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House of Lords

Friday, 18 July 2014.

10 am

Prayers—read by the Lord Bishop of Carlisle.

Assisted Dying Bill [HL]

Assisted Dying Bill [HL]

Second Reading

10.07 am

Moved by Lord Falconer of Thoroton

That the Bill be read a second time.

Lord Falconer of Thoroton (Lab): My Lords, in the last stages of a terminal illness, there are people who wish to end their life rather than struggle for the last few months, weeks, days or hours. Often it is not the pain that motivates such a wish, but the loss of independence and dignity. Those who love them often try to help, sometimes by going with them to Switzerland. Nobody wants assisters who are motivated by compassion to be prosecuted. The courts and the prosecution authorities recognise this impulse and have tried to steer a course between Section 2 of the Suicide Act 1961 and the desire not to enforce it. But the current situation leaves the rich able to go to Switzerland, the majority reliant on amateur assistance, the compassionate treated like criminals and no safeguards in respect of undue pressure. Many people, caring so much for those they leave behind, are dying earlier and alone because they fear implicating their loved ones in a criminal enterprise. They hoard pills or put a plastic bag over their head when they are alone.

It is time for a change in the law, but only a very limited and safeguarded change. Good-quality end-of-life care can alleviate much of the suffering of the dying process and we must continue to strive to improve it. However, a minority of those who are dying, no matter how good the end-of-life care, do not wish to go on struggling. The principle of this Bill is that those who are terminally ill should have choice over how they die, but subject to effective safeguards that prevent pressure or abuse. It would lead not to more deaths, but to less suffering. Disabled or older people without a terminal illness would not be eligible for an assisted death. The Bill does not legalise voluntary euthanasia where a doctor directly administers life-ending medication; rather, it provides that the final act in an assisted death must be taken by a patient who has mental capacity both at the time of the request and at the time of their death.

Oregon’s Death with Dignity Act has been in place for 17 years. It enables someone who is terminally ill to request the option of an assisted death. There has been no evidence of abuse since its inception. Only a small number of patients have an assisted death—fewer than 80 in total in 2013—out of the annual 30,000 deaths in Oregon. Around 40% of dying people who meet the strict safeguards to obtain life-ending medication never use it, simply taking comfort from having the option.

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Critics of my Bill cite the voluntary euthanasia laws of Belgium and the Netherlands as an example of the slippery slope. In fact, it is not a slippery slope but a deliberate path chosen by legislators in those countries. From the beginning, they created laws that allowed both dying and non-dying people to be directly helped to die based on a subjective analysis of suffering. The Belgian and Dutch laws provide no evidence of a slippery slope. More accurately, they confirm that the law you enact is the law you get. That is why it is so important that we get it right from the outset. I have built on the Oregon model, but with more safeguards. I reject the Belgian and Dutch approach.

Clause 1 of this Bill enables an adult who is terminally ill to request to be given assistance to end their own life. No other person, including the patient’s doctor, family and partner, is able to initiate the process of requesting an assisted death. Clause 2 defines “terminally ill” and “terminal illness” as applying to a person who is expected to die from a terminal illness within six months.

Clause 3 sets out the safeguards. First, the patient must sign a declaration, witnessed by an independent witness, that it is their “clear and settled intention” that they wish for an assisted death. Secondly, two doctors must countersign the declaration. Before countersigning, the two doctors,

“having separately examined the person and the person’s medical records and each acting independently of the other, must be satisfied that the person—

(a) is terminally ill;

(b) has the capacity to make the decision to end their own life; and

(c) has a clear and settled intention to end their own life which has been reached voluntarily, on an informed basis and without coercion or duress”.

In deciding whether to countersign the declaration, the two doctors,

“must be satisfied that the person making it has been fully informed of the palliative, hospice and other care which is available”,

to him or her. These safeguards are set out expressly in the Bill. While the Secretary of State has a power under Clause 8 to issue codes of practice to provide guidance to doctors in discharging their roles under the Bill, the safeguards themselves and the conditions that need to be satisfied before an assisted death can occur are spelt out in the Bill. Those who suggest that the safeguards are not in the Bill are mistaken.

Clause 4 sets out the practical arrangements for providing medicines to enable a terminally ill person to end their own life. The attending doctor would write a prescription for the necessary medication, but it would be delivered only after a 14-day cooling-off period for reflection, or six days if both doctors agree that the person is likely to die within one month. The attending doctor, or another doctor or nurse authorised by the attending doctor, would deliver the medicine at the patient’s request after the period of reflection had passed, check that the person had not revoked or did not wish to revoke their declaration and remain with the person until the medicine had been taken and the person had died, or the person had declined to take it. The person would have to administer the medication himself or herself. If a patient has lost the ability to

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swallow or finds it very difficult, the Bill makes provision for a syringe driver to be installed. However, it would be illegal for a healthcare professional directly to administer the medication. The final action must always be taken by the patient.

Clause 5 enables health professionals to refrain on the grounds of conscientious objection from assisting a person to die in accordance with the Bill. Clause 12 contains a sunset provision, which would enable the Bill to be repealed by resolution of each House and without the need for further primary legislation after the Act had been in force for 10 years.

The courts have said repeatedly that the current law does not work—most recently, in the Supreme Court a few weeks ago—and have urged Parliament to construct a workable law. The Bill provides for an assisted death in circumstances where there are adequate safeguards to prevent abuse or pressure on those who are terminally ill. There are those who say that you can never be sure about a prognosis of how long someone has to live. Of course, I accept that there can be no certainty. However, whether the issue is assisted death or the decision no longer to treat a patient, the physicians have to do their best. That the prognosis cannot be certain is not a reason for abandoning those who wish this option. Whether the right period is six months will no doubt be addressed in Committee.

Some say that the courts should be involved as an additional safeguard before an assisted death occurs. We should constructively consider that issue in Committee. Others say that the change in the law will place pressure to take that option on those who are dying. I disagree. The numbers will be small—that is the experience in Oregon. The safeguards make clear the exceptional nature of the course. Some say that the current law should just be allowed to continue. They are wrong. Without intending to be, and despite the very best efforts of those who seek to enforce it, the current law provides the option of an assisted death to those rich enough to go abroad; for the rest, it provides despair and often a lonely, cruel death—and no adequate safeguards.

The noble and learned Lord, Lord Neuberger, the President of the Supreme Court, said in his recent judgment:

“A system whereby a judge or other independent assessor is satisfied in advance that someone has a voluntary, clear, settled, and informed wish to die and for his suicide then to be organised in an open and professional way, would, at least in my current view, provide greater and more satisfactory protection for the weak and vulnerable, than a system which involves a lawyer from the DPP’s office inquiring, after the event, whether the person who had killed himself had such a wish, and also to investigate the actions and motives of any assister, who would, by definition, be emotionally involved and scarcely able to take, or even to have taken, an objective view”.

Some say that the Bill devalues the lives of those who are disabled and puts pressure on them to take the option of an assisted death. I disagree. The option of an assisted death is available only to those who are terminally ill and is available to the disabled on the same basis as everyone else. While it is for Parliament to reach its own judgment on the merits of the Bill, it is significant that polling suggests that support for a change in the law is just as strong among the disabled

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as it is in the general population. The general population supports the change at a level of above 70%; among the disabled the level is 79%.

There is a common goal, whichever side of the debate you are on, for a law that shows compassion to the well motivated who help someone to end their life when they already have a terminal illness, but in a way that provides proper safeguards against abuse and pressure. The Lords, working constructively together, can craft such a law. It will then be for the Commons to decide whether that is a law that they are willing to pass. The time for royal commissions and Select Committees has passed. Our work on the Bill will affect so many people’s lives—in the way they die and in being with someone they love as they experience a final illness. I believe that the time has come for change. I beg to move.

10.19 am

Lord Mackay of Clashfern (Con): My Lords, I am deeply opposed to the Bill but strongly in favour of it being afforded a Second Reading so that we may have the opportunity to discuss the many vitally important issues that it raises. After such discussion, there will then be an opportunity to take a vote on whether it should pass this House.

The Bill is named the Assisted Dying Bill, but the only part of our existing law that it seeks to amend is Section 2 of the Suicide Act 1961. Its only subject matter is assisted suicide. Dying is a much wider topic than suicide. Why does the title not correspond to that narrower subject matter? Section 2 of the Suicide Act is an important protection for the vulnerable. We may feel strong today and may be able to weigh up issues with which we may be confronted. However, the devastating effect of serious illness can speedily make us vulnerable, so that although still possessed of mental capacity we become much more susceptible to influence than when in health.

We have presently in place a framework for the operation of Section 2. The section states guidelines for the institution of prosecution which were put in place after wide public consultation and which of course are subject to amendment as circumstances change. The DPP told the commission of the noble and learned Lord, Lord Falconer of Thoroton, that the law was working well in practice. I know that the Supreme Court has taken a different view of that matter; that is for your Lordships to judge.

The Bill proposes that assistance to suicide will be made lawful within six months, reasonably estimated, of death. What is the principle that gives such an importance to six months? Why should a course of action that may attract a prison sentence suddenly become lawful because a person is thought to be within six months of death? If the Bill becomes law, will the DPP’s guidelines have to recognise this landmark and put cases outside this boundary beyond their reach?

If the Bill becomes law, a person within six months of death will face the agonising choice of deciding to seek assisted suicide or awaiting the natural ending of his or her life. Presumably, the attending doctor will have to advise the patient of the option of assisted

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suicide, which will be open up to within a short time of death. The evidence from Oregon suggests that it is very difficult for a patient to reach a concluded view on this matter. The noble and learned Lord referred to the fact that a number of people who declared a settled intention to take their own lives in fact did not use what was provided and died naturally. Is it compassionate to introduce a dying person to a regime that requires such strenuous decision-making?

The Bill is strongly promoted by an organisation called Dignity in Dying, which was formerly called the Voluntary Euthanasia Society. I have seen a number of people die with dignity who did not commit suicide, assisted or otherwise. The suggestion seems to be implied that assisted suicide will lead inevitably to a dignified, comfortable and speedy death. Can this suggestion be justified? I have seen some evidence that it is not at all certain that this will be the outcome. If that is correct, will the attending doctor be obliged to tell the patient this prior to the patient proceeding to decide on this new choice that the Bill will give?

I thank the noble and learned Lord for his clear exposition of his Bill, which I found very helpful indeed.

10.23 am

Lord Dubs (Lab): My Lords, I support the Bill, because I do not wish to deny other people something that I might want myself some day in future. Some years ago, I went to see a friend of mine who had motor neurone disease. His whole family was there; he could no longer communicate, except on a keyboard, and he had assembled the family because they together wanted to ask me to support a change in the law. He died not long afterwards, but it was a heartfelt wish on his part. How could I say no to such a plea?

Recently, I was introduced to a woman who had taken her husband to Zurich. She said that the whole thing was a dreadful experience, because he was not ready to go but he was terrified lest his illness progressed to the point when he would be unable to make the journey. He wanted to die at home, surrounded by his family, instead of having to make the journey to Switzerland. That is surely another reason why the law should be changed.

On both sides of the argument, we have had very moving letters, and I find some of them very persuasive indeed. Some came from people whom I knew years ago. One letter said:

“My mother was in great pain at the end which the drugs did not remove. She was begging to die”.

Another letter said:

“Everyone should be able to choose when to end their life when the suffering becomes unbearable”.

She talks about someone close to her dying in agony. Yet another letter said:

“My personal interest is my concern at the way my father died. He had suffered for some time from a terminal lung condition and towards the end of his life his suffering became intolerable. He wanted to die but under the present law his doctors were unable to help him. After months of unnecessary suffering he died”.

I do not think that we can say to those people that we are not prepared to do anything for them. Of course,

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public opinion is overwhelmingly on our side; 70% to 80% of the public consistently want a change in the law.

I have enormous respect for Members of this House who take a different view and I am sorry that we find ourselves on a different side of the debate today. I am a convert to this cause. Years ago, I would not have supported the Bill either but, as I learnt more about the issues, I decided that I had no option but to change my mind. I am conscious that quite a few Members of this House have in recent years changed their mind as well; they have certainly said so to me.

I would not support this Bill unless I was satisfied that there were adequate safeguards. Today, anybody can go to Zurich if they can afford it and there are no safeguards at all; there might be pressure on them, and so on. My noble and learned friend has already referred to Oregon. There is a happy balance—“happy” is not the right word, but there is a balance—between palliative care and those who have opted for assisted dying, because they can go into palliative care knowing that at any point they can make the decision to end their lives. Because they are in control of this, many choose not to do so. Surely that is the outcome that we all wish to see.

10.27 am

Lord Lester of Herne Hill (LD): My Lords, the question raised by the Bill is whether an exception should be made to the existing criminal law for doctor-assisted suicide of the terminally ill, within the narrow limits and stringent conditions prescribed by the Bill. We should oppose the recent suggestion to withdraw the Bill in favour of a royal commission, as the noble and learned Lord, Lord Falconer, said. We have the benefit of the work of the Lords Select Committee on Medical Ethics and the Lords Committee on the Bill proposed by the noble Lord, Lord Joffe, and the evidence that they gathered. The Supreme Court has decided that Parliament should have the opportunity to decide whether Section 2 should be amended. The time is overripe for both Houses of Parliament to take that opportunity.

I was amicus curiae in the Bland case about whether it was criminal homicide to withdraw artificial feeding from a victim of the Hillsborough tragedy, Tony Bland. He was in persistent vegetative state and would never recover consciousness. His family and the healthcare team believed that it was in his best interests to end what remained of his life and the Law Lords agreed. Like all of us, the Law Lords believed in the sanctity of human life; their judgments were based on the principle of personal autonomy—that patients of sound mind have the right to choose whether to accept medical treatment. Tony Bland could not make that choice. They decided that the common law permitted his life support machine to be switched off without risk of criminal homicide.

What then of MND victims such as Chris Woodhead or my late client Annie Lindsell? MND is a degenerative neurological condition with no known cause or cure. It kills the nerves controlling movement so that sufferers, while retaining total brain function and being able to feel pain, find themselves completely trapped inside a completely paralysed body.

