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With the law as it stands, we have the best of both worlds: deterrence combined with compassion. Palliative care, end-of-life care, has the Government's focus at present. We would be well advised not to tinker.
Baroness Greengross: My Lords, one key question for any independent inquiry on this issue must be how we can give dying patients greater choice and control
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Almost 90 per cent of people seeking assisted dying in Oregon do so from within the palliative care services. Evidence from countries which have legalised assisted dying does not support the claim that it would undermine developments in palliative care. The percentage of patients in Oregon enrolled in hospice care programmes has more than doubled. In Belgium and the Netherlands there has also been improved palliative care provision since legislation was introduced.
Palliative care and assisted dying legislation share many common values: the alleviation of suffering, patient choice and a patient-focused process. They should not be seen in isolation. True patient choice at the end of life should include access to high-quality palliative care. An independent inquiry would show that assisted dying legislation would enable us to ensure that palliative care improved and increased in this country.
Lord Taverne: My Lords, those who help relatives who cannot travel to Switzerland by themselves to commit suicide are clearly as guilty of a serious crime as those who drive a getaway car to a bank robbery. However, whether they are prosecuted is a matter for discretion by the DPP. Is this a tolerable state of affairs? Even with guidelines, uncertainty remains.
My noble friend Lord Carlile defends the law as it stands, but someone who is an even more eminent lawyer in this House-the noble and learned Lord, Lord Bingham-has indicated that the number who go to Switzerland for this purpose shows that the law needs overhauling. Further, who can fail to feel revulsion at the different treatment of Mrs Inglis and Mrs Gilderdale? They were charged with different offences in different circumstances, but both acted nobly out of deep compassion to assist in the suicide of a loved one. There were very different outcomes: one was acquitted; the other has to serve nine years. In the case of Mrs Inglis, if the jury had had any guts or compassion it would have defied the law, as juries have with unjust laws in the past, and acquitted her. Our law in the field of assisting suicide is not only an ass; in the words of Mr Bumble, it is a disgrace to our society.
Baroness Meacher: My Lords, a minority say that vulnerable people would be at risk from a change in the law. In reality, vulnerable people need protection. As things stand, about 1,500 deaths each year are a result of doctors ending life without an explicit request to die from the patient.
The most comprehensive research on assisted dying legislation and its impact on vulnerable people by Margaret Battin et al in 2007 examined data from Oregon and the Netherlands. They looked at vulnerable groups, including chronically ill and disabled people.
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Finally, surveys consistently show that a majority of groups that might be considered vulnerable, including elderly and disabled people, support a change in the law to allow assisted dying for terminally ill people. I would very much welcome an independent inquiry in this area. It would highlight the importance of legislation to protect vulnerable people.
Baroness Jones of Whitchurch: My Lords, over the past few years we have seen an increasing number of hard cases-difficult moral cases-hitting the headlines. We have seen cases of Britons travelling abroad to die, people committing suicide behind closed doors and, just this week, as has been referred to, loving parents assisting their children to die. These cases are not going to go away; if anything, they are likely to increase as the media spotlight gives courage to others to follow their lead. As things stand, we are exporting the problem to other countries' jurisdictions, while at the same time failing to provide proper protection from potential coercion or abuse.
These complex cases give us a particular challenge, but we should not be making up the law on assisted dying as a knee-jerk reaction to them. That is why I support an independent inquiry into the issue to enable a serious measured response to all the issues surrounding this important debate, away from the media spotlight.
Baroness Murphy: I am tired of these polarised debates, I have to say. It is time that we looked at ethical, societal and practical issues in a dispassionate way. I therefore strongly support an investigation along the lines proposed by the noble Lord, Lord Warner.
Let us take, for example, the issue of mental competence. I think that noble Lords will agree that the decision to die requires the highest test to be satisfied. An inquiry would allow us to define in advance how the complexities of mental competence, depressive thinking and undue influence could be assessed properly in practice. Does it not make more sense to review mental competence and the influence of mental state before the event via a safeguarded law, as opposed to afterwards via an investigation of a mercy killing and a potential prosecution? I think so.
As to those who quote Martin Amis, he is as serious about killing off older people as Jonathan Swift was about boiling babies.
Baroness Warnock: My Lords, I strongly support the proposal for an independent inquiry. I totally disagree with the view that an independent inquiry is not a suitable vehicle for coming to moral decisions. A truly independent inquiry has time, its members can listen to one another's arguments and, above all, when they come to their inquiry they will not be in an already entrenched position.
We are not likely, in this House or the other place, to come to a consensus on this important issue. We are all too much entrenched as lawyers, priests, doctors or philosophers. An independent inquiry is exactly what is needed now, and it would not overshadow the results of the Select Committee chaired so ably by the noble and learned Lord, Lord Mackay. I am very much in favour of this proposal.
Lord Parekh: My Lords, I must declare a possible conflict of interest: if the law were to be changed, as I think it should be, I might wish to be its beneficiary. As all the recent cases show, the current law on assisted dying is the source of much unhappiness and misery. It is constantly circumvented, it is out of pace with public opinion and it is increasingly becoming discredited. Desperate individuals who seek relief from unbearable or unrelievable pain want to take their lives, and they either go to Switzerland, lean on sympathetic doctors or turn to botched or highly gruesome forms of suicide. The law therefore needs to change.
It is obvious that we have had a lot of public and parliamentary debate on this subject. Why do we need an inquiry? I think we do because much of the debate is either not based on evidence, or based on wrong conclusions drawn from the evidence, or based on certain hypothetical fears and arguments not properly considered. We therefore need an independent inquiry that could look at the evidence more impartially.
Often we are told that we do not need to worry about assisted suicide because there is palliative care, but palliative care does not address the same question. Much pain is unrelieved, and palliative care does not address the issues of dignity and autonomy, nor does it address the simple fact that one might have reached the point where one does not wish to live or to become a burden either to society or to those that one deeply loves.
Baroness O'Neill of Bengarve: My Lords, my name was omitted from the first printing of the Speakers List so I apologise if I am surprising anyone. Many points have been made. I just wish to stress that if there is an independent inquiry-whatever "independent" might mean here-it should recognise that the safety of the people is the fundamental purpose of legislation. In my view, the draft legislation that we have debated in the past has not paid sufficient attention to that.
This debate has been polarised between autonomous choice and those who do not favour it. If we get serious about autonomy, we have to realise that much choice is impulsive, and measures have been suggested for dealing with that. However, I have not seen any good way for dealing with choices made when depressed, and we have not even begun to discuss choices made out of deference.
On the other side, we see sentimental references to compassionate friends and family. Friends and family are sorely tried by terminal illness, and they have a plurality of complex motivations. That may include great compassion, but one has to recognise that they may also be heirs, they may be burdened financially by
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We have to get a little further before we are even ready to think about the terms of reference for a supposedly independent inquiry, and I hope that any such inquiry would test its conclusions by attempting to draft legislation that could meet the standard of not endangering members of the public.
Lord Lester of Herne Hill: My Lords, the noble Lord, Lord Warner, has raised a topical and complex question of great public importance. Current English law on assisted suicide for terminally ill and mentally competent adults is not satisfactory; it sweeps too broadly and leaves too much discretion to prosecutors and too much uncertainty to patients and those who care for them.
An exception to the law of homicide is needed to give mentally competent adults the choice of a medically assisted death if they have a terminal illness and no possibility of recovery and they have a clear, settled and informed wish to die. There need to be strong and effective safeguards against abuse by relatives, friends or anyone else. That is why a decriminalising measure must ensure that assistance is given only by doctors and nurses and only in accordance with good medical practice.
An objective independent inquiry would provide evidence and informed opinion on whether and how such an exception should be made. It is needed for the reasons given by the noble Lord, Lord Warner, and others. We have nothing to fear but fear itself.
Lord McColl of Dulwich: My Lords, helping people to kill themselves is often portrayed as something humane and harmless, but the noble Lord, Lord Joffe, told the Select Committee that it was just "a first stage". The noble Baroness, Lady Warnock, said in September 2008:
"If you're demented, you're wasting people's lives-your family's lives-and you're wasting the resources of the National Health Service",
and that if you are old and sick and thinking of dying,
Those remarks were condemned by Alzheimer's charities, but the pressure is on for involuntary euthanasia.
Alison Davis was severely disabled at birth with multiple defects. She bravely bore all these until she was diagnosed with an incurable disease. Her repeated requests for euthanasia were refused, and there followed three serious suicide attempts. She was rescued by her friends, who persuaded her that her life was worth living. She formed a charity looking after orphans in India and has found the past 15 years the happiest that she has ever had. She said to the Select Committee that if euthanasia had been legalised, she would have been deprived of the best years of her life. What have noble Lords to say to that?
The Parliamentary Under-Secretary of State, Ministry of Justice (Lord Bach): My Lords, I congratulate my noble friend Lord Warner on securing what has turned
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By any standards this is a very distinguished cast list, and I thank all noble Lords for the discipline that they have shown in their speeches and, of course, for what they have said. My belief is that tomorrow's copies of Hansard should sell like hot cakes because the arguments for and against change in this field have rarely, if ever, been put so concisely and so well.
The moral and ethical questions surrounding this issue have been well rehearsed. Time is short-although, I fear, not short for me-so I will focus on what my noble friend has asked: namely, what consideration the Government have given to holding an independent inquiry on assisted dying to examine the evidence for and against a change in the law. As he reminded the Committee, in an Oral Question last October my noble friend raised the issue of an independent inquiry or commission. I said then that it was an idea that I would take back.
A public inquiry is a long-term commitment. Whatever the merits of an independent inquiry on this issue, I have to tell the Committee that realistically there is little prospect of such an inquiry being set up during what remains of this Parliament. At this stage, debating the possibility is academic. However, the question of whether there should be an inquiry will almost certainly arise again in the next Parliament. Therefore, it is more than useful to have this opportunity to consider the issue.
I and the Government have made clear on previous occasions that our view is that any change to the law in this area is, of course, an issue of individual conscience. It is rightly a matter for Parliament, rather than government policy, to decide. We therefore take a neutral view when others seek to change the law. To be clear: this means neither standing in the way of such a change nor actively pursuing it.
There are of course options open to Parliament if it wants to look at the issue of assisted dying, whether in relation to people who are terminally ill or more widely. One such option would be consideration by a Select Committee. Indeed, as we have heard, the Assisted Dying for the Terminally Ill Bill, brought by my noble friend, Lord Joffe, was considered at some length by a Select Committee, mentioned in this debate, and chaired by the noble and learned Lord, Lord Mackay of Clashfern, which reported in April 2005.
Beyond such options, the question of holding an independent inquiry on the issue is not as straightforward as it may seem. I hope that noble Lords will appreciate that, whatever a Government may say, it may not be perceived as neutral for us to facilitate any such action. Even if we remain entirely neutral on the moral issues involved, the very fact of setting up such an inquiry would be seen by some as tantamount to a policy decision that the law should be changed. In the debate, it was interesting that those in favour of change were very keen on an inquiry and those who were against change were equally keen for there not to be one.
The Government have not been blind to the extremely high public profile that this issue has had over many months-particularly in the past few weeks and days-or to the growing pressure to put in place a mechanism to allow the issue to be properly looked at. Our postbag in the Ministry of Justice reflects the very real concerns that members of the public have about this issue and, I am afraid, the extent to which it polarises opinion. Some people have called for a public consultation but, in the absence of any policy proposals-and such proposals could be difficult to formulate when starting from a position of neutrality-a public consultation would be unfocused and unlikely to reach any meaningful conclusions.
Of course a public inquiry can be a good way of responding to an issue or events that have caused, or are capable of causing, public concern. In theory, I do not doubt that the sort of independent inquiry that my noble friend envisages and argues so strongly for would be a good way of ensuring that all the relevant issues around assisted suicide were properly addressed. These include personal beliefs, personal autonomy, safeguarding the vulnerable and medical ethics, among others. Evidence could be taken from all relevant disciplines, including health professionals for whom any relaxation of the law could, and probably would, have significant implications. However, we argue that in practice there is a very real question about whether such an inquiry could be expected to resolve this extremely divisive issue.
