The next group were patients who wanted to die and did not want to prolong their suffering, or that of their relatives around them. A dear friend of mine came into this group. She pleaded with me to help, but I could not. I was not brave enough to break the law and end her suffering. It meant that I seldom visited her after that, in the last weeks before she died, because I could not bear her reproachful stare. I had let her down. She understood why, but that did not relieve her suffering. That to me is an intolerable burden, too.
There is then a third group who have been saved in some way or other by heroic medicine and face the prospect of a life of tubes, respiratory machines and artificial feeding. Some say that God should determine the end of life, but does modern medicine ever give God a chance? I sometimes feel that the people in this category, who may have locked-in syndrome or a long-term neurological condition, are in the words of Article 3 of the European Convention on Human Rights, being subjected to torture or to inhuman or degrading treatment. Should we allow this? They have no choice because they can no longer express themselves. Sadly, this Bill would not apply to them, but I hope that we can discuss this further in Committee.
But my opinion is irrelevant, in any of these cases. I respect all patients and the views that they have or might have had. That is why I support this very modest Bill, which will allow some patients who are able to to make the choice whether to live or die and how and when they do it. It is not our decision—it is theirs.
1.12 pm
Baroness Wheatcroft (Con): My Lords, we have heard that hard cases make bad law, but we have also heard that there are so many hard cases that, as my noble friend Lord Baker said, it may be incumbent on us as legislators to try to find a way in which to alleviate this situation.
My belief in the need for change stems from personal experience. Many noble Lords have spoken about their own experiences, and I am sure that we are all delighted to have heard the happy ending to the story told by the noble Baroness, Lady Symons. But my own mother’s experience with leukaemia did not have such
a happy ending. She fought it for as long as she could, made the most of her life and adored getting to know her grandchildren—but, in the end, she was in a hospital bed, begging for help. She was in agony. I, too, begged for help; I ran around the hospital trying to find a medic who would do something. But they argued that she was getting as much morphine as they dared to give her, that any more would be illegal and that they could not help.
The noble Baroness, Lady Finlay, referred to this Bill as offering a loaded gun. If my mother could have grasped that loaded gun, she would have fired it—and, if she could not have done, I think that I would have fired it for her. It was a terrible situation, but it was many years ago and we are now assured that palliative care is so much better. Nevertheless, I do not believe that my mother would have wanted to fade away in what the noble Lord, Lord Lester, referred to as dazed oblivion. I think that she would have wanted to say her farewells and choose the time to go with dignity—and I, too, would want that option.
Of course, there need to be very strong protections. I share the horror, itemised by the noble Lord, Lord Tebbit, at the apparent sanctioning of gender-based abortions. I am appalled when I hear that the two doctors who, in theory, are required to sanction abortions in this country, apparently routinely sign the forms without ever seeing the mother in question or even her medical records. So this Bill will need to make the most stringent demands on the doctors who are to be involved in potentially accelerating death. It may be that as the Bill goes through Committee there are further safeguards that can be put in. However, I do not think that we should believe, as the noble Lord, Lord Empey, suggested, that we are risking creating a generation of Dr Deaths, keen to bump us all off as soon as possible. Compassion has always been the route of the best doctors—and this Bill is all about compassion.
I struggle with the concept of a mother’s right to choose to end the life of a healthy baby, but I have absolutely no doubt about the right of an individual to choose when their life is very nearly over that they would like to go with dignity.
1.16 pm
Baroness Grey-Thompson (CB): My Lords, the Bill that the noble and learned Lord, Lord Falconer, is proposing is simply not fit for purpose. However, this debate is an important one. It is too simplistic to suggest that this is simply a debate about compassion versus suffering. Making law is not a popularity contest, and we should not pass legislation based on emotion; it is about protecting the whole of society, not just the strong-willed and self-confident. The Supreme Court urged your Lordships’ Chamber to consider whether the law should be changed; it did not say that the current law does not work.