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Annie Lindsell, along with other MND patients, did not want to choke to death on her own mucus when she became unable to swallow. She did not want to have to starve herself to death or endure invasive surgery, nor did she want to live in a doped haze with palliative care. When the quality of her life became unbearable to her, as she began to be unable to swallow, and was at imminent risk of suffering severe distress, involving choking, Annie and her doctor wanted to be confident that her doctor would be able lawfully to relieve her severe distress, even though the probable consequence was to shorten her life. They needed to know that, if her doctor agreed, she would be treated with drugs at that stage so that she could die with dignity, fully aware of her circumstances. That is also Chris Woodhead’s wish, expressed so movingly in this week’s Sunday Times. He does not wish to have to starve himself to death.

Patients have the right to life. They also have the right to personal autonomy and dignity. They and their doctors need to know what exception there is to the law of homicide, enabling a doctor, acting in accordance with the patient’s wishes and the doctor’s conscience and judgment as to the appropriate medical treatment, to administer that treatment, even though it will end the patient’s life. Unless the criminal law and good medical practice are clear, conscientious doctors, seeking to act in the best interests of their terminally ill patients, and the terminally ill patients themselves, are left in a state of uncertainty and anxiety.

This very narrowly drawn Bill will give them the certainty that they deserve. As the noble and learned Lord, Lord Falconer, said, it is not a slippery slope if Parliament draws the line. The Bill does not threaten the lives of vulnerable people, including the disabled. I hope very much that the House will not only allow it to proceed but approve it for the other place.

10.32 am

Baroness O'Neill of Bengarve (CB): My Lords, this Bill, as we already have heard, arouses great passions and considerable confusion. No doubt we shall hear many claims and counterclaims about the adequacies of the supposed safeguards in the Bill, but I think that at Second Reading it may be more useful for us to concentrate on what the Bill aims to do, for there remain fundamental confusions. I shall try to be brief.

First, the Bill does rather little to assist the dying. That noble purpose would require legislation that entitles all of us in our dying months, weeks and days to the necessary help and care, and pain relief, whether or not we are competent to choose. A Bill with those aims would have to address very large issues, above all the currently patchy availability of high-quality palliative care and incomplete availability of high-quality pain relief. This Bill proposes little to assist most of those who are dying. I agree with the noble and learned Lord, Lord Mackay of Clashfern, that it is mistitled. This is not a Bill about assisting the dying.

Secondly, the Bill does little to support the choices of those who are dying. A Bill that centred on protecting the choice of those who are dying would concentrate on choices to refuse treatment, which can be, but so

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often are not, set out in advance directives, or choices about where to die. Do those who purport to care about the choices of the dying really have nothing to say about respecting or protecting the wholly uncontroversial choices of many who die on general wards, when they would have preferred to stay at home or in their nursing home with appropriate care and pain relief? Do they have nothing to say about choices that can be set out in advance directives? Seemingly so. The Bill supports only the choices of the few who might choose to commit suicide.

Thirdly, the Bill is not about altering the law on suicide. Suicide is not now a crime. It would be impossible to prosecute those who succeed. Attempted suicide used to be an offence, but it was decriminalised in the Suicide Act 1961. Fourthly, the Bill is about selectively decriminalising actions that, in the words of that Act,

“aids, abets, counsels or procures the suicide of another”,

by defining exceptions to this provision. The offence of aiding and abetting suicide was amended in the Coroners and Justice Act 2009, with greater emphasis on the element of intention.

So, we are dealing with a proposal to amend the law on aiding and abetting suicide. There are many good reasons, which I need hardly spell out, why we need legislation that makes it an offence to aid and abet another’s suicide. The question actually raised by the Bill is whether it is feasible or advisable to create an exemption for certain cases. The 1961 Act already provided that prosecution should not be automatic. In the wake of the Coroners and Justice Act, the Director of Public Prosecutions published a policy which sets out considerations for and against prosecution; and prosecutions are very few. However, this policy would be dislodged if the potential offence that warrants investigation or requires an inquest were abolished. The policy works because there is no immunity from investigation, from an inquest, or, if the facts of the case prove adverse, from prosecution. If there were no offence, none of these protections would remain. We shall have to see what case can be made for such a risky move.

Some of the Bill’s proponents have recently publicly recommended it as a modest proposal. I wonder whether they have recently read Swift’s great satirical essay that gave this notable phrase such long-lasting currency in our language.

10.36 am

The Archbishop of York: My Lords, let me state at the outset that the official Church of England position was made very clear on 9 July 2005, when the General Synod voted on a motion referring to the joint submission of the Church of England House of Bishops and the Roman Catholic Bishops’ Conference to your Lordships’ House Select Committee. The motion argued strongly against making assisted suicide or euthanasia lawful. The vote was carried by 297 votes to one. This position was reaffirmed in a General Synod motion in 2012.

The present Bill is not about relieving pain or suffering; it makes that quite clear in its definition of a terminally ill patient to include those whose progressive illness can be relieved but not reversed. The Bill is about asserting a philosophy, which not only Christians

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but also other thoughtful people of good will who have had experience in care for the dying must find incredible—that is, the ancient Stoic philosophy that ending one’s life in circumstances of distress is an assertion of human freedom. That it cannot be. Human freedom is won only by becoming reconciled with the need to die, and by affirming the human relations we have with other people. Accepting the approach of death is not the attitude of passivity that we may think it to be. Dying well is the positive achievement of a task that belongs with our humanity. It is unlike all other tasks given to us in life, but it expresses the value that we set on life as no other approach to death can do.

We need time, human presence and sympathy in coming to terms with a terminal prognosis. To put the opportunity to end one’s life before a patient facing that task would be to invite him or her to act under their influence rather than dealing with them.

It is possible to think abstractly that one’s early death would be welcome to one’s nearest family and would spare them trouble. But in fact the best service one could do for them would be to accept their care and to show appreciation of them at the end of one’s life. When it was discovered that my mother, Ruth, had aggressive throat cancer, she was expected to live only a few weeks, but through the skill and care of the hospital and Trinity Hospice, she was able to live for 18 months. During this time, our children, who had been born in England, were able to get to know and love their grandmother, and she was able to delight in them. This was a gift.

The right reverend Prelate the Bishop of Worcester, John Inge, recently wrote about his wife, Denise, who died of a sarcoma on Easter Day. He writes:

“How easy it would have been to succumb to despair when the diagnosis was given. It looked as though she had only days, or weeks at most, to live ... as the dreadful effects of chemo took their toll and I became more and more … distressed at seeing her in such pain and discomfort … How tempting it would have been for me”—

if assisted dying had been legal—

“to have suggested that … it would be ‘for the best’ for her to end it all there and then.

Many … argue that it would have been the ‘compassionate’ and ‘caring’ thing to do”.

But Denise survived several more months, and during the times when I visited and prayed with her and Bishop John, I saw her emerge from the initial darkness to enjoy some precious time with friends and family. Shortly before she died she wrote:

“Contemplating mortality is not about being prepared to die, it is about being prepared to live. And that is what I am doing now, more freely and more fully than I have since childhood. The cancer has not made life more precious—that would make it seem like something fragile to lock away in the cupboard. No, it has made it more delicious”.

The Assisted Dying Bill could deprive some terminally ill individuals and their families of this very important time of shared love and wonder. I urge noble Lords to resist it. This is far too complex and sensitive an issue to be rushed through Parliament and decided on the basis of competing personal stories. It may be better if a royal commission were to look at this, with members from both sides not appearing as if they were shouting across the banks of a river.

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10.40 am

Baroness Jay of Paddington (Lab): My Lords, I rise to support my noble and learned friend’s Bill. I see it as a tightly focused and compassionate Bill, which will clarify the incoherent legal framework we have heard about today. It is more than 20 years since I first debated assisted dying. Since then I have sat on two Select Committees on this matter, visited the Dignitas organisation in Switzerland, and observed the Death with Dignity Act in Oregon. I have learnt a great deal from those experiences and my views have evolved and strengthened over that time.

I am today absolutely committed to the provisions in my noble and learned friend’s Bill. It has a narrow, specific focus on the terminally ill; it contains strict upfront safeguards and eligibility criteria; and it is an entirely appropriate measure for this country to adopt. My opinion has been reinforced by many personal approaches urging us to pass this Bill. Over my years in this House, I have been the object of many lobbies, as I know others have, but this has been totally different. Many of the individual stories are very hard to hear and difficult to read. My most recent correspondent, just this week, watched his wife die only a few days ago. He writes:

“She struggled with the vestiges of living … All she sought was peace and the law forbade it. How can that possibly be right?”.

Testimony like that makes it difficult to understand how anyone can reject a measure based on the reduction of human suffering.

However, I want to emphasise the constitutional significance of our proceedings. I have just stepped down after four years of holding the privileged role of chairman of your Lordships’ Select Committee on the Constitution. That position has emphasised to me the central role this House plays in the significant part we take in scrutinising the detail of legislation. It is our most important constitutional function. If we look at the Bill from that perspective, it would surely be a gross dereliction if we did not pass it beyond today’s Second Reading towards the close, dispassionate and detailed analysis it needs.

Of course, our duty to give the Bill proper consideration has been spotlighted by the findings of the Supreme Court. It is worth, even in this short debate, mentioning just some of the points it made. The justices unanimously held that the United Kingdom must decide whether the current law on assisting suicide is incompatible with Article 8 of the European Convention on Human Rights—the right to private life. In other words, it is not an imposition from the European Court. A majority of the court held that they had the constitutional authority to make a declaration that the general prohibition on assisting suicide was incompatible with Article 8. Two of justices were prepared to make that declaration then, but the others declined to do so, taking a view that Parliament should be allowed to debate the issue, as we are doing today.

The noble and learned Lord, Lord Neuberger, President of the Supreme Court, said:

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“Parliament now has the opportunity to address the issue … if it is not satisfactorily addressed, there is a real prospect that a … successful, application for a declaration of incompatibility may be made”.

He was saying that we could face an extraordinary impasse, whereby the Supreme Court has ruled that two of our important pieces of our law are incompatible. Presumably, that would then lead to very rapid, hasty legislation being introduced—an unsatisfactory situation.

The fundamental understanding of our unwritten constitution is that Parliament is sovereign. The judges, however wise and authoritative, do not make the law; Parliament does. We have before us a timely and considered Bill; we have the opportunity to act and we must do so.

10.45 am

Lord Purvis of Tweed (LD): My Lords, I am conscious that I am a new Member of your Lordship’s House, but it is now 10 years since I proposed my Private Member’s Bill in the Scottish Parliament to amend the law in Scotland to allow a capable adult in the particular circumstance of coming to the end of terminal illness to access the means to die with dignity. The Bill of the noble and learned Lord, Lord Falconer of Thoroton, is in identical terms, with the same safeguards and only minor differences, given the differing legal jurisdictions in Scotland and the rest of the United Kingdom. For example, the 1961 Act has never applied in Scotland, and the law of culpable homicide would apply. In turn, both were informed by the law in the state of Oregon, which has now been in operation for 17 years.

I therefore strongly support the noble and learned Lord’s Bill, but in doing so acknowledge its scope only for England and Wales, and hope that progress for reform can similarly be made for Scotland in the Scottish Parliament, where even prosecutorial guidelines such as those that apply south of the border do not exist.

It is of sadness to me that in those 10 years some people who have come to the end of their terminal illness have endured their final days in a manner they did not want, with needless additional distress for them and their loved ones. Indeed, between debates in the Scottish Parliament for my proposal, a close friend and mentor of mine—a deeply religious man who had overcome disability for many years—endured that exact circumstance and would have availed himself of the reformed law in his last week, had it been open to him; instead, food and hydration were withdrawn.

In those 10 years in Oregon, a state not too different in size to Scotland, 907 people asked for medication to be prescribed to them under law so they could take it in the final days of their life, if they so chose; 581, or less than two-thirds, did so. Since the law came into operation in 1997, the number of people using the lethal medication in their last days has ranged between five and 22 deaths per 10,000. The median time between someone who made the formal request under the law and then using it was 47 days.

What does this 17-year history show us? There has been no slippery slope. The legislation allows someone to ask for the medication and have the knowledge that

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it is there should they need it, and should they choose to take it. A third never did but their final days were comforted and eased by the knowledge that they could have done so. It also shows that the medication is used when the patient is really towards the end of their life, in their final days. It is not a law that has been abused; it is not a law whose scope has been widened; and it is not a law that has had a damaging impact on the palliative care fraternity, medical profession, vulnerable people or disabled people, because it is about the choices that an individual can have at the very last days of their life, with legal protections, oversight and transparency in operation.

Among other research, I spent a week in Oregon, and have retained links since, speaking with families, doctors, palliative care workers, academics, lawyers, the police, the regulators and the public. That and the continuing very close interest I have taken in the past decade have given me the confidence that if we want to change the law in this country, then we have the capacity and ability to do it well. I simply do not agree with those who say we have the capacity to legislate for profoundly complex ethical issues on birth, stem cell research, withdrawing and removing treatment, food and hydration, mental capacity, or “do not resuscitate” classifications, but we cannot do so on this issue—the final days of a terminal illness.

I found that many people criticised my Bill not for what it was, but for what they claimed it to be. I suspect the same applies to the Bill of the noble and learned Lord, Lord Falconer. It is not about suicide, or vulnerable people being pressured into suicide, or about disabled people having any other consideration than abled people. But this is indeed a profound area to debate, touching on emotion, faith, medical ethics and personal choice and autonomy. A balance needs to be brought to all those issues, within the cold operation of the law; but after a decade of work in this area, and consideration of all aspects of it, I believe now, more than ever, that it is the duty and appropriate time for Parliament to conduct calm, confident lawmaking with evidence-based judgments. We temper that with a thread of humanity and compassion, and we should draw the conclusion that it is right that this Bill progresses.

10.49 am

Baroness Greengross (CB): My Lords, I have worked with and for older people for more than 40 years and spent six as an equality and human rights commissioner. I have been very fortunate in having conversations with many hundreds of older people. In this day and age, fortunately most people who die are older people. What they really want is to remain being treated as adults, not as lesser individuals. I want to know why a small number of people who become incapacitated lose the right to the freedom of choice that most of us have when we come close to death.