Let us leave aside for a moment the question of whether it would be appropriate for the Government to set up an inquiry and, instead, look at some of the considerations that would necessarily be involved in doing so. Under the Inquiries Act 2005, Ministers can establish an inquiry, appoint the inquiry panel and set the terms of reference for that inquiry without the need for resolutions of Parliament. Indeed, we debated this matter in another context throughout last summer. Although the inquiry is independent, sponsoring Ministers will be accountable to Parliament for its spending and governance.
Even the best-managed inquiry will inevitably involve significant costs and resources, although there is no argument against that. As this House knows, controlling the costs of such inquiries was a prime motivation for the 2005 Act. Surely, therefore, before deciding whether to hold a public inquiry, it is sensible for Ministers to be very clear that the benefits of the inquiry, in both the short and longer term, will be worth while, given the expenditure of costs, time and effort.
A crucial factor in controlling the cost of any inquiry is its terms of reference. They must be tightly drafted to establish the scope of the inquiry. The sponsoring Minister has responsibility for setting the terms of reference, although the Inquiries Act specifically requires him or her to consult the chairman on them. This helps to ensure that they have a shared idea of the scope and purpose of the inquiry.
The legal, administrative, practical and resource implications of any change to the law in this highly controversial-
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall): My Lords, the Division Bell has rung. The debate will adjourn for 10 minutes to allow the Division to take place.
Sitting suspended for a Division in the House.
Lord Bach: My Lords, before we were so rudely interrupted I was making my concluding remarks. I thank all noble Lords who have been good enough to return to listen to me for the last couple of minutes of this debate.
I was talking about the benefits of inquiries and pointing out-I hope sensibly-that the legal, administrative, practical and resource implications of any change to the law are considerable. There are many different aspects to this complex issue and so the range of options that an inquiry could be asked to consider is potentially very wide. Our real worry is that however carefully we drafted the terms of reference, there could be no certainty that such an inquiry would reach a consensus or anything like it. Given the deeply divided views on this issue it would be necessary to ensure a balanced membership, which might make reaching a consensus even more difficult. I do not think that a majority of seven to six either way would constitute a good result.
Indeed, the Select Committee that considered the Bill of my noble friend Lord Joffe, to which I have referred already, from March 2004 to March 2005 did not take a position either way on this central issue. The danger, although I am not saying that it is inevitable, is that we could embark on a time-consuming and potentially very expensive exercise that might not take us very much, or any, further forward.
As I have said, this is clearly not an issue that can be resolved in what remains of this Parliament. I have absolutely no doubt that the debate will continue in one form or another in the next Parliament. In the mean time, I again thank my noble friend Lord Warner for raising the issue and I thank all those who have contributed so well to today's debate. It once again reinforces the importance of Parliament in providing a forum for considering this huge ethical issue.
To ask Her Majesty's Government what assessment they have made of the dangers in shared surface street designs for blind and partially sighted people and other vulnerable pedestrians; and whether they will request local authorities not to introduce such schemes until their research on shared space is concluded.
Lord Low of Dalston: My Lords, I am pleased to have this opportunity to highlight the dangers that blind and partially sighted people, as well as other
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The streets and public spaces in this country are increasingly busy and complex. Some of us are in cars, buses or lorries, and others are on two-wheeled vehicles, such as bicycles and motorcycles. Those of us on two feet have for some time been the poor relations. Traffic control systems favour the motorist and, to a lesser extent, the cyclist. The pedestrian space is often, by comparison with the roads, poorly maintained and cluttered with advertising frames and extraneous signs.
Therefore, it should be a welcome development that the concept of shared space has arrived. It seeks to strike a fairer balance, giving vulnerable road users such as pedestrians and cyclists a better deal. It also seeks to create more pleasant public spaces that we can all enjoy, free of clutter and unnecessary signage. Why, then, are blind and partially sighted people across the country vociferously opposed to these developments? It is simply because in delivering the concept, many town planners and designers are introducing shared-surface streets. In those designs, it is not only the clutter that is removed. Kerbs and, often, controlled crossings, are banished.
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