This Bill proposes a fundamental change in the relationship between doctors, patients and families. We have to recognise that not everyone’s motives are altruistic; not everyone has a caring family. People can be coerced. We do not live in a halcyon world where choice generally exists for everyone. Our position here
in your Lordships’ Chamber gives us an extraordinary ability to make choices over every single aspect of our lives. We are privileged; we should not assume that everyone is in the same position as us. It is difficult to measure whether choice is being freely given or not. Will two doctors really have time accurately to assess this? For many people, life is something that happens to them or even passes them by. They have no choice—and, soon, they could have less.
The Bill suggests that people could be offered other alternatives—but what if you live in the wrong postcode or no alternative is available? Then there appears to be only one choice. In essence, it would be licensing assisted suicide within the National Health Service. The Bill does not contain safeguards; it has initial criteria, and no detail how those will operate. The Secretary of State may, if he wishes, issue a code of practice.
Some in favour of this Bill are expecting a Hollywood death, where you slip away, versus what is otherwise portrayed as a bad death. People need to know the practicalities of what this change in law could bring. Will it be at the exact time of their choosing? Will it be at home, or with family close by, or are there going to be a number of Dignitas-style facilities around the country? Peter from Redcar wrote to me and said that he believed it was the first step to euthanasia, especially as it coincides with current economic times.
We continually hear that this Bill is based on Oregon, not on Holland or Belgium, and we have been told that it is a modest Bill for a handful of people. Oregon is smaller than Yorkshire. Of course, the numbers are small, but there is a rising trend, and no audit is carried out about how requests for assisted suicide are handled. In 2012, the population of Oregon was 3 million, compared to 56 million in England and Wales—so we could be looking at 1,600 people per annum. This is not a modest number. I was very interested to listen to the noble and learned Lord, Lord Falconer, on Radio 4 this morning, and I am sorry that he is not in his place at the moment—
Baroness Grey-Thompson: Apologies—the noble and learned Lord is not in the place where he was sitting earlier. I listened with great interest to what the noble and learned Lord said. He must stop being reluctant to discuss the precise figures. People need to know how many people this may affect.
Professor Theo Boer, a regulator of Dutch law, said that recent developments and extensions were not intended by the legislators who drafted the original law. We should listen to him.
Why are people worried? It is because many disabled people are not terminally ill. However, many terminally ill people experience some sort of impairment and there is a great deal of confusion around that. There is a myth that our lives are so tragic or painful that we must want to end them. Just this week I was told, “You must have wanted to kill yourself many times in your life”. No, I have not. I have experienced excruciating pain. When I was 19, I snapped a metal rod off my spine that came out through my skin, but I have never
considered killing myself. The fact is, however, that many people expected that I would ask for that. What if those people were related to me?
Becky got in touch with me this morning and said that a doctor very recently told her—I quote verbatim—“You cost the NHS too much money. It would be better off if you were dead”. A mum wrote to me to tell me about her son who, at a low point in his life, expressed a desire not to carry on. She checked the criteria in the Bill and found that he would qualify. He is not terminally ill, as we think about it—he has severely complicated diabetes.
Some of the cases highlighted in the media concern people who are not terminally ill and would supposedly not fit the terms of the Bill. However, this raises concerns that this is just the tip of the iceberg or an attempt to soften public opinion. The charity Care has shown that those who support the Bill in principle change their mind when they are presented with the reality of assisted suicide. Then the percentage of those who support it drops from 73% to 43%.
Finally, the noble and learned Lord, Lord Falconer, wrote in his own inquiry, when referring to whether this provision was for disabled people:
This is why I and many others are deeply worried.
1.21 pm
Lord Young of Norwood Green (Lab): My Lords, I have listened carefully to the 45 contributions so far. When I have been out of the Chamber briefly, I have watched them on the screen. I regret that I have to disagree with, the noble Baroness, Lady Grey-Thompson, whom I have come to respect and regard as a friend, as I do the noble Baroness, Lady Campbell. We do not often disagree and I deeply respect their views and concerns. However, I have to say that they do not represent the entire disabled community. There are other views, as the noble Lord, Lord Baker, drew to our attention. Therefore, I have to balance my feelings of friendship and concern with what I have just heard.
I make it absolutely clear that I support palliative care. It is a mark of our civilised society that we do not push people out into the snow in the winter and say, “Well, that’s your lot”. However, there are limitations to palliative care. The most reverend Primate, who, unfortunately, is not in his place, gave us a moving account of someone who was helped through the most difficult period of their life. However, that does not gainsay the right for people of sound mind to have the right to choose to end their suffering. I believe that having that choice is a fundamental right.
We have been reminded that the church is not absolutely solid in its conviction on this issue. Archbishop Tutu, the former Archbishop of Canterbury—the noble and right reverend Lord, Lord Carey—and, more recently, the Bishop of Buckingham, have all said that they have changed their minds, and I can understand why.
We have heard very genuine concerns about whether this is the start of a slippery slope and about the position of vulnerable people. Of course, I share the
concerns of everybody else in this Chamber. During my brief ministerial career, I learnt that there was no such thing as perfect legislation. However, that does not mean that the situation cannot change. We are not embarking on a voyage that no one else has tried before. Noble Lords, including the noble Baroness, Lady Meacher, in her careful, forensic examination of what has happened in Oregon, have shown that this has not proved to be a slippery slope. The statistics may be different in different circumstances but they are there and this practice has taken place over a long period.
I do not claim to provide an answer to all the concerns, but I make a plea that we should not make sweeping allegations that cannot be substantiated and which, in many cases, unfortunately, are anecdotal. I have great respect for the noble Baroness, Lady Finlay, but I winced a bit when she said that the Bill was within a whisker of promoting euthanasia. That does not help us to have the kind of debate that we should be having. I also have great respect for my noble friend Lord MacKenzie, but he said that the Bill would trample over the Hippocratic oath. I do not believe that it would. I do not believe that the vast majority of doctors and nursing practitioners in this country would see the Bill as a blank cheque, as someone described it. It will not transform the landscape. Those people will continue to maintain their position. I am glad that my noble and learned friend Lord Falconer brought this legislation forward.
People have said that the current law is sufficient. However, that is not what the Supreme Court felt, or at least it felt that the matter was worthy of examination. I do not profess to have enough legal expertise to decide whether or not that is the case, but we have been invited to address this issue and we should do so.
I am glad that there seem to be a lot of signals that the Second Reading of the Bill will not be voted down, unlike what happened on the previous occasion on which we debated this issue, and that we will have the opportunity to address some genuine concerns that have been expressed here today. I look forward to that opportunity and thank my noble and learned friend Lord Falconer for giving it to us.
1.26 pm
Baroness Nicholson of Winterbourne (LD): My Lords, I offer three short stories to illustrate the false thinking behind this mistaken Bill.
The first takes place in a dark private room in a famous nursing home. I am the visitor beside the bed of a very sick, motionless and almost speechless friend. In comes a doctor who, during a brief two-minute patient record check, comments loudly that this patient would be better off dead. Five minutes later, an agency nurse comes in. I thank her for her work to ease the patient to a more comfortable head position. She answers, “This patient should be dead; we need the bed”. I murmur an objection, fearful that the patient can hear and will feel distressed. The nurse replies, “All these old people taking up NHS space should not be allowed to survive. Those beds are needed for the living”. The wish to dispose of the old is prevalent in
our society. We must fight it and not succumb to its throttling embrace through death on demand, which underpins this Bill.
Another night, another private room—this time in a famous NHS teaching hospital. The patient asks for more curative action from the nurses. The doctor explains that no more remedies are available and that all curative channels have been exhausted. The patient, understanding, asked next for palliative care. That never came; instead, the executioner—the youngest nurse—came with the dose of death. I realised that I, the visitor, was witnessing an unrequested, enforced and medically authorised killing. It was not a comfortable death and it left behind an overhanging sense of personal guilt for all, and of mistrust of the health professionals—another fundamental weakness of this Bill.
A third and final tale concerns the great Lord Tonypandy, formerly the much loved Speaker of the other place. His stomach cancer, he was told, was terminal. “How long?”, he asked, and was told, “You have still three weeks to live”. As he lay on his bed across the river, gazing from St Thomas’ at this Parliament, where he had given so much service to us all, an ancient Roman Catholic priest came as an unknown visitor to him, a lifelong Methodist. A real miracle took place and later that afternoon doctors declared him in full remission. His life, and joy in being alive, continued for another 20 years.
Doctors, as they are the first to say, are not God. They truly cannot tell when death will steal upon us. That argument underpinning this Bill is also false. Nor will the doctors act as the executioners themselves: the nurses will be instructed to act, or, more likely even, the untrained, unmonitored health assistants. The rigorous overview the Bill offers will not take place in the cash-strapped, overworked NHS. I do not want our trusted NHS to turn from being the National Health Service into the national death service—the change that this Bill offers. As for pain and caring for the acutely ill and dying, just five minutes walk away inside St Thomas’, I found the Lane Fox ward, the ultimate in NHS hospital permanent palliative care. It is calm, welcoming and staffed with brilliant professionals, where the memory of the late Lady Lane-Fox is gleaming. The patients have real lives, and each one exhibits personal value despite their highly vulnerable medical conditions.
Do not use my taxes on the proposed state death department, with its inevitable growth in records of hits and misses, of targets and bonuses for each bed emptied. Instead, spend funds on replicating the best of care offered by the model across the bridge, by the hospice movement and other home-based forms of GP-led patient care. I profoundly oppose this Bill and strongly oppose the thinking behind it for the malign actions that it would create.
1.30 pm
Lord Moser (CB): My Lords, I want to make two points. First, speaking as a statistician, I want to refer to a number of recent social surveys on this subject. They all come out with between 75% and 80% in favour of a Bill along the lines of today’s Bill. The
leading organisation, the National Centre for Social Research, in its last survey two years ago, reported 81% in favour. This is just to highlight public opinion on this subject, which clearly ought to be in our minds today.
I have long been interested and concerned about this incredibly complex and important topic, have spoken in a number of recent debates here, and confirmed my views elsewhere. On balance, I am totally in favour of the Bill of the noble and learned Lord, Lord Falconer, and I am sure that when we have detailed, proper debates on the subject, we will be able to amend and improve it.
However, I pick out one crucial issue. I am now in my 90s and obviously think even more about this difficult subject. As I do so, I have not the slightest idea about how I would feel if I were unfortunate enough to suffer from a terminal illness, apart from the obvious suffering, which, if at all possible, should be avoided. One thing I know for certain, however, even at this stage, is that I would want to have a choice—a clear, voluntary choice. If there are ways out of such a terrible situation, I would not want to be blocked by the law—which is the present situation—and would, to put it mildly, be very upset.
In short, among all the issues that have already been well covered in this debate, the one that I would pick out for sure is that if and when anyone gets to the position of having a terrible, terminal illness—given all the safeguards in the Bill—they should have every possible choice and no legal barriers put in their way.
1.34 pm
Baroness Cumberlege (Con): My Lords, my interests are declared in the register. I am aware of my limitations. I am not a philosopher, a theologian or a humanist. What I do understand is the health service. As a GP’s daughter and someone engaged in the NHS, social services and charities, I have seen the services from many different angles. The people who work in the health service have to be practical, highly skilled and very busy. They are ready to make bold decisions and are always trying to do their best. We have a public who expect the health service to always get it right, and when it does not do so they frequently sue. We want things to be medicalised—bad behaviour, obesity, and alcoholism. We are squeamish about death, and this Bill seeks to provide a solution—a gagging draught of poison to sort that one out.
So what are the realities of this Bill? The hope that the GP, who has known us all our life, will spend three or four sessions counselling us about our expectations of life and death is pie in the sky. Most people are registered with a practice, often a large one, which is open five days a week for 10 hours. Any doctor may see us. The doctor of our choice may, allowing for holidays and training courses, be available for 25% of the hours in a year. With a list as long as your arm, time for long, philosophical chats and analysing medical uncertainties is really not on.
Granny and Grandpa have made their wishes known. They have signed papers. Then what happens? They say: “Well it’s best done in hospital isn’t it? After all they know best. We wouldn’t like it at home, it’s not
nice”. It is realistic to expect that 80% of those being put to death will be in hospital. There will be a lovely ward with beautiful murals, piped music and easy access to the undertaker set apart from the main hospital whose business is caring and cure—and the budget is out of control. Wait for the great scandal. More legal doses are given at weekends when staff are short, tempers frayed and the drunks are rolling in, causing mayhem. Doctors are busy. They will sign death certificates en bloc for trusted colleagues. The doctor who questions will be sidelined. It was not meant to happen but it is practical. The same will happen with the high hopes of the Bill. We are not talking about a slippery slope. This is a glacier. Doctors are wary because they know the realities; try as they might they may get it wrong. We gave up executing murderers, in part because, on occasion, we got it wrong.
The NHS is magnificent but it loses notes and muddles patients’ names. Bits of paper saying “Please put me down” will end up in the wrong place with the wrong person. If we extrapolate the Dutch experience, we would expect up to 40,000 deaths per annum in seven or eight years’ time. Is this really the triumph we seek? Is this compassion? Is this humanity?
Most of us subscribe to our local hospices, a movement started by Dame Cecily Saunders that has inspired similar work in the rest of the NHS, led by the noble Baroness, Lady Finlay. It is they who show true humanity. They bring goodness to death, whereas this Bill brings only despair. In practical terms, would we prefer to die in the arms of one who cares for us, or be administered with venom by a licensed killer?
1.38 pm
Lord Rea (Lab): My Lords, I take a rather more optimistic view of the National Health Service than the noble Baroness. I speak as a retired GP who now supports the Bill.
Assistance in ending a life is of course rejected by the official voices of the medical profession. However, there are signs of change among the membership. All noble Lords will have received the letter from Sir Terence English—former president of the Royal College of Surgeons—and 26 other distinguished doctors. They are not satisfied with the current state of the law and back the provisions of the Bill. They feel, as I do, that this is a humane Bill.
The well known phrase based on the teachings of Hippocrates, which guides the work of doctors and nurses, and often quoted in French,
“guérir quelquefois, soulager souvent, consoler toujours”—
to cure sometimes, to relieve often, to comfort always—applies particularly at the end of life. However, some people, even if their pain is largely relieved by good palliative care—the best, of course, is excellent—still clearly and logically wish to end their life because its quality is so poor, with no end in sight. Of course, depression may play a part in this, as was pointed out by the noble Baroness, Lady O’Cathain. In some cases good medication and psychological support can sufficiently lift their pessimistic outlook, and of course efforts must be made to identify where that is the case.
However, there remain others of sound mind, who are not clinically depressed and clearly and logically have decided that they have suffered enough and want to end it all.
I can understand why palliative care givers are very reluctant to accept that helping to end a life can, in a small minority of cases, be the ultimate and appropriate form of compassion. Judging by the Oregon experience, this minority amounts to 0.2% of deaths, which if applied to the UK would work out at some 1,000 deaths annually. These people would have died soon in any case, but often in pain and distress, not where and when they chose. The Bill would allow just that.
It is normal practice for your Lordships’ House to allow Private Members’ Bills to have a Second Reading. I hope the House will continue that tradition today.
1.41 pm
Baroness Warnock (CB): My Lords, it seems to me obvious that the law has to be changed. We are often told that it works well, but the trouble is that Directors of Public Prosecutions change and the law is not stable. The guidelines are therefore not stable and uncertain. It is clear that we do need to change the law; that is what we are being offered in the Bill.
It is sometimes said by those who are hostile to the Bill that the number of people involved is very small and therefore those people who are suffering have to be sacrificed, as it were, for the sake of the common good and for the rest of society because of our attitudes to the dying and so on. However, it is not completely clear to me that the numbers are so small. They are certainly not particularly small at the moment as palliative care is not, alas, available to everybody. It has been estimated that there are as many as 30,000 bad deaths a year for those who have no access to proper palliative care. Even if the numbers were much smaller than that and even if palliative care were evenly distributed and easily accessible, it still seems to me very hard to say that we know people are suffering but they have to put up with it as any attempt to alleviate that suffering will adversely affect an uncountable number of other people who will be put at risk. That is the core of a great many of the arguments that we have heard.
On that point, the older one gets the more one is told that one is vulnerable. Of course, everybody is vulnerable as far as that goes, but there is one form of vulnerability that I do not fully understand. It is somehow thought to be wrong that people who are approaching death and are terminally ill should take into account the suffering, expense and misery they are causing to their family as they are being a burden. Of course, they are also a burden to the state. Why is it that this is thought to be a wrong motive, or part of a motive, for wanting to end one’s life when it is coming to an end anyway? I totally agree with Matthew Parris, who wrote in the Times on Wednesday that if he were terminally ill that would certainly be a large part of his motive for wanting to die. I completely agree. For all of one’s life up to that stage, altruism is regarded as rather a good thing, a virtue. If one sacrifices oneself in a modest way for one’s family, that is also thought virtuous. I do not understand why one should not be
allowed to exercise that virtue at the very end of one’s life, and not have it assumed that this is an idea that has been put into one’s head by somebody else. It is not; it is there already.
Finally, there is a point that is quite difficult to make. People sometimes talk as though life were a kind of stuff, which perhaps has been given by God, but whether it has or not, it is a kind of stuff that is valuable in itself, rather like water. We might well be told to save water at all costs. There is no life whatever that is not lived by some living creature. If a person, a human being, has decided that his life has no value, that he does not like it and that it is hateful to him, then he and he alone is in the position to say whether it is valuable. I do not think there is such a thing, such a stuff, as life that is abstract and common to everybody. Everybody has his own life and values, each for himself.
1.46 pm
The Lord Bishop of Bristol: My Lords, many of us will speak today in the name of compassion, but, as is clear, we shall take very different views in terms of what compassion looks like in relation to those who are suffering unbearably and, in particular, as to whether my noble and learned friend Lord Falconer’s Bill is fit for the purposes he and his supporters pursue with such vigour.
I am neither a doctor nor a lawyer, but for some years I was a chaplain to a hospice at home. There I observed people who were able to die well and free from pain. What I consistently saw there was both affordable and effective palliative care.
Many of us who are opposed to the Bill are greatly concerned by the unintended consequences that it will inevitably bring into play. It is simply not good enough for those who support the Bill to dismiss out of hand this genuine concern. It is for them to give us consistent evidence that our fears are unfounded. Sadly, the available evidence appears to raise, rather than allay, anxiety. The rising numbers in applications for assisted dying wherever the law has been changed are clearly worthy of note. I note that the supporters of the Bill quote Oregon but are strangely silent on the Netherlands. Let me quote directly from a Dutch ethicist, previously in favour of assisted dying, who said that the rise in the numbers has been driven in part by some form of assisted death becoming the,
“‘default’ mode of dying for cancer patients”.
In Oregon, the percentage of referrals for psychiatric monitoring to aid the assessment as to whether a person’s decision to take their own life is from a “clear and settled intention” has fallen dramatically. That is in spite of the reality that almost 60% of those who express a wish to die suffer with issues of depression.
There is surely a rightful concern that some people will be put under severe pressure to request the right to die with assistance. My noble and right reverend friend Lord Harries of Pentregarth has already mentioned that, in Washington, 61% of those who requested the necessary drugs did so because they did not want to be a burden to their families. Which one of us does want to be a burden to our families? It is a common reflex
not to want to involve our families in our ongoing care, but it is also a reflex that is capable of ready manipulation by others.
We need time to think again. My sense is that we need to halt the progress of this Bill and I agree with my colleague the right reverend Prelate the Bishop of Carlisle in calling for a royal commission with a balanced membership. Theo Boer, who has already been quoted, is a member of the regional review group on euthanasia in the Netherlands. Having previously been a supporter of the legislation, he advises us in this way:
“I used to be a supporter of legislation. But now, with twelve years of experience, I take a very different view. At the very least, wait for an honest and intellectually satisfying analysis of the reasons behind the explosive increase in the numbers. Is it because the law should have had better safeguards? Or is it because the mere existence of such a law is an invitation to see assisted suicide and euthanasia as a normality instead of a last resort? Before those questions are answered, don’t go there. Once the genie is out of the bottle, it is not likely to ever go back in again”.
Noble Lords will be pressured to vote for this Bill because not to do so would be lacking in compassion. But the route suggested by the noble and learned Lord, Lord Falconer, is not the only way to alleviate the suffering of patients and relatives, and it is a route certainly fraught with danger and uncertainty.
1.51 pm
Baroness Royall of Blaisdon (Lab): My Lords, I emphasise at the outset that this is a matter of conscience. It must never be a party-political issue and I am of course speaking in a purely personal capacity.
I am a long-time supporter of Dignity in Dying and I welcome this opportunity to debate these issues, which are of fundamental importance to our society. I respect the strongly held views of those on both sides of the argument and those who are still wrestling with the complexities. The noble Lord, Lord Cormack, is absolutely right when he says that we must treat each other with respect and tolerance. We have already heard, and we will hear throughout the day, extraordinary and moving testimonies. We will hear of people’s fears, we will hear of faith and we will hear of hopes for a change in the law, but it is right and proper that we are debating these issues. They relate to all of us and to every member of our society.
As has been said, the Supreme Court recently asked Parliament to address this issue and the House of Lords is the right place to do this before our elected representatives deliberate on these issues. We have the freedom to speak without the constraints that elected office can sometimes bring and many of us have the experience of death that comes with age. Four minutes per intervention is adequate for this Second Reading, but this Bill is of such profound moral significance that it requires detailed examination and line-by-line scrutiny in Committee. Society deserves no less.
Our own experiences naturally influence our views and the death of my husband was one of the deepest influences on my life. Many years before Stuart died, we used to talk about death, including with our children—it is part of life. But I am still afraid of death—my own death and the death of others. Stuart and I agreed that, if people are terminally ill and have a very short time to live, they should not have to suffer.
When I voted in favour of the Joffe Bill in 2006, my husband was right behind me; it was not a decision that I took alone.
When Stuart was diagnosed with terminal cancer, these conversations were interspersed with tears, but there was also a great determination to live and to savour every moment that we were given together. However, despite the care of the NHS, the operations, the treatments and a drug trial, the pain increased and he got sicker. Having said that, when he died, he was not ready to die—we were still making plans for the future and at that stage he certainly would not have chosen to die. But I know—not from intuition but from our conversations—that if the disease had continued to ravage his body and if assisted dying had been available at the time, he would in due course have wished to exercise that choice. As it was, death arrived when we still nurtured hope.
A Christian friend had terminal cancer and was receiving superb care in a hospice but she was ready to die. This had nothing to do with being a burden—she wanted to die. Millions will not want to die; they choose life. Quite rightly, the will to live is strong, but the few people who wish to die should, in my view, be allowed to choose to do so. To be in favour of assisted dying is not a criticism of palliative care—it is not a question of either/or. Palliative care is often, and should always be, excellent. The noble Baroness, Lady Finlay, has ensured huge advances in this area and I pay tribute to her tremendous work. Nor is this a criticism of hospices, which have my strongest support. Palliative care and end-of-life care must be improved. Notwithstanding the quality of end-of-life care, some people in the final days or weeks of a terminal illness wish to end their protracted suffering or anguish, and they wish to exercise their freedom to die with dignity. When you have a terminal illness and you are in pain, it is not a weakness to want to die. I do not accept the vision of despair outlined by the noble Baroness, Lady Cumberlege, although of course she is right to express her views.
Of course, there must be the strongest safeguards and most robust protection for the vulnerable. That is why this debate is invaluable, bringing the most difficult issues to the fore so that they can be properly explored. It has also been the catalyst for a wider debate in the country, but ultimately this must be a matter for Parliament. Politicians have a responsibility to discuss these issues. I think that the Bill provides the necessary safeguards and protection and, while the proper arguments that have been made about a slippery slope must be considered, I am not persuaded by them. However, these are precisely the issues that must be explored in depth. I would say to my noble and learned friend that undoubtedly during our deliberations some changes to the Bill must arise, but I support the Bill. For me, the goal must be to allow people who are suffering at the end of their life to choose to die. This, I believe, is a matter of compassion and human dignity.
1.56 pm
Lord Hameed (CB): My Lords, there is already a “right to die”. There is nothing in law to stop us dying if we wish to do so. We hear a lot of talk about people
being kept alive against their will, but there is nothing in law to prevent a patient from telling a doctor that he or she does not want to continue with life-saving treatment. Indeed, a doctor who continued with treatment in the face of such a request would be guilty of an offence.
However, this Bill is about something else. It is not about giving us a right to die; it is about licensing doctors to involve themselves in deliberately bringing about the deaths of some of their patients. We sometimes hear the argument that, if it is acceptable for a doctor to withdraw life-saving treatment at a patient’s request, it should be equally acceptable for a doctor to comply with a patient’s request to be given lethal drugs. But there is a world of difference between the two situations. A refusal of further treatment is not the same as a suicide wish. A patient refusing treatment is accepting that nature should take its course. When a doctor complies with such a request, he or she is not withdrawing treatment in order to end the patient’s life. Intention is vital in such matters.
It is claimed that doctors sometimes end the lives of seriously ill patients on the quiet because the law would not allow them to do so. An assisted dying law, it is claimed, would introduce regulation into this area. The evidence for this is scanty and in some respects the reverse is true. The most authoritative research on the subject, by Professor Clive Seale, has concluded that such illegal action by doctors in Britain is—I quote his words—“rare or non-existent”. By contrast, other research has indicated that, where assisted dying has been legalised, the incidence of illegal action by doctors—that is, ending the lives of patients in a way not allowed under the law—is higher.
We should remember that laws do more than just regulate. They also change the culture. A law that says that it is acceptable for doctors to involve themselves in bringing about the deaths of this or that group of patients—in this case, people who are terminally ill—sends the message that this or that group should be seen as candidates for death rather than as patients to be cared for. The clinical ban on ending life may not suit every patient all the time, but it is necessary if we are to be able to place our lives in the hands of doctors with confidence and without fear.
2 pm
Lord Cavendish of Furness (Con): My Lords, I oppose the Bill as it stands, as I have opposed similar measures in the past. I am happy to accept the poll findings that suggest that there may have been a shift in public opinion towards the noble and learned Lord’s Bill and that social attitudes have changed. Against that, of the 30 informed and reasoned letters that I received in one post last week, 28 asked me to oppose the measure and only two, including one from the noble Lord, Lord Joffe, urged me to support it.
My contention is that, while the Bill may offer something for a tiny minority, it will add fear and distress for a vulnerable majority, exposing them to the risk of coercion, whether it is real or perceived. I also take issue with the noble Viscount, Lord Craigavon, who seemed to suggest that those of us on this side of
the argument felt that there was virtue in suffering. I have to say that I have not heard a single speaker on our side making that point.
My interest in this subject, which I declare, stems from my experience as a founder of St Mary’s Hospice in Ulverston, Cumbria, more than 20 years ago and my subsequent close involvement with it. The hospice movement has changed attitudes to death and dying. Rather as the service of baptism traditionally invited the local Christian community to share in the responsibility of a new life, so now do communities through ownership of their local hospice share in supporting those taking leave of life, which echoes a point made by my noble friend Lord Mawhinney.
There is a modern tendency to speak of the great issues that face mankind as though they have never been talked about before. It seems to me that a sense of history enjoys less respect than it used to. When I turned to history, I found it instructive. From the ancients to the present day, assisted dying has been the subject of, if not furious debate, thoughtful debate. Then, as now, it was nuanced. Then, as now, opponents examined the question of unintended consequences, which has been so often mentioned by your Lordships. Mercy killing—a loose translation—was illegal in ancient Rome, but there were exceptions. The younger Pliny supported it, as the noble Earl, Lord Sandwich, told your Lordships. Pythagoras and Hippocrates opposed it. Francis Bacon deliberated it and appears to have reached a conclusion that what was wanted was better palliative care. While Thