enable; that is, after all, one of the reasons why they are made. It is all very well to talk of safeguards, but if you read the facts rather than the spin-about what is happening in Oregon, for example-you will see that so-called safeguards do not work as the campaigners claim.
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