I would like to be clear that the Bill is not a case of giving someone a new right. It is just the opposite. Without it, at its most basic, we are going to deny certain people who are terminally ill and have become disabled the right that every other adult has in this country: the right to terminate their life. If people are

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worried that there may be, in some few cases, undue pressure brought to bear on some people to end their lives, my view is that this happens a long time before the Bill would be considered. However, if there are worries, I share them. I do not want anybody to be abused, to be forced to think they must die. Our real goal is to ensure that sufficient safeguards that make people feel easier with the Bill are put in place in Committee; it is not to deny a few people the rights that everyone else in this country enjoys. I do not want it on my conscience that I have denied somebody who has become physically incapacitated and cannot endure their suffering any longer, but is unable to terminate their life without some help, the right that everyone else enjoys.

I do not deny that palliative care has become extraordinarily effective in many instances—in fact, most instances—where people have access to it. More and more people are going to put their faith in it. That is right. However, if people have had enough of suffering, for whatever reason, they should surely have the right to that choice. The Bill is not about a small number of malevolent people trying to pressurise those who are vulnerable; it is about a small number of people, near to death, sometimes dying in agony.

As I said, there is much work to be done in Committee to ensure that any further proper safeguards are put in place. I want that; I am sure all noble Lords do. The sooner we get started, the sooner we can once again hold our heads up high in the fight for true compassion and against any discrimination.

10.52 am

Lord Wigley (PC): My Lords, I support giving the Bill a Second Reading. This is clearly a most difficult issue, in which we have to balance the sanctity of life with the freedom given to us as individuals to make choices. We have to balance the fears some hold about the abuse of any new provisions in the Bill with the real suffering experienced by thousands of people, so graphically described in so many letters they and their families have written to us. We have to deal with the present imbalance, whereby those lucky enough to have the material resources and family support can go to Switzerland to end their lives, whereas those without the resources or family support have to struggle on from day to day, suffering pain and anguish with no means of relief in their reach.

The existing prohibition on medical assistance to die causes some terminally ill people to take matters into their own hands, without adequate support, and some relatives to risk prosecution for helping a loved one die. The Bill would bring clarity to the law and provide greater certainty for terminally ill people and their loved ones.

The Bill has strict safeguards and eligibility criteria. People who are not mentally competent or terminally ill, such as disabled or older people who do not have a terminal illness, will not be eligible. A few weeks ago, the Supreme Court issued a clear warning to Parliament that, if it does not address the issue of assisted dying satisfactorily, the courts could. It is therefore vital that the Bill is allowed to progress through today’s debate and on to Committee stage, where it can be dealt with on a clause-by-clause basis.

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There are of course dangers of abuse and there must be safeguards against the ultimate abuse of vulnerable people in their weakness, disability or old age feeling the pressure of relatives to bring about their own end for ulterior motives. However, in the Bill we are dealing with individuals who are already confronting their own deaths within months. Consequentially, families will also be aware that their support will be required for only a limited period of time.

Noble Lords may be aware that disability issues have been high on my agenda throughout my parliamentary career. I am clearly uneasy if this legislation causes anxiety to some disabled people. I emphasise only that the Bill is geared not to disability, but to terminal illnesses, which generally are totally unrelated to disability. If a blind person, a deaf person or a person who is wheelchair-bound comes into the ambit of the Bill, it is not because they are deaf, blind or cannot walk. It is because they have a condition from which they will die within months.

If further safeguards are needed, let us examine them in Committee. Let us not kill off the Bill today to close off the possibility of improving it. The prospect the Bill offers is to provide to those who wish it the possibility of a dignified death in their own homes with their loved ones around them, not the bleak alternative of going to a foreign country to a lonely death in strange surroundings. Compassion must surely demand that we do better than this.

10.56 am

Lord Tebbit (Con): My Lords, no one could dispute the good intentions of the Bill, but the road to hell is paved with good intentions. We have to be careful of the words we used. I noticed that the noble Baroness, Lady Greengross, referred several times to the “right” that we all have to take our own lives. We do not have that right; we have only the capacity to do it.

I will not repeat many of the points so well made by other speakers, but I am concerned at the financial incentives to end the lives of the frail, the handicapped, the ill and the elderly. They—or perhaps I should say, looking round the House, “we”—are a financial drain on our families, on pension funds, on the health service and, indeed, the economy generally. I and my wife—who, as the House will know, was crippled almost 30 years ago by IRA/Sinn Fein—have seen a lot of this. The Bill would provide a route to great savings in public and private expenditure, and to a great pressure on the elderly, the sick and the disabled to do the decent thing and cease to be a burden on others. Those who care for such people are all too familiar with the moments of black despair that prompt those words, “I would be better dead, so that you could get on with your life”.

Of course, supporters of the Bill say there is an effective barrier in it against such pressures. Two doctors must certify that the individual seeking help to commit suicide has fewer than six months to live and is of sound mind. Late last year, the Daily Telegraph exposed the doctors who performed sex-selective late abortions. We now know that there are doctors who pre-signed wads of blank certificates without even knowing the names of the women concerned, certifying, without

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seeing or knowing who they were, that their health would be at risk without a late abortion. The CPS left it to the BMA to deal with those doctors. The BMA did nothing. Will there be doctors pre-signing the certificates prescribed by the Bill? What will the sanctions be against those who do so?

Lastly, a few months ago an elderly lady asked me to advise her how she could ensure that her wish to leave all her assets to a charity for ex-service men and women could be entrenched against any attempt by other would-be beneficiaries to override it. “You see”, she said, “I have no children but I have several vultures awaiting my death”. This Bill will be a breeding ground for vultures, individual and corporate. It creates too much financial incentive for the taking of life.

11 am

Lord Joffe (Lab): My Lords, although I have introduced four previous Bills on assisted dying to this House, there is nothing I wish to add to the powerful and comprehensive speech of my noble and learned friend in favour of a change in the law. Rather, I will focus on the evidence underpinning the case for a change in the law and the lack of evidence—I underline the word “evidence”—underpinning the concerns of opponents to such a change.

While there can be no direct evidence in the UK as assisted dying is unlawful, the experience in Oregon, upon whose legislation the Bill has been modelled, is persuasive in that over 16 years there has not been a single prosecution for abuse of that law. The evidence for this is 16 detailed annual reports by the Oregon Health Authority in relation to the Death with Dignity Act, which is the model upon which our Bill is based. Among many other matters, these reports demonstrate what has already been said: that there has been no slippery slope, with the number of assisted dying deaths after 16 years being 0.2% of total deaths, or one death in every 450; that there has been no widening whatever of the legislation; that 97% of assisted dying patients died at home; and that 90% were enrolled in hospice care.

The evidence in Washington under the dignity in dying legislation shows a similar pattern. In Switzerland, arguably the most conservative country in Europe, lawful assisted dying has existed for 60 years. The incidence of such dying is similar to that in Oregon, being between 0.3% and 0.4% of all deaths. The overwhelming majority of Swiss citizens support the law as it stands, and a recent attempt there to change it was decisively rejected.

In the light of that evidence, it is incumbent on the opponents of the Bill to explain why they believe that a law which works so well elsewhere will not work equally well in the UK and to show what evidence they have for contending this. In that regard, I respectfully suggest that repeated assertions of conjecture or strongly held personal opinions are not adequate substitutes for statutory and objective, carefully researched evidence.

The Bill’s opponents frequently raise the issue of mental capacity. The law in relation to the right of people with mental capacity to make decisions on their own lives was endorsed in a fine judgment by

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Dame Elizabeth Butler-Sloss, as she then was, in the 2002 case of Miss B v an NHS trust. The judgment read:

“A mentally competent patient has an absolute right to refuse to consent to medical treatment for any reason, rational or irrational, or for no reason at all, even when that decision may lead to his or her own death”.

The learned judge added the following:

“There is a serious danger, exemplified in this case, of a benevolent paternalism which does not embrace recognition of the personal autonomy of the severely disabled patient”.

It would seem that many of the caring and compassionate opponents of assisted dying are influenced by the same benevolent paternalism that was raised in opposing Miss B’s wish to end her life. It is clear that the law, if it were changed, would mean that elderly, frail and physically disabled terminally ill patients who are mentally competent would have the same right to make decisions on their lives as other terminally ill patients.

It is of course essential to seek to protect all terminally ill patients from pressure by others to end their lives. This is specifically covered by the safeguard in the Bill that requires that both assessing doctors must be satisfied that the informed decision is voluntarily made.

The Bill is not a radical innovation in UK law. It follows naturally from a development of our law which allows mentally competent patients to refuse medical treatment, where doctors can refuse to treat dying patients whom they judge they cannot help, where doctors are obliged at the request of a mentally competent patient to disconnect the patient from the life-support equipment which is keeping the patient alive, even though this will lead to the death of the patient, and where those who under the DPP guidelines assist terminally ill patients to die for compassionate reasons will not be prosecuted.

In conclusion, there is one question in the 11 years that I have been working on assisted dying which has not been answered. That question is: what answer do the opponents of this Bill propose should be given to mentally competent, terminally ill adult patients for whom palliative care is not the solution and who appeal to their loved ones for assistance to end their suffering by ending their lives?

11.06 am

Lord Avebury (LD): As a Buddhist, I recognise that this Bill contravenes fundamental Buddhist beliefs in the inviolability of human life, but there is also the Buddhist principle of compassion, which I think applies in the extreme circumstances of distressing terminal illness. That, it seems to me, weighs heavily in consideration of this Bill and is partly what has persuaded me to support it. I believe that the same is true of many other people of strong religious faith, both Buddhists and Christians. They believe, as I do, that helping people who are suffering from distressing terminal illnesses outweighs the principle of inviolability of human life.

We also have in front of us, as has been mentioned, the DPP’s current guidelines on cases of “encouraging or assisting suicide”, which maintain that in certain circumstances a person should not be prosecuted for helping someone to die. We have the Supreme Court’s

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ruling, which has been referred to by several noble Lords, that the Bill should be given a Second Reading so that the issues it raises can be properly and thoroughly discussed, as was recommended by the Select Committee on the Bill of the noble Lord, Lord Joffe, as long ago as March 2006. I hope that the opponents of assisted dying will respect the Supreme Court’s clear message that safeguards and checks at the time of a person’s decision to end their life are better than our present system, under which any inquiry happens only after a person’s death.

There is also the opinion of a large number of people in this country—80% according to one poll—reflected by the Times, the Guardian, the Observer and the Evening Standard, that Parliament cannot duck responsibility for considering the plight of terminally ill patients whose suffering cannot be relieved by palliative care in the final weeks of their lives. I recognise that palliative care is effective in the large majority of cases of terminally ill patients, but it is not effective in all. There are still many for whom the final weeks are ones of severe pain or distress, and that is why many patients look towards the end of their lives with dread.

Like many of your Lordships, I have had letters from patients who are in constant, severe pain which treatment cannot remedy. It is a great source of worry to them that, in the last six months of their lives, they may be forced to live in terrible pain and discomfort. Others write to me about relatives who died recently from inoperable brain tumours, for example, but not before they had been forced to suffer several weeks of intense physical and existential pain before finally achieving unconsciousness. There is plenty of evidence to show that modern drugs and care are not always able to control or alleviate pain at the end of life.

I declare an interest. In June 2011, I was diagnosed with myelofibrosis, a rare form of blood cancer, which can be cured in fit patients only by stem cell transplants. For patients older than 70 with poor medical histories, stem cell transplants are not recommended. The prognosis is that either the bone marrow turns to fibre and blood cells are manufactured in the spleen which becomes enlarged, or, in some cases, MF can transform to acute myeloid leukaemia, a serious blood and bone marrow cancer, which progresses quickly. These are unattractive prospects to look forward to in the last weeks of my life. I would expect that, in agreeing to this Second Reading, your Lordships would give the tens of thousands of people diagnosed with conditions that may similarly lead to weeks of torture before they die the means of escape from that unnecessary fate.

11.11 am

Baroness Finlay of Llandaff (CB): My Lords, like many others, particularly doctors who will be expected to be involved in assisting their patients’ suicide, I do not support this Bill. But the Supreme Court has asked Parliament to look at the issue and we should not oppose it at Second Reading. I have worked caring for dying patients for more than 25 years and I have registered my interests.

This Bill has broad categories into which almost anyone can be shoe-horned and it comes within a whisker of full-blown euthanasia. Are there safeguards?

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No, there are only broad categories into which you will find some doctor who would state that almost anyone fits. Let us take a prognosis of six months: there is no accurate test at all. Even a best guess is so surrounded with inaccuracy that the only honest answer to the question, “How long have I got?”, is to say, “I honestly can’t tell”. Even of those thought to be likely to die within 48 hours, about 4% improve and some even go home. But this Bill is not about them or about better care at the end of life; it is about assisted suicide, effectively on request.

Nor is it about a right to die. Everyone will die. If you do not want treatment that might prolong your life, you can refuse it. For those with motor neurone disease on a ventilator who want to stop treatment, we can manage their dying peacefully and gently as they die of their illness. When treatment is withdrawn, it is not withdrawn with the doctor’s intention of bringing about the patient’s death; when lethal drugs are supplied, they are supplied with that intent. This Bill is about licensing doctors to supply lethal drugs to some of their patients and helping them to commit suicide, however long their life might otherwise have gone on for. I have seen the strongest people, including politicians and senior doctors, be the most vulnerable when facing dying—vulnerable to coercive influence and vulnerable to their fears. The role of my profession is to address those fears and to support those people, not to encourage them, even silently, to believe that they should foreshorten their lives.

Today’s doctors are worn down by workload. They do not know their patients in detail. They know only what they are told in a brief encounter. They cannot possibly detect coercion from family. I cared for a lady whose family we all believed were loving but they stopped visiting as much once her fixed-term life insurance expired. What about subtle coercion from staff attitudes that are negative or instil hopelessness?

The signature of a second doctor provides no assurance. Who is going to find this second doctor? He or she is likely to be known to the first doctor as someone who sees physician-assisted suicide as a reasonable response to severe progressive illness. Let us not forget that Dr Shipman’s 176 cremation forms were all countersigned by a second doctor.

Of course, palliative care does not have a magic wand to make everything right. Nothing in medicine has 100% success. Even assisted suicide sometimes fails to kill. But we do not kill patients with morphine properly prescribed to relieve pain, or with nerve blocks or other interventions. The Francis report showed how bad care can be. The well intentioned Liverpool care pathway failed: it became just another tick-box exercise. That is what this will be—a set of forms to be filled in, without proper scrutiny of the assessments, the processes and the administration.

Those of us at the sharp end who care for terminally ill patients day in, day out know that the real work of assisting someone to die is not just something on a to-do list. It calls for good care, dedicated support and time, and not the quick fix of offering the medical equivalent of a loaded gun.

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11.16 am

Lord Mawhinney (Con): My Lords, we are all indebted to the noble and learned Lord, Lord Falconer, for introducing this Bill. I say that as someone who is not in favour of it and will do his best to see it amended and subsequently defeated. He is right to identify the fact that this is now a major public issue that needs to be taken seriously and to be resolved. I came much later than he did to the view that this Bill should go into Committee. I initially thought that we should take care of it today, but I am persuaded that it should go to Committee stage to be examined. The danger of this Bill lies in the detail, not in the generality.

Not for the first time, my noble friend Lord Tebbit and I have similar thoughts. When I read about the safeguards and how important and how good they would be, my mind also turned to abortion and the 1967 Act. Exactly the same arguments were deployed then as are being deployed now in relation to doctors. In that case, seven grounds had to be used. The Library tells me that in 2013 there were 185,000 abortions in England and Wales, and that 36% of them were not for the first time. As regards the six months proposal, my mind turned to the Lockerbie bomber.

We have twice been told that more than 70% of the public think that this is a good idea. But we have not yet been told that in the very same polls, 47% thought that it would lead to abuse of elderly and people who are dying. That abuse led me to my second thought. I will not repeat stories from letters that we all have received, except for one paragraph from a lawyer, whom I do not know, who suffers from multiple sclerosis. He wrote:

“Vulnerable people, especially those with progressive conditions, can feel a real burden on the people around them. Diagnoses can be very frightening and isolating. Such individuals will undoubtedly feel pressure to end their lives if Parliament decides to pass this Bill”.

Last year, my beloved mother died. She spent the last 18 months of her life in a home. She died of Alzheimer’s and increasing dementia. She kept telling us that she was a burden. I like to think she did that in the confidence of knowing that our love for her was such that, however big the burden, it was but nothing compared to the love that we shared, and had shared, throughout all our lives. I thought to myself, if my mother thinks she is a burden, in her context and with the love of her family, how many others will think that they are burdens and will not be met by similar support and love?

The one thing that is missing from this debate—and I was glad the most reverend Primate the Archbishop of York spoke about it—is that there is no philosophy of life in this Bill. I am a Christian. I have always tried to take my faith seriously. I believe that life stems from and is a gift from God, and that this belief, widely shared, should govern our views on the end of life as it pervades the thoughts of many at the wonder of birth.

11.20 am

Lord MacKenzie of Culkein (Lab): My Lords, I am sorry that I am unable to support the Bill in the name of my noble and learned friend, although I know that it has been introduced from the very best of motives. I

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speak as a nurse who has been on the nursing register for some 39 years. It is some time since I practised, but I have spent a good deal of my working lifetime representing nurses and nursing. Of course, nursing has changed in that time; social attitudes have evolved since my first entry into nursing as a student nurse. But I am clear about this: what has not changed is the ethical basis and ethos of nursing.

I have always understood the central tenet of nursing to be duty of care—about promoting and maintaining health, preventing and/or treating illness and injury and helping patients to recover and, where that is not possible, giving the best quality of life until death. I do not believe that giving the best quality of life until death can include the nurse delivering and assisting the patient to ingest a lethal lytic cocktail on the authorisation of an attending physician.

Doctors are busy people with time at a premium. It is nurses who are with patients for 24 hours out of 24, so it likely to be the nurse who would be, in the words of the Bill, the “assisting health professional” duly authorised to carry out the function of actually assisting the death of the patient by preparing these lethal drugs. I hesitate to use the word “medicine”, which is in the Bill, because medicine, if my Latin is any good, is something to do with healing and not death. The nurse would prepare the medical device, load the syringe driver or, as the Bill says, assist the patient to ingest.

The Bill tries to give safeguards by saying that the final act of self-administration lies with the patient. How will a patient with motor neurone disease who cannot swallow and cannot move their arms because they are paralysed carry out that final act? They will not. They are excluded from the Bill. So the compassion, which we all share, is selective. It does not apply to all people with serious, progressive neurological conditions, for example.

I do not want nurses to be in a position where in the course of their normal duties a patient might say—it could be said as a joke, but it might be said seriously out of concern by a vulnerable patient—“I hope, nurse, you’re not one of these who assist dying”, or perhaps in the more vernacular, “I hope you’re not one of these who bumps people off”.

Many in the medical profession say, rightly, that assisted dying facilitated by a physician will fundamentally alter the patient/doctor relationship. In my opinion, that applies in exactly the same way to the nursing profession. I see any legislation based on the Bill as leading inexorably, maybe a long time in the future, to assisted suicide as a right rather than an exception. We have heard about slippery slopes. I am sure that the noble Lord, Lord Steel of Aikwood, when introducing the Abortion Bill in 1967, said many of the same things that have been said today. Now we see how society has evolved and that position has changed.

If that happens in this country to the public perception of assisted dying, it could follow that there will be seen to be a duty on nurses and doctors to be involved. That is not something that I want any part in facilitating, conscience clauses notwithstanding. This is an enormously difficult area, but there are too many unresolved issues at the heart of the Bill, not the least of which, as it is

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presently drafted, is that it would lead to nurses being in serious contravention of the Nursing and Midwifery Council code.

Given the intervention of the Supreme Court, there is a powerful argument, despite what my noble and learned friend has said, for a royal commission to take a long, hard look at this issue before it returns to Parliament. For those reasons, not the least of which is the potential for serious damage to the ethics and ethos of nursing and the public trust of nurses, I regret that I cannot support the Bill.

11.25 am

The Earl of Glasgow (LD): My Lords, I have long been involved in the campaign to see assisted dying legalised, but I am reluctant in this time-sensitive Second Reading debate to repeat the arguments that I made in earlier debates. Rather, I have chosen excerpts from three of the many letters that I have received from the public, which put the case for assisted dying far better than I can.

A lady GP called Jane Robson said:

“I have been a GP all my working life … I have seen and welcomed the development of palliative care, the Hospice movement, and the improved drugs and facilities available for the care of the dying. However the fact remains that for some people the process of dying is still horrific. It is not just a question of pain, but the slow decay of the body—the bedsores, the ulcers, the intolerable itch, the failure of the gut, the liver, the kidneys, with all those attendant miseries, not to mention the loss of autonomy and dignity. Many people, who have seen a relative go through this, wish that the sufferer had had some choice at the end, and would wish it for themselves in the same situation—I certainly do”.

This is from another lady. She said:

“Should my health deteriorate, and I become terminally ill, I dread, not only the physical suffering I might have to endure, but also the emotional suffering my family would have to bear, in order that the law, as it currently stands, is adhered to”.

She continues:

“If this Bill is passed there will be fewer dying adults, and their families, having to face unnecessary suffering at the end of their lives. It will also allow mentally competent adults, like myself, or for that matter, any member of my own family, to request life-ending medication from a doctor, which they would self administer at a time of their own choosing … I would like to re-iterate, above all, that this Bill will give dying adults like myself, peace of mind that the choice of assisted dying is available. That I, myself, will not have to continue to live daily in dread of the suffering that I fear the most”.

I have one final letter, if I may. It states:

“I know that I, and numerous others, will feel much happier and confident to know that we are able to decide when to end our own lives should we become terminally ill. I believe no more people will die because of a change in the law but far fewer will suffer unnecessarily. It is a tremendously important Bill and I believe is supported by an overwhelming majority of the public”.

I could not put the case better than any of those three ladies.

I get very angry when those who oppose the Bill misrepresent what it is actually proposing and fail to mention how limited its aims intentionally are. It applies only to those who are already terminally ill yet still in sound mind who want, as we all surely do, some control or say in the manner of their own death. It has nothing to do with coercing vulnerable old people into killing themselves. Yet our opponents use emotive

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words such as “legalised killing” or “euthanasia” and talk about this being a slippery slope that could lead to the eventual demise of the frail, disabled or mentally ill. No, it does not. No, it is not. The Bill is about personal choice and the alleviation of unnecessary suffering—the choice to decide how, where and, to a small extent, when you want to die.

Finally, it is worth pointing out, as my noble friend Lord Purvis of Tweed has done, what has been demonstrated in those countries and American states that allow assisted dying. When a dying patient has the peace of mind of knowing that he has the option of an assisted death, only one in three actually takes the pills that will put an end to their suffering. The will to live, we must remember, is very strong. The Bill is not pressuring, encouraging or inviting anybody to die. It is giving them a choice that they do not have at present.

11.29 am

Lord Blair of Boughton (CB): My Lords, I declare the interest that I was a member of the commission of the noble and learned Lord, Lord Falconer, on assisted dying. I agreed with its findings and I support the Bill.

I will talk in my short time about the commission. First, this was a comprehensive inquiry, which took evidence for 18 months. It ended with a comprehensive report, which is over 300 pages long. It is therefore a little unnecessary to suggest that we need another royal commission. Secondly, it is worth remembering that, while not being the complete answer to the principle objected to by some, every proposal in the Bill is voluntary. It is voluntary for those who wish to die; it is voluntary for those who wish to assist them, whether or not they are healthcare professionals. Thirdly, in the visits that the commission paid to Oregon, which is the only equivalent jurisdiction with an equivalent law, we found evidence neither of a slippery slope down to involuntary euthanasia nor of the elderly being pressured. Fourthly, the Bill is particularly well circumscribed. It does not include anything to do with those without mental capacity to make such a decision, nor does it include those who are disabled, however fundamentally, but who are not dying. One of our commissioners, who signed up to the report, was Dr Stephen Duckworth, himself a disabled campaigner and a person suffering from serious disability. Fifthly, that means that the Bill is aimed at the very small number of people who are dying, who are unable to kill themselves and whose pain cannot be treated.

One of the people who came to give evidence to the commission was Dr Ann McPherson, an Oxford GP and founder of Healthcare Professionals for Assisted Dying. She died of cervical cancer before the report was published. I would, with a heavy heart, recommend that noble Lords Google or look at her daughter Dr Tess McPherson’s account of her mother’s death; it is in the British Medical Journal. Ann had access from the inside of the profession to the best that medicine could provide to ease her passing. It could not. The account of her death is harrowing, shocking and—bluntly and sadly—quite disgusting. It is the compassionate aim of the Bill to prevent others from dying so badly.

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Others are better qualified to speak about those kinds of points. I want to talk about one part of my own expertise. For as long as the law remains unchanged, as I said in a debate last December, while prosecutors may have guidance that makes the prosecution of assisted suicide unlikely, each such death means a police investigation. The house will be a crime scene: tents, officers in forensic clothing, photography and the seizure of computers, last letters, presents and bank statements. This is a homicide scene and it is immensely distressing for those left behind. The funeral will be delayed for a post-mortem. Relatives will be faced with months of anxiety, waiting for a prosecutorial decision. It is also an extremely unpleasant task for the police and an entirely unnecessary one.

Thelma Stone is a friend of a friend. She recently wrote to me about the death of her husband Alan, who was terminally ill with motor neurone disease and took his own life. Your Lordships may think that she puts this rather mildly:

“One feels a certain loneliness on top of the bereavement when one is treated as a potential criminal at such a painful time”.

At the end of “King Lear”, Kent says of the dying king:

“O, let him pass! He hates him

That would upon the rack of this tough worldStretch him out longer”.

It is not just the dying but their relatives and friends who need to be released with compassion and safeguards from the rack of these kinds of awful deaths.

11.33 am

Lord McColl of Dulwich (Con): My Lords, one of the essential issues raised by the Bill is whether it is possible to amend the law to relieve the distress of someone who wants assistance to end his or her life, while at the same time providing adequate protection against the foreseeable dangers that will arise as a direct result of such an amendment. I shall focus on three such dangers.

First, there is the risk that one might create a society in which the vulnerable, the dependent and the weak believed that they had a duty to die. Such people may convince themselves that they wished to end their life when they would not otherwise have done so. I do not believe that one can legislate away this risk. It takes time and effort to look after someone who is seriously ill. Even when it is time and effort willingly given, the person who is ill may feel that he or she is a burden to others and to society at large. It is but a small step for that person to feel that he or she ought not to go on living and should request assistance in dying. I cannot support legislation that is likely to create a society in which the dependent and the sick feel a subtle pressure not to go on living. A duty to call for assistance in dying may sound far-fetched now and it is not what the supporters of this legislation intend to create, but it is, in my opinion, an unintended consequence of changing the law as proposed. The proposed safeguards against this are inadequate. It is all very well to refer to,

“a clear and settled intention to end their own life which has been reached voluntarily”,

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but just how voluntary is such an intention if it is induced by a perceived duty to die? Words such as “coercion” and “duress” are insufficiently nuanced to protect against this danger.

Secondly, there is the risk that the bond of trust between the doctor and the patient is weakened or destroyed. The bond of trust is easily broken and, once broken, is not easily restored. At present, there is a clear rule. The doctor’s duty is, above all, to do no harm. The medical team is trained always to care and never to kill or assist in killing. That trust will be undermined when assisting in death comes to be regarded as just another treatment option, which is the effect of the Bill.

Thirdly, there is the risk that the boundaries set by the Bill will prove to be logically unsustainable: the “slippery slope” argument. The safeguards in the Bill are not safe; they are defective. They are the equivalent to first aid boxes in a lifeboat that turn out to be empty. It is instructive to learn from the legislation of safeguards in other areas of life. Section 14 of the Factories Act 1961 says:

“Every dangerous part of any machinery … shall be securely fenced”.

This was replaced by the Provision and Use of Work Equipment Regulations 1998, which require that dangerous machinery shall have guards and protection devices that must,

“be suitable for the purpose for which they are provided … be of … adequate strength”,


“not be easily bypassed or disabled”.

The safeguards in the Bill fail each of those requirements. For all these reasons, I urge the House to reject the Bill.

11.38 am

Lord Mawson (CB): My Lords, it is good that we are having this debate today, but I am afraid that I cannot give the Bill my support. I will set out a few reasons why.

First, the Bill seems to assume that we live in a rational world and that families and individuals can be trusted to behave in a rational manner and make rational decisions when faced with the trauma of losing a loved one in the circumstances that the Bill describes. As a jobbing clergyman who has spent the past 35 years of my life working with probably some of the most vulnerable families in this country, and who has presided over what must be hundreds of family bereavements and funerals, which have been both a great privilege and a responsibility, I know from experience that reason and rational behaviour are often not what we are dealing with in crises like these. Individuals and families say and do many things when they are vulnerable, which they regret later but at the time seem all too clear.

Anomalies exist which show that people change their minds over whether they want to live or die. The body often needs time to adjust to severe injuries and illness. An intelligent debate has to acknowledge these anomalies. Life is not a simple process of rational judgement and behaviour—far from it. It is very complex.

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In writing this speech, I am conscious of a number of people who have relayed their family stories to me in recent weeks. I think today of the young Bengali man who faced a moment such as that which this Bill seeks to legislate for. Life seemed to be at an end; the illness he was diagnosed with and the prognosis seemed at the time all too clear and he wanted to die. However, because of the present legislation, time was on his side. Only months later he made a considerable recovery and today lives a good life. Those who say they want to die are always profoundly tied up in a complex set of social, cultural and family relationships, and pressures that an outsider will have limited understanding of.

I always tell people who do not come from Yorkshire that to understand us, you have to be one of us—or forget it. Imagine a western doctor trying to understand the inner emotions and family conversations taking place with this Bengali man. I have worked with this community for 30 years and am still struggling to understand the inner workings of another culture I am not a part of. Are we saying in this case that it would have to be two Bengali doctors who make the decision and, if so, which bit of Bangladesh would they be expected to come from? Could we be certain that there would always be a Bengali doctor on hand? Indeed, if there was, how would we test what family connections there were and what family conflicts there had been in the past that the doctor might be unintentionally connected with? This is all subtle stuff for all of us, often unspoken and a can of worms. All our family cultures are a can of worms. What training do our doctors have to be able to demonstrate this wisdom of Solomon in our inner cities when we live in multicultural communities? When faced with a human circumstance like this, they will simply see the world through a biomedical prism. They will be unsighted, I suggest, on nine-10ths of the human picture that will affect the decision.

Secondly, we tend to have a blind faith that doctors and social workers will protect the vulnerable, yet we are given daily examples where we are failed by specialists. It has been my great privilege over many years now to work with some very good and trusted doctors, but it has also been my lot to have to sort out a number of doctors who were not trustworthy—indeed were downright dishonest—and had other agendas on their minds than that of the patient. Doctors are not gods, they are people, and the culture of the NHS is very prone to taking simple legal safeguards and slowly, over time, building a whole culture around them that has many unintended consequences. I have buried people who paid the price for this incompetence and cultural malaise. The health service is in some chaos at the moment, with healthcare professionals rushed off their feet, and the idea that doctors will have the time, let alone the competence and space, to deal with these very challenging matters properly seems fantasy to me. How will this work in practice in the present climate in the health service?

Finally, so much of this debate has been about, “Me, me, me; my rights, my life, my choice”. Yet we human beings are fundamentally social creatures; we are not islands floating aimlessly in a sea, but are part of a family, a community and a culture. What we do as

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individuals has profound rational and irrational affects upon us all. Human beings can achieve great things, but we can also behave like sheep, and once the herd starts to move on this it may well move together and we will not be able to stop or fully understand its inner logic. The people who will pay the price will be not the well meaning but the vulnerable.

11.43 am

Baroness Warwick of Undercliffe (Lab): My Lords, I put my name down to speak in the debate as the scope of the Bill, because it is so limited, seems to address a real need and to be an important step forward in the process of thinking as well.

Like many other noble Lords in the debate, a personal experience has influenced me. The process of my mother’s death gave me a firm commitment to the right of patients to full disclosure of information about their illness and to the right to choose how and in what way they will be treated. I do not use my mother’s case in support of the Bill—I do not know what she would have chosen had she been fully informed—and can bring only my own convictions to this debate.

During the attempt of the noble Lord, Lord Joffe, to bring in legislation in 2005-06, I was very struck by a comment from a colleague from these Benches whom I greatly admired, Nora David. She said:

“As somebody aged 92, I think it is patronising for opponents of the Bill to suggest that elderly people are unable to make informed decisions about their lives”.

Like everyone else in your Lordships’ House, I received scores of letters on the subject prior to this debate. They have all been extraordinarily moving, and I was struck by the number that made the same point as Lady David. She also said:

“If I were terminally ill, I believe that I would be the only person with the right to decide how I die and whether I preferred palliative care to assisted dying. It would provide me with an additional option on how to end my life, which I would find tremendously reassuring, whether or not, in the end, I decided to exercise that option”. —[Official Report, 10/10/05; col. 46.]

That had a powerful effect on me. I strongly believe in personal autonomy, and there is no more crucial point in life where that seems relevant than when one is close to death. The letters—all of which I have read very carefully, as I know all noble Lords will have done—show that, for some, the option of palliative care, even when it is excellent, is not what they want.

I appreciate the very real anxieties of many in the House, including many of my friends, about whether there are safeguards for the vulnerable and about fully informed consent. It has taken some considerable time for me to reach the conclusion that compassion, none the less, requires us to act. My noble and learned friend Lord Falconer set out lucidly the terms of the Bill and, in particular, the safeguards that would apply. I felt they were comprehensive, but perhaps they can be strengthened even more as we take the Bill through the House. The decision of the Supreme Court last month set the criteria which we should apply. I have been convinced that this Bill, with its narrow scope and the safeguards it contains, will ensure that the decision about how you die in the context of a final

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illness will be in the hands of the individual concerned, and will give the individual the control that they want over the last days of their lives.

11.46 am

Baroness O'Cathain (Con): My Lords, I believe that a great strength of this House whenever we look at a Bill—we have looked at a lot of them—is that we seem to have a mental checklist of things that we should always take into consideration; an impact statement, in effect. One of the things we always take into consideration is the effect of the Bill, whatever its subject or object, on the population as a whole, particularly on the vulnerable and on those who do not really have the capacity to decide what is the right way of doing things. In my view, this proposed legislation turns that on its head. In effect, there is a grave danger that if the Bill were to be enacted, the vulnerable would be the most negatively affected. We are talking about the vulnerable as if they are the subject and object of the Bill, but we are not going through the effect on individuals.

We know this from the huge number of letters we have received and, indeed, from our own personal experience. Time and again we are moved by these letters, but the thing that shrieks at me from them is whether anybody has done anything about depression. In fact, I do not think depression has been mentioned at all in the debate so far. I have personal experience, both from my own very close personal relationship and from my best friend. Both cases were desperately difficult deaths over the long term—years and months. In both cases, when the victims, so to speak, were actually treated with anti-depressants and given a regime aimed at lifting their hopes, they became much more amenable to friendship, to discussing life and to planning for reuniting with their maker in a way that would not have been possible if they had had this option, three or four months earlier, to say, “I want to end my life”.

Time and again I have read of the serious deep anxiety that many have of the prospect of being a burden. I am sure most of us feel that—I feel that. That is fine, up to a point, but what we have to do is instil a complete change in our attitude to the elderly in terms of realising that they can still, even at the end of their lives, teach us a lot and help us with many things which we will use in the future. What about the effects of assisted dying on those who administer the means, whatever they are, of moving these people on? We had a moving speech from the noble Lord, Lord MacKenzie of Culkein. So far as I could gather, his point was that it is all right for us who do not have to do the deed, but what about the people who do and how long does it stay in their memory?

Polls have already been referred to and, I am sure, will be again. We have had so many polls that we are befuddled. The one result of polls of which I am certain is that people constantly change their mind—even the Guardian today has changed its mind. What really bothers me, however, is that, behind the headline figures, the polls show a shocking apathy. I think that, when people are polled, they do not think of the depth of the meaning behind the question. The ComRes poll

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that appeared yesterday gave the most disturbing result that 47% of supporters of the Bill would still support it even if it resulted in people being pressured into ending their lives early so as not to be a burden. Are we really sure that this is what this country believes?

Let us not forget that the World Health Assembly adopted a ground-breaking resolution on palliative care on 23 May this year. Nowhere was assisted suicide—or its euphemism, assisted dying—mentioned. Instead, the need for greater palliative care and the importance of hospices in end-of-life care were resoundingly echoed by elected health experts from around the world. Not for the first time in your Lordships’ House, I wholly endorse that hope.

11.51 am

Lord Brennan (Lab): My Lords, to make it lawful for doctors to assist people to commit suicide is a profound step. This morning’s editorial in the Guardian said that it would change the moral landscape of our nation. A Bill that proposes this therefore demands, whether you are for it or not, rigorous examination. If one applies that examination at this early stage, the Bill can be seen to be dangerous in its effect.

First, it favours the few invulnerable against the many vulnerable, who may be pressured into it by fears of being a burden, either through physical dependency or financial cost or both. I use those adjectives, “invulnerable” and “vulnerable”, following Lord Sumption, one of the judges in the recent case. He used them in counterpoint to explain the difference between the strong and clear-minded and the weak, depressed, ill and confused. At paragraph 228 of his judgment, in referring to the risk to the vulnerable, he said:

“There is a good deal of evidence that this problem exists, that it is significant, and that it is aggravated by negative modern attitudes to old age and sickness-related disability”.

The problem will surely get worse. Over the next 25 years, people of 60 and above will become 50% of the population of the nation, presently estimated to take up 60% of the National Health Service’s costs. Can it be doubted that the problem that Lord Sumption identified is not going to get worse? Of course it is, both in the individual case and in society, where the cost of living as an old or sick person will be balanced against the treatments of death under these arrangements. We must be realistic. Limited today, it will be extended soon enough if necessary.

Secondly, there is a danger to the medical profession. This Bill dismantles the Hippocratic oath by creating two kinds of doctor: those who will not help you to kill yourself and those who will. I cannot imagine more diametrically opposed medical standards than those. How is it to be resolved within the profession? How can it help public confidence in doctors and nurses?

Thirdly, the Bill is limited in its effect, but the prospect of litigation and further legislation is obvious. The more we are told about autonomy and choice, the more a group of litigants will say to the court, “I want to exercise my autonomy and my choice. Why is it restricted to the terminally ill? Why six months? Why the discrimination between those types of cases and

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me? Look at the Equality Act”—et cetera, et cetera. It will come. The noble and learned Lord, Lord Falconer, has not told us, nor has any of his supporters thus far, what they will do in the future if this Bill is passed. Is this a first step or the last step?

Fourthly and finally, there is a danger to Parliament. If one doubts that it is as serious as I have suggested, look at Clauses 8 and 9. The Bill states that execution, oversight and regulation are given by us to the Executive to devise and implement without reference to Parliament. I find that astonishing.

I accept the misery that can come with illness and the time near to death, but in the 21st century, with all the technology and medical advances that we have, are we driven to the conclusion, in the words of one of the royal colleges, that it is best to be compassionate by eliminating suffering through elimination of the sufferer? Surely we can do better than that.

Legislating for hard cases nearly always produces bad law. In the rigour that we apply to this Bill, let us make sure that we do not make that mistake again.

11.57 am

Lord Birt (CB): In a free, secular society, my Lords, the presumption should be that adults are free to do what they wish, subject only to not impinging on the rights of others.

I can see no reason at all for denying individuals the right to manage their own imminent, irreversible and prospectively painful, wretched or deeply distressing death—in their own interest, and in the interests of the loved ones that they will shortly leave behind.

A civilised society must offer, too, expert advice and support to ensure that the individuals who have made that choice can reach the last and gravest of life’s milestones with dignity and certainty. One part of that advice and support must be to ensure that the individual’s decision is freely reached, without pressure from others; and that it is considered and settled. Of course, honest medical professionals, working voluntarily in these difficult and challenging circumstances, must have legal protection as well as obligation.

This carefully constructed Bill meets all these needs. It vitally extends our freedoms and it has my unqualified support.

11.58 am

Lord Empey (UUP): My Lords, sometimes we perhaps overestimate our ability to bring about events. Everybody wants to see suffering diminished, but this House cannot end suffering. We cannot bring an end to suffering; we cannot bring an end to poverty. Therefore, what is it that we are trying to do? We are trying to help; we are trying to bring, I suspect, the best that we can do in the legislative framework to help the human condition. But we are requiring a specific group of people to do it in this Bill. We are requiring the medical profession in the broadest sense to be the people who implement what is proposed in the Bill.

Two weeks ago today, I had the privilege of attending a graduation ceremony, at which my daughter was graduating in medicine, along with 300 other students. It was a great privilege to see those young people, who

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had put five years of their lives behind the idea that they could go out into the world to help and bring healing to many people for the rest of their lives. Those people have not been taught or trained in how to bring life to an end.

I come from a region where we have seen the long-term consequences of asking a group of people to do a specific job, such as protect the community. Many years later—and we shall see this with our troops in Afghanistan—those people began to show the symptoms of post-traumatic stress. I fear that asking a very small group of our community to carry out something that is almost the very antithesis of what they have been trained for could, in the long term, have serious consequences for those individuals. I just do not believe that it is possible to bring precision, however well meaning it might be, to this situation.

We have 14 days, six months, six days, two doctors and one health professional: what does all that mean? It means that, ultimately, some doctors will specialise in nothing else because so many will not do it. I fear that we have not thought through the consequences for the health professionals who will be at the sharp end of this. However much any of us could face, we do not know what we will face.

It is not only older people who will be affected by the Bill. Many young people will find that they have conditions that become terminal. We must think through what it means for the people we ask to implement this legislation. They will be the people at the sharp end. Have we really thought through the consequences? What will we teach them in university in a few years’ time? What will we be training them for? It will be the opposite of and go against the atmosphere of hope that I was privileged to see two weeks ago. Will we damage that and, ultimately, damage those young people?

12.02 pm

Baroness Blackstone (Lab): My Lords, I congratulate my noble and learned friend Lord Falconer on introducing this Bill. Parliament must have the courage to consider these issues, as the Supreme Court has said. The current law is not working and those who claim that it is are being complacent. The law now needs to be clarified, as others have already explained so well.

We live in a society that promotes individual autonomy and values allowing its members to choose how they spend their lives. We value freedom of speech, of association and of movement. We value tolerance and allowing people to make their own choices, even if we wish to make different choices. The same freedom of choice that applies to how we live should also apply to how we die. If we respect human rights, we should not deny those who know that they are dying the right to bring their lives to a more rapid end to alleviate their misery.

I do not normally talk about my own experience in this House but today I will break my own rule. I have been haunted for a long time by the death of my grandmother, to whom I was very close. Hospitalised with terminal cancer, she longed to die and to escape her agonising pain. She told my mother that she had a bottle of sleeping pills with her, prescribed before she

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went into hospital. The morning after my grandmother died, my mother found the empty pill bottle in her handbag. She had made her decision without being able to talk about it, and taken the pills with no one to hold her hand or comfort her—with no one to say goodbye to—by herself in a hospital bed.

When my former husband was diagnosed with stomach cancer and given six to nine months to live, eventually becoming overwhelmed by horrible pain and terrible discomfort, he was cared for at home by superb hospice nurses, for whom I had the greatest admiration. But it was harrowing for him and for those who loved him. Ten days before he died, he said to me, “I just want this to come to an end”. I asked the health professionals if they could help him to die as he desperately wanted. Of course, they could not.

Those who argue that palliative care can always ensure a peaceful and painless death are flying in the face of the evidence, as I know from my own experience. I greatly admire the doctors who have chosen this specialism, and of course I want to see more patients benefiting from palliative care, but I would admire them much more if they admitted that not everyone can be freed by this treatment from the viciously painful death that they are suffering. It would be more compassionate to accept this and to reflect on a system that combines palliative care with legally assisted dying for those whose suffering has become unbearable.

I have received many letters from members of the public describing the horrors of the prolonged and painful deaths of people they love, or violent and lonely suicides such as that of my grandmother. These letters are of course anecdotal, as is my own experience, but what is not anecdotal is the strength of public opinion about the need for a change in the law. As others have said, opinion polls show that an overwhelming proportion of those asked favour change. A recent survey also showed that most Anglicans, Catholics and Jews back assisted dying. So I beg religious leaders to respond to the views of their congregations. I also hope that those who are against this carefully constructed Bill will think again by looking at the evidence from Oregon, where assisted dying has not led to the slippery slope or to countless dying people being pushed into it.

Let us be clear: the safeguards in the Bill are strict. The numbers wishing to make use of its provisions will be limited. Let us therefore back it in the interests of love for our fellow human beings, compassion, the relief of suffering and respect for the right of individuals to make their own decisions.

12.07 pm

Lord Harries of Pentregarth (CB): My Lords, there is clearly a general desire that this issue should be debated; I shall not, therefore, oppose the Second Reading of the Bill. However, I am filled with a deep disquiet about it.

First, I recognise from research done in Oregon and elsewhere that the main reason people wish to take lethal drugs is that they fear losing control over their lives. I can well understand this; I have exactly the same fear. However, this reason is closely linked to

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another: the worry about becoming a burden on family or friends. The 2013 report on the situation in Washington state revealed that 61% of those supplied with lethal drugs gave this as one of their main reasons, while 50% did so in Oregon. Certainly, if I knew that I had an illness of body or mind that would make me totally dependent on others, I would seriously ask myself whether it would not be better for them if I died. We must ask ourselves whether we really want to put people in a position where they will inevitably be tempted to seek an early way out, rather than become an increasing burden on those they love.

Secondly, if the Bill is passed, it is absolutely certain that one that allows people with severe illness at any age to seek lethal drugs would follow in the course of time. The reason is simple: if we are moved by compassion for people who have only six months to live, how much more do we feel compassion for someone who may have a totally incapacitated life ahead of them for years, if not decades, such as poor Daniel James, the young paraplegic injured in a rugby accident? It is totally inconsistent to argue for autonomy in the case of those who are dying and not others who may be in even greater distress.

Many supporters of the Bill in this House have been quite honest in saying that they see it as a first, tactical step to obtain what they are really working for. Others also make it clear that they would like to take a step beyond that. For example, the co-sponsors of the Bill in Luxembourg said that they were deeply disappointed that it did not include children or dementia cases. In other words, they wanted not just assisted dying and assisted suicide but euthanasia for those who lack the mental capacity to make the decision for themselves.

The noble and learned Lord, Lord Falconer, stressed that there is no slippery slope. He says that the law you get is the law you enact, but one law can follow another. The rational case can be made for all the steps I have described, but that rational case is based on exactly the reasons behind this Bill: the overriding of personal autonomy over everything else and the desire or pressure to alleviate suffering at whatever cost.

I stress that I am not arguing for or against such steps at the moment; I am just saying that, if the Bill is passed, we have to face the consequences. I fear dreadfully for the whole attitude of our society to the vulnerable and incapacitated. I see the Bill as a tremor, warning of a seismic change in our society towards those who require costly, arduous care day and night. I believe that we should stick to the present law, together with the sensible guidelines of the DPP. Keeping the present law sends out a clear message that our society values every human person, however dependent on others they may become, and even if they feel that they are a burden as a result. We should concentrate on the priorities indicated earlier by the noble Baroness, Lady O’Neill of Bengarve.

12.11 pm

Lord Cormack (Con): My Lords, we have had some extremely moving and powerful speeches this morning; none more powerful than the speech just made by the

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noble and right reverend Lord, Lord Harries of Pentregarth. I am bound to say that I agree very much with the substance of his arguments.

I do not for a moment question the total integrity and sincerity and desires of the noble and learned Lord, Lord Falconer of Thoroton; I do not think that anyone in this House does. I think that we have to conduct this debate in a spirit of mutual tolerance and respect, and it is crucial that we should do so, but we also have to remember that, day after day in this House, we talk about the importance of the rule of law and our obligation to help those who are least able to help themselves—the most vulnerable in our society.

This morning, we have been dealing with both those issues, because we are dealing with the rule of law and how, or whether, we should change it in this regard, and we are dealing with how we are best able to help the most vulnerable in our society. I entirely agree with my noble and learned friend Lord Mackay of Clashfern and the noble and right reverend Lord, Lord Harries of Pentregarth, that the Bill should be given a Second Reading, because it is crucial that these important issues should be debated and discussed in minute detail and that this House should come eventually to a decision on whether the law should be changed and, if it should, how it should be changed.

In this context, the noble and right reverend Lord put his finger on it, because if we go down this road, this will be merely the first stage. When I listened to the noble Lord, Lord MacKenzie, who made a very moving speech, and the noble Baroness, Lady Finlay—two people who have given their lives to medicine, to helping the weak and the vulnerable—I realised that I do not wish us to embark down that road, which will end when it will be entirely permissible for anybody to do virtually anything.

We must recognise that we are embarking on a very difficult adventure if we indeed agree to support the Bill of the noble and learned Lord, Lord Falconer, at the end of the day. I sincerely hope that we will not. We have heard some powerful arguments. The noble Lord, Lord Brennan, made an extremely powerful and moving speech, and I hope that it is one that all noble Lords who are not present today will read, mark, learn and inwardly digest.

It is often said:

“Thou shalt not kill; but need’st not strive

Officiously to keep alive”.

Of course we are not in the business of seeking to increase suffering, but the fact is that the present law allows a degree of latitude without placing our doctors and nurses in the position in which the noble Lord, Lord Empey, does not want his daughter to be placed in a few years’ time.

Why have I come emphatically to the view that this would not be a good law to embrace? I will tell your Lordships in one or two sentences. First, I am powerfully influenced by the fact that the noble Baroness, Lady Campbell of Surbiton, who will speak shortly, is against it. The noble Baroness, Lady Grey-Thompson, is against it. Here we have wonderful examples of what the triumph of the human spirit can achieve. If they say that they do not want to go through that legal door, I am strongly persuaded to support them.

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I end with a brief quote. We have all had many letters. I received one this morning from a Roman Catholic parish priest in Lancashire, which read:

“Whilst we should not take extreme measures to prolong life, we certainly should never take deliberate steps to end or shorten life, nor assist in suicide”.

We should not, and I hope and pray that we will not.

12.16 pm

Lord Alli (Lab): My Lords, this is a difficult and incredibly moving issue, as evidenced by the previous 28 speakers. I am no stranger to difficult moral issues in this place, but I have always had the certainty that what I believe is right and my opponents were always wrong. I do not have those certainties here today, and I do not believe that anyone in this House is entirely right or, indeed, entirely wrong. One thing that we learn in this place is that there are very few moral absolutes.

The Bill challenges so much of what we hold dear. It takes a big principle that life is precious, God-given and should be preserved and challenges it. The Bill says, “In some circumstances we, the state, should help you to terminate your life”. It is like an act of war on a personal scale—justified, perhaps in the extreme, but nobody wants to do it.

I have thought long and hard about the Bill, and the easy option was not to participate in this debate today; with more than 125 speakers, that was probably the wiser option too. But to go with the crowd and hope not to be noticed would feel like a dereliction of duty and, like everyone here today, I think that that is not the way that this House operates.

With limited time, let me set out what I believe—not what a court believes, not what a judge believes but what I believe. I believe that I am the guardian of my own life; I believe that my behaviour is my responsibility; and I believe that, in the end, I should have the right to decide whether I wish to bring my life to an early close. I also see the dangers of that position: the dangers to the vulnerable; the dangers to a moment in time; the dangers of abuse and, yes, of unintended consequences.

The Bill, in these specific circumstances, lays down some measures to protect the vulnerable and limit the potential for abuse, but we have to think about that much more carefully. However, I add my support to it today. I fully understand that it could open up a broader debate, as the noble and right reverend Lord, Lord Harries, said, about how we end our lives, but we in this House should not be afraid of that debate or of passing the Bill because, for me, it is not about a future position. Equally, I am confident that this House and the other place are competent to deal with the future as it presents itself. I say to my noble and learned friend Lord Falconer of Thoroton, thank you very much for introducing the Bill. I admire you greatly for doing so, as I do every Member who has spoken in this debate or put their name down to speak.

12.20 pm

Baroness Campbell of Surbiton (CB): My Lords, I have fought for autonomy the whole of my life. I have fought for that for myself and for others. I do not want this Bill.

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First, I must declare a very important interest. This Bill is about me. I did not ask for it and I do not want it but it is about me nevertheless. Before anyone disputes this, imagine that it is already law and that I ask for assistance to die. Do your Lordships think that I would be refused? No; you can be sure that there would be doctors and lawyers willing to support my right to die. Sadly, many would put their energies into that rather than improving my situation or helping me to change my mind. The Bill offers no comfort to me. It frightens me because, in periods of greatest difficulty, I know that I might be tempted to use it. It only adds to the burdens and challenges which life holds for me.

However, it is not just about me. My story is echoed by the majority of disabled and terminally ill people in Britain today. Many of them are outside this House, protesting against the Bill. I urge your Lordships to go and talk to them. Many more will have written to your Lordships. Supporters of the Bill argue that there is a hard and fast distinction between terminal illness and disability. I can tell you absolutely that there is not. We, the folk this Bill claims to serve, know that. The Bill purports to offer choice—the option of premature death instead of pain, suffering and disempowerment—but it is a false choice. It is that of the burglar who offers to mug you instead. That is not choice. Pain, suffering and disempowerment are treatable—I have to believe that—and they should always be treated. My long experience of progressive deterioration has taught me that there is no situation that cannot be improved.

I have spent my life developing ways to prevent people in vulnerable situations feeling powerless and burdensome. They do get cajoled and do feel a burden, especially when they are at home with no one to come and assist them to go to the toilet and to have dignity. I have seen this transformation when people have been helped. Those whom society once saw as totally dependent have become active and valued human beings. I am afraid that assisted dying will bring back outdated beliefs that devalue disabled and terminally ill people, when we have tried so hard to get away from them. Small wonder then if some succumb to those beliefs and see premature death as the only answer. Small wonder if family, friends, doctors and others see it as their duty to support that goal. It appears easier, cheaper and quicker—and it is.

The Bill is motivated by fear and pity but as the greatest French novelist, Balzac, observed,

“pity is death to us—it makes our weakness weaker still”.

Death is seen as a release from pity, for both giver and receiver, but there are far better ways of responding. We must put our energy into providing the best support, be it medical, social, practical or emotional, to disabled people and terminally ill people. We are nowhere near there yet. Helping people to live with dignity and purpose must surely be our priority. Disabled people and terminally ill people do not deserve pity. They deserve so much better. The Bill has become a runaway train, and the more frightening because of that. Please let us pause and find ways to reflect further. The Bill is not the answer.

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12.25 pm

Lord Baker of Dorking (Con): My Lords, that was a most moving speech. I am sure that your Lordships will recall that there are disabled Members of this House who do not share the noble Baroness’s anxieties—the noble Lord, Lord Low, is one. Many severely disabled people who are waiting to die would also not share her anxieties. All this goes to show is that every group is divided. The disabled are divided and the doctors are divided. The Church of England is also divided and I would like to touch upon that, since we have the two archbishops in the House.

All Christian sects, and indeed most religions, have condemned suicide— none more eloquently that the Catholic Church. Chesterton, the great Catholic writer, said that the act of suicide was the worst sin of all because it put man’s judgment above the judgment of God. However, I am not a Catholic but an Anglican. The great advantage of being an Anglican is that since 1533, we have been allowed an infinity of interpretations. My church has thrived by dispute and by being disputatious. It is the very nature of the Church of England to do that. Dean Stanley, the great Dean of Westminster in the 19th century, said that the Church of England was neither right nor left, but broad. That broadness has been demonstrated by the two archbishops in the House today who, in the Synod this week, managed to reconcile views on gay marriage and women bishops. That is a triumph and when I see them pitched against the noble and right reverend Lord, Lord Carey, the former Archbishop of Canterbury and the Bishop of Buckingham, I am quite sure that I look upon that not as a crisis but as almost par for the course. I am quite sure that by being broad, the two groups would be brought together—and being a Conservative, I am aware of being a member of a broad organisation.

I am not too concerned about divisions within the Church of England. I take the view of the noble and right reverend Lord, Lord Carey: I believe that God is a loving, compassionate and caring God and that he would not wish to subject any of the creatures which he has created to long periods of suffering, which can in fact be mitigated or eliminated. That is a view which I share. The suffering of someone such as Chris Woodhead, the former Chief Inspector of Schools who has motor neurone disease, has been eloquently expressed. Motor neurone disease has been described as a disease where you live in a prison which gets smaller by six inches every year. If it ever fell to me to be in that position and not be in control of my bodily functions, I would not want my gift of life to continue—and I would want to be the person who made that decision.

Before I sit down, I have one thing to say about the legal side. I am not a lawyer but it is quite clear to me that the present law on suicide cannot be enacted. I see a former High Court judge nodding, so I must be right on that. That is why four years ago, the Director of Public Prosecutions introduced the concept of compassion. All the judges frowned at that and said, “Compassion has nothing to do with the law. You can’t define compassion. It is a bundle of sentiments and attitudes. It is subjective and not objective”. But

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the Director of Public Prosecutions made that statement four years ago because he knew that juries would not convict. In cases that were brought, juries did not take rational decisions on the state of the law. Their hearts were plucked and they decided on humanitarian values. When juries will not convict, the law should be changed. This has happened in our history. It was once a provision that everyone who stole more than £10 should be hanged. When juries then did not convict offenders, particularly those who were young people, the level was slowly raised and then abolished.

When a law cannot be enacted, it should really be changed and it should be for us legislators to change it. I do not think it is the job of the noble and learned Lord, Lord Neuberger, and the Supreme Court to do that; nor do I think it is the job of the Director of Public Prosecutions. As legislators, we have a responsibility to change the law and if one of the roles of legislators is to reduce suffering then I hope that we will fulfil that duty, and fulfil it well.

12.28 pm

Baroness Meacher (CB): My Lords, I support the Bill of the noble and learned Lord, Lord Falconer, and I will respond to a few of the concerns expressed by the Bill’s opponents. I am very saddened to find a number of people who I greatly respect on the other side of this argument.

Several Peers have told me that their main concern about the Bill was that it might change our attitude to death, but we must change that attitude and end the taboo which has prevented terminally ill people talking about their plight. People often go to their graves lonely and in fear and misery, feeling unable to talk to anyone about what they face.

Former Archbishop Desmond Tutu is surely right; he called for a mind shift in the right-to-die debate. That shift has, of course, happened in a very safe way in Oregon, the example followed closely by the Bill. We know that more than one-third of terminally ill people in Oregon have in fact talked about their forthcoming death. Many choose to discuss their options and have had their fears allayed and wishes met. The result is that only 752 people have finally taken the pills or whatever out of nearly 500,000 deaths since the introduction of the law 17 years ago. I must add that there has been no move to abolish the law—or indeed to extend it to other groups, a fear that many have mentioned. Everyone in Oregon benefits from knowing that they can end their suffering if it becomes unbearable. We all know that any suffering is more bearable if we can do something about it.

Our opponents say that they fear unscrupulous relatives. In Oregon, concern about being a burden to the family is not a significant factor in choosing an assisted suicide. The former chief executive of the Oregon Hospice Association, no less, told us that concerns about being a burden are commonly voiced by terminally ill people, whether or not they seek an assisted death—that is a common feeling when you are terminally ill. Our opponents need not fear abuse by relatives; the safeguards have been shown in Oregon to deal with this relatively small problem very well.

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In their literature, our opponents have taken a quote from Keir Starmer, the former DPP, out of context to imply that he is content with the law as it stands. I spoke to Keir Starmer last week. This was not his meaning, but his guidance has resulted in the investigation of 84 cases of assisted dying. In every one, the relatives have been deeply compassionate and none has been prosecuted. I hope that the misleading quote from the former DPP will be removed from our opponents’ literature.

Our opponents have suggested that people who are depressed and may not have capacity have had an assisted death in Oregon. The former CEO of the Oregon Hospice Association, a convert to the Assisted Dying Act since it was introduced, made it clear that only those whose judgment is sound will have an assisted death. Many people with depressive feelings have those feelings because of their terminal illness, and their judgment is perfectly sound.

Lastly, a medical Peer said that, as a doctor, she could not face both ways. My noble friend does not need to. The guiding principles for every doctor in all their work are, of course, to follow the best interests of the patient and to respect a competent patient’s autonomy, wherever that takes them. These principles provide a clear direction of travel for any patient wanting help to end their intolerable suffering.

12.32 pm

Lord Brooke of Alverthorpe (Lab): My Lords, I, too, am grateful to my noble and learned friend Lord Falconer of Thoroton for stimulating this debate by tabling his Bill. I say that not because I support it but because I do not see him as an opponent; I still see him as a friend. I believe that the noble Lord, Lord Joffe, started the ball rolling with this, and since then the momentum has gathered pace. My noble and learned friend’s commission, followed now by the Supreme Court’s intervention, requires that we address this issue and find a way through it.

This also gives me an opportunity today publicly to thank the scores and scores of people who have written to me on this topic—people whom I would judge, rather like myself, as ordinary people expressing their views overwhelmingly in the majority against the Bill. They are frightened by the possible change that such a law might bring, no matter how it may be dressed up or caveated with safeguards for the time being. They are frightened that it will be the start of a journey that will lead to other changes that not only will be about assisted suicide—helping someone with six months to live—but will go beyond that, as indeed we have started to see in Belgium.

Many who have written to me are carers, disabled people, nurses, doctors. They are people who, from reading their letters, are as compassionate as any of us can be. They are people who give service to the public over a wide area. They are people who have been expressing, too, the concerns that they have had in dealing with death and changes within their own families. They have written to me about their emotions and feelings on seeing loved ones depart, sometimes with suffering. They have also described their fears about where this change may lead and how it will affect their

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vulnerable family and friends. Those with disabled members of the family are particularly concerned that that may be further down the line under another agenda.

The unintended consequences cannot be ignored. I wonder how in law we can avoid someone coming back to raise fundamental questions, amendments and challenges to the law. Like my noble friend Lady Meacher, I raise the point about death. We have not had sufficient debate previously about death and how we approach it. Those who have written to me have talked about their fears, not just about their family but about how they may approach death, and their fears of it.

I am frightened of dying too, as I get older; it is an issue that comes into my head virtually every day, in a way that it did not when I was younger. That leads me to consider the nature of my life, where I am going and what it is about. It leads me to think about whether I can continue to control everything in my life—and I have controlled a good deal of it, for much of my life. But I know that, as I get towards the end, I will not have that control open to me. I have learnt that I will be required, and need, to accept what is coming to me—to embrace it and to move forward, whichever way life or death is taking me.

I have come to the view that there is a power in my life that is greater than myself, far greater than the controls that I can exercise, and I must render myself up eventually to that power, as all my forebears have done. Do we now have more suffering than our forebears had? Do we have greater difficulties in dying than they had? I believe that death is part of the journey, the final rung on the ladder, and that we need to concentrate increasingly on those unfashionable issues of trust and faith that, regrettably, have not been mentioned too much in the debate today.

12.37 pm

Viscount Craigavon (CB): My Lords, I strongly support the Bill, not because I want my views to prevail but because it gives people who are eligible the choice to decide for themselves. I am grateful to those who have written to us individually, giving their personal and sometime very moving stories, with support for the principles and practice of this Bill. Attitudes and public opinion have changed over time and are changing, but I feel desperately sorry that we are not able to move faster to meet the needs of those who are currently suffering. In my brief contribution, I shall focus on how attitudes have changed and, in my opinion, will continue to change, both in the House and outside. Like others, I look forward to discussing the detail in Committee.

I have to say that I am astonished that we are still being told by some to take comfort that suffering is somehow a virtue. Some people still also take refuge in asserting that palliative care is the answer to everything. Like most people, I wholeheartedly support palliative care and its extension, but we have had numerous descriptions and reports of conditions where in 10% or 15% of cases such care is not successful or not

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wanted. Individual choice should be respected. We heard two very good examples from the noble Baroness, Lady Blackstone.

In debates like this, we should say again and again that those who want to believe that suffering is a virtue, and those who want to believe that palliative care solves everything, can claim that belief, but I would say: please do not inflict that on unwilling others. It should not be a premise for any respectable argument, nor to avoid addressing real need or distress.

As the noble and right reverend Lord Carey has written, we should be grateful for the courageous examples of Nicklinson and Paul Lamb, even though their cases may be outside the terms of this Bill. We should be very grateful to the noble and right reverend Lord for leading the break-up of the apparent Orwellian consensus in the Church of England, supported by the first serving bishop to back the right to die, the Bishop of Buckingham, and aided by the clear-speaking Canon Rosie Harper. A YouGov poll of the laity showed a clear majority of the Church of England in favour of such a Bill as this. The opposition to the church leaders is not from secularists, but from within the churches themselves. Similarly, a historical “thus far and no further” policy crumbled on women priests and then on women bishops; the new front of same-sex marriage has still to be resolved. With bishops, as with some medical royal colleges, soundings of the members are not readily reflected at the top. I was grateful for the particularly fine speech of the noble Lord, Lord Baker, on this subject.

At the end of this process, in bringing assisted dying, with safeguards, into being, I hope that those on the wrong side of history might want to acknowledge, eventually, the continuing suffering they will be causing.

12.40 pm

Lord Stone of Blackheath (Lab): My Lords, I do not like conflict; through this aversion, I am able to suggest win-win solutions that do not present themselves, normally, to those on opposite sides of an argument in the various other arenas in which I work. So, with your permission, I would like to spend two minutes on a suggestion that seems to me to allow, in this instance, personal choices for those like me who would want assisted dying, but also allows appropriate safeguards for those who do not wish to have that option.

I have never been frightened to die; it is the manner of my death that sometimes troubles me. Were I to be diagnosed with a terminal illness and be told that I had six months, or less, to live, I want the choice to control the manner and timing of my death. I would like to be given the choice to spend my last days with my family and friends to see them individually and collectively. Wanting to see me end my pain and relieve them and me of a burden is not a pressure, it is love. In the last minutes, having put myself, as I am able to with meditation, into a state of mindfulness, perhaps with some Bach in the background, being allowed, with medical assistance, to drift off at a time of my choosing would be a good death. I would not want to be sedated into obscurity for days on end. While I do not want that, I appreciate that others may.

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The word “choice” is key here. If people with religious conviction or medical professionals opposed to assisted dying do not want this option, they could simply choose not to partake. For my part, I am reassured by the safeguards in the Bill that two doctors, plus other relevant care professionals, would assess me against the eligibility criteria and then, if I qualified, I could choose when and how I took the medication, if I took it at all.

This Bill should go through to the Committee stage to be looked at in detail, clause by clause. Those who, should they become terminally ill, do not want to have an assisted death could perhaps consider what amendments would reassure them. This would allow me and the majority of the British public who want to have a choice to have it. I am president of HealthTalkOnline, which was co-founded by the late Dr Ann McPherson, who was a saint. It helps inform patients living with more than 80 different illnesses and conditions about choices they can make to manage their lives. We have collected thousands of on-screen interviews with patients, conducted over 10 years across 10 countries, and posted them on our website. Ann was a GP and campaigner on issues including patient choice, covered by HealthTalkOnline, young people’s healthcare—she wrote The Diary of a Teenage Health Freak—and assisted dying. In the months leading up to her death from pancreatic cancer, Ann developed immunity to the effects of morphine, could barely move and was unable to eat solids. Ann’s wonderful daughter Beth, herself a GP, has written of her mother’s death:

“She expressed beyond doubt a wish to be put out of her misery. Yet there was nothing her doctors or loved ones could do to achieve her wishes without breaking the law. She received fantastic care ... but still she died a slow, painful and undignified death … Even when heavily sedated she was still not comfortable ... In those circumstances, to deny her the right to choose her own method and time of death was nothing short of cruel”.

Assisted dying will not cause people to die—their terminal illnesses are going to be what kills them—but a law which enables assisted dying would stop people living the end of their life in fear of a terrible death. I sympathise with people who, for whatever reason, choose to accept a death like this, but we must allow this Bill to progress so that other dying people can have the choice denied to my friend Dr Ann McPherson.

12.44 pm

Lord Tombs (CB): My Lords, today’s debate has already shown how complicated is the proposal for mercy killing—for that is what we are discussing. The desire to relieve seemingly unbearable suffering is understandable and even praiseworthy, but the means chosen may involve even more suffering for others, whose vulnerability may not be immediately apparent.

We rightly seek in our society to protect life, and so murder and suicide are illegal, as is assisted suicide. This Bill seeks to protect an individual deliberately assisting in a suicide from the consequence of his or her action and opens a number of other difficult problems. The present law deals with this by requiring that the sick person involved is mentally competent to acquiesce in a decision to terminate his or her life and has not been subjected to arguments or actions seeking

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to influence that decision. Both these requirements are difficult to satisfy with certainty and the Bill seeks to pass the buck to doctors.

Determination of adequate mental capacity is a difficult process requiring specialised skill, and to further determine that external persuasion has not been used is a virtual impossibility. The Bill seeks to place the responsibility for these judgments on the doctor, ignoring the fact that family doctors are heavily overloaded with everyday work and generally do not specialise in psychiatric matters. The great majority of doctors are opposed to the Bill, having become doctors to treat their patients, not to kill them. The approach of the Bill is to regard patient suicide as part of a patient’s treatment.

External influence may be based on the burden of care placed on others by the victim’s condition or on financial considerations. The doctor is in no position to judge these difficulties, lacking detailed knowledge of the family background. It is not surprising that most medical practitioners do not support the Bill. To suppose that lay people have superior or even adequate capability in this dangerous area is presumptuous and irresponsible.

The law as it stands is clear and has performed well. Participants in the suicide themselves presently bear the responsibilities which the Bill seeks to pass to doctors, seemingly impervious to the effects on other participants who are left clear of responsibility for their actions.

Overseas experience of assisted suicide is not encouraging. In Belgium, assisted death is available to seriously sick children, and in some adult cases it has been reported that cancer-treating drugs have been refused and assisted suicide offered as the only alternative.

Many hazards to our society lie in the acceptance of the proposed Bill and the gradual so-called normalisation of its provisions, as has occurred in other countries adopting similar proposals. Safeguards prescribed in legislation become disregarded in practice, and audits cease to be performed. Effectively, euthanasia has arrived by stealth, an outcome which has proved unhappily common.

It seems perverse to promote such measures at a time when the UK leads the world in palliative medicine and the provision of hospice care. Surely we should build on these advances to strengthen the caring attitude which underlies our support for charities in needy countries and volunteers to support that work. To seek to hazard such resources by a steady erosion of care in society would surely be tragic.

This Bill seeks to damage caring responsibilities in families and society at large by introducing crude measures amounting to a blank cheque in a highly sensitive area which have not been evaluated. I oppose the Bill.

12.49 pm

Lord Macdonald of River Glaven (LD): My Lords, if this Bill passes into law it will, I believe, herald a fundamental and irreversible shift in the attitude of the state to the deliberate application of death. If it takes place, I am sure that this shift will in time, and

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perhaps not long into the future, bring further changes in our approach to death by human hand. Many people will support this present shift and some will support the shifts to come. For my part, I do not.

When I was the Director of Public Prosecutions between 2003 and 2008, scores of these cases came across my desk. They are always considered by the DPP personally, not by a lawyer in his office. I did not in a single circumstance authorise a prosecution against anyone who, through compassion, had helped a son, a daughter, a husband, a mother or a friend to die. It was as long ago as 1949 that Hartley Shawcross, the great Nuremberg prosecutor and Attorney-General in the post-war Attlee Government, reminded the House of Commons that it has never been the law of England that in every case where there is sufficient evidence for a prosecution, that prosecution must be brought. That is because in this jurisdiction we have always understood that inflexibility and justice rarely go hand in hand. There is nothing new in that; it has been part of our system of justice over the years. So it is that prosecutors have, and always have had, a discretion. Where there is sufficient evidence, they have always asked themselves, “Would it be in the public interest to prosecute this case?”.

The position we have arrived at in this country is this: a broad prohibition of law to deter those who might take action through venal motives—and such people do exist. It would be foolish to assume that everyone counselling a suicide acts from pure motives or that venality is always absent. However, coupled with that prohibition of law is a clearly defined discretion to protect those who face an impossible choice and who act from motives that are beyond reproach. Under the system as it presently exists, they do not and they will not face prosecution. To those who respond by saying, “But these people face the uncertainty of investigation before they are relieved of the threat of prosecution”, my response is that surely it is unthinkable, even under the scheme being proposed by the noble and learned Lord, Lord Falconer, that there should be no inquiry following an assisted death, if only to determine that a detailed and prescriptive law such as the one he is proposing has been complied with and not broken. There will always be an inquiry and there should always be an inquiry. If I am wrong about that, and if in fact we are being invited to enter a world in which the deliberate infliction of death is protected from inquiry, I believe that we should decline that invitation, as I do.

12.52 pm

The Earl of Sandwich (CB): My Lords, in our last debate on this issue, when we considered the Bill brought forward by the noble Lord, Lord Joffe, I mentioned a friend of mine whose husband was kept needlessly alive after brain surgery against his wishes. He died a few years ago in considerable pain and he would have opted for an assisted death. His wife is now in her 90th year and she says that she is not afraid of death, but of the process of dying and of the prolongation of suffering in life—what she calls “this ever-present death”. Being a classicist, my friend has a Latin quotation to offer us from Pliny the Younger. In

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Book III.16, Pliny writes about a Roman lady called Arria, who was famous for her courage. She used the following words for her caring family when she was herself preparing for death,

“potestis enim efficere ut male moriar, ut non moriar non potestis”.

“You do not have the power to prevent my death, but you can make sure that I will die badly”. In other words, carers, with the best of motives and their undoubted skills, can also be the unwitting agents of the most horrible suffering that could be said to be worse than death itself, which then comes as a blessed relief.

Life may be sacred, and yet doctors already intervene at various critical points in people’s lives, including at the end of a terminal illness. I do not think that the church, the palliative care community or even doctors, let alone families, should have a legislative monopoly on death. Let us give that right to a small number who are suffering needlessly.

“I can’t understand why I have to go on living like this—why can’t I just die?”,

said Dr Ann McPherson, who was mentioned earlier by the noble Lord, Lord Blair. She died in terrible pain after suffering from pancreatic cancer for four years. What right has the church or any other institution to prohibit death or to prolong life in these circumstances? What right has the palliative care community to provide the ultimate comfort if it allows suffering and falls short of providing the ultimate relief? I agree that doctors are in a separate category and I admire those who already take the law into their own hands. The Crown Prosecution Service has also shown, in its own way, commendable compassion to those families who decide to go through their ordeal in Switzerland. We must be grateful for that, but it is not enough. The law does not offer proper protection.

This is a limited measure which helps only a very few; it is not the tip of the iceberg or the slippery slope. It is a humane gesture towards a small number of people who are suffering intolerably. Of course I acknowledge that there are risks, and the noble Lord, Lord Alli, set out very well what the risks on the other side are, but let us take courage like the Roman lady and take this modest step forward. I urge the House to accept the Bill.

12.56 pm

Lord Elton (Con): My Lords, I can enter a debate like this only with extreme trepidation. I should like to say first that we are debating the Bill in outline and that it will be very different when we have finished with it in Committee, so it is important that the Committee stage should be gone through properly. The second thing I should do is declare two interests. The first is shared by many, which is that I am 84 years old. I suspect that the second is not shared by quite so many: I have had cancer since 1997. Therefore in two senses I am in the frame for the provisions of this Bill. I thank the noble and learned Lord, Lord Falconer of Thoroton, and the noble and right reverend Lord, Lord Carey of Clifton, for extending their compassionate hand to me, but I have to say with the greatest courtesy, “Thank you, but no thank you”.

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The reason takes us into the larger scale. I long to deal with many of the points that have been raised, but it seems to me that the great continental drift through which we are living—our tectonic plate in history—is as has been described in detail by the noble Lord, Lord Brennan. What takes control of legislation once it is out is the administration, and the context in which that happens is a peculiarly sinister one at the moment. First, as has been mentioned two or three times, we are becoming increasingly aware here in the United Kingdom of the limitations and great expense of care which, if it is to improve, will become even more expensive. The second is the limitations and huge expense, which is projected only to increase, of the National Health Service. The background to that is a recognition—which we are only now beginning to take on board in this country—of the dangers of a very rapidly increasing global population, impending shortages, and therefore strife over food and water.

An administration aware of these pressures can only think, “Not how compassionate but how convenient is this piece of legislation?”. It opens the door to a new concept of social priorities and social duties at the end of life. What I look forward to—my interest is limited because I shall not live that long—is the world in which my children and grandchildren will live, where there will be increasing pressures to regard people at a specified age, which no doubt will start very high but diminish as pressures increase, as being not very public-spirited if they go on. That is a whole new social climate, and I think that it is deeply hostile to the only thing that actually makes life in this world tolerable, which is the suffusion of love throughout society. Love is what makes the world go round; it is what makes it possible to live here and rejoice. Therefore I am in principle against the Bill, but I cannot say what the Bill will be like when we finish.

Finally, I declare another interest. It has been said three times, I think, that we need to change our concept of death. I heartily agree with that. My third declaration of interest is that I am a Christian. I regard death not as a pit but as a door; not as an end but as a beginning of something far more glorious. I tell your Lordships—those who will come to consider that in their closing days—that it is true, and wonderful, and you should seize hold of it and live more happily.

1 pm

Lord Stirrup (CB): My Lords, the proposers of the Bill are good people, of good conscience, and with good intentions. Their objective is to alleviate suffering, and who could not be sympathetic to such a cause? Like many noble Lords, I have witnessed loved ones undergoing a painful and prolonged death. I have been humbled by their courage and distressed by their anguish. They have borne their suffering with fortitude, but I have wondered why, when their lives have been so full of love, their ends should have to be so full of pain.

I, for one, have no moral or religious objections to people seeking to end their own lives. I understand why some choose to do so, and they should have that freedom. However, I have very serious concerns about people helping to take the lives of others, which is

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what the Bill proposes. The term “assisted suicide” appears—and perhaps is designed to appear—fairly innocuous. However, in essence it proposes to legalise participation in the taking of someone else’s life. Yes, the circumstances envisaged in the Bill are special, the person whose life is involved wills the act, and the act is intended for humanitarian purposes. However, the fact remains that individuals will be taking another’s life, which is a very serious matter indeed. Such a change in the law would be of the first importance. As a consequence, there is a very great burden of proof on those who propose that to show that they are not opening a Pandora’s box.

That is doubly so, given the involvement of doctors in the process. I have close family ties to the medical profession, and have thought long and hard on this aspect of the Bill. Very properly, we have a prohibition on doctors actively taking human life. Some would argue that abortion crosses such a line, but I believe that the laws on abortion are based on a judgment of when a person’s life might be deemed to start. That is of course a matter of debate—sometimes violent debate—but, accepting the disagreement on that point, the logic of the position seems clear. Doctors may of course withhold artificial support to life, and death may be the result. However, they are not in that case actively involved in the taking of a life. The absolute prohibition remains intact.

The Bill seeks to remove that prohibition. Some might say that the act cannot be ascribed to the doctor. The patient administers the drug; the doctor merely prescribes it. Doctors very rarely administer the drugs they prescribe. However, if a doctor mistakenly prescribes an incorrect drug or dose, and a nurse administers the drug and the patient dies as a result, the doctor remains responsible. He or she cannot avoid accountability just by the addition of further steps in the treatment process. Under the proposals of the Bill, doctors will be killing people. The killing is, of course, intended to alleviate suffering. It is at the patient’s express wish, and with their active participation. However, a line will have been crossed. What will then be the next step? How long will it be before the circumstances in which assisted suicide is legal will be broadened—each step small and seductive in itself, but adding up to a great distance? Where will it end? How, in the absence of the absolute prohibition, will we defend against further encroachment and the obvious dangers that could result? The Bill answers none of those questions.

A good military defensive position requires suitable terrain—a river, or perhaps high ground. If one intends to retreat from that position, one needs to know in advance where the next defensible line is, otherwise one simply keeps retreating, and risks the retreat becoming a rout. The Bill takes no such precaution, and therefore opens the way to an unpredictable and potentially very dangerous future.

1.04 pm

Baroness Symons of Vernham Dean (Lab): My Lords, I, too, thank my noble and learned friend for introducing the Bill and the whole House for the way in which it has debated this issue.

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In November 1990, my father, aged 77, was diagnosed with acute myeloid leukaemia. He was terminally ill, but the doctors thought that they could prolong his life for some months with chemotherapy. He died before the chemotherapy began. Less than 14 months later, my husband, aged 38, was also diagnosed with acute myeloid leukaemia, which was well advanced and very aggressive. He was given less than two months to live. Again, the doctors sought to prolong his life with chemotherapy.

My father was elderly; he died without pain, and at peace. In contrast, my husband was relatively young, but suffered almost unbelievable pain, and was in acute mental anguish. I was called into the hospital in the early hours one morning. My husband’s pain was overwhelming. The only way to administer morphine was to spray it down his throat. When at last he could speak, he told me that he wanted to stop the pain and mental torment. He said that he wanted to go gently, and asked me to accept that.

I relate those experiences because they illustrate two fundamental flaws in my noble and learned friend’s Bill. My father and husband were both given little time to live, and suffered from exactly the same terminal illness. One, suffering little pain, and at peace, who very much wanted to survive a few extra months, died within days. The other, suffering constant and appalling pain, and very much not at peace, longed for release.

My noble and learned friend’s Bill tries to define a terminal illness but fails to do so, because such a definition is impossible. It was impossible in the 1990s, given the advances in medical science; now, 20 years later, any definition becomes less and less plausible. What was thought to be terminal last year may be treatable this year, and that is no basis to end a life.

My second concern is the following. Several years ago, when we debated the Bill in the name of the noble Lord, Lord Joffe, one of my noble friends—a supporter of assisted dying—told me that the Bill was aimed not at young people with terminal illnesses, such as my husband, but at those who had largely lived their lives. However, of course, the Bill does not distinguish between one adult and another. The same provisions must apply to those aged 18, 38 or 80, as they do in the Bill. Yet so often it is the young who despair, particularly young men, as the suicide statistics tell us—suicide being the greatest cause of death among young men in this country. Those young men cannot face the tragedy of a life not to be lived, and opt for the release that is offered them. I fear not only for the elderly under my noble and learned friend’s Bill, but for the young.

I cannot know what would have happened in my own family. I do not know what the outcome would have been if my noble and learned friend’s Bill had been on the statute book. However, I am profoundly grateful that it was not. I know that my husband longed for release, and that today my son still has a father, and I still have a husband.

1.08 pm

Baroness Tonge (Ind LD): My Lords, I, too, thank the noble and learned Lord for bringing the Bill to the House. It is difficult to think of something different to

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say after this long debate. However, my thoughts for this debate were stimulated by a remark made by a GP friend of mine, who wrote of the intolerable burden the Bill would place on doctors if this measure became law. That puzzled me, because my clinical experience has been rather different, and quite varied.

I practised medicine for over 30 years, working in general practice and community health, and then I was managing a district nursing team. Dying patients fell into roughly three groups. The first was a very small sample who, when faced with agonising and terminal cancer, treated the pain as part of their purgatory and a preparation for the afterlife, which they genuinely looked forward to. Suffering they saw as a sort of down payment, which would shorten the time it would take them to get to heaven. Not having a religious faith, I was nevertheless impressed by these people, and of course respected their view and did all that I could to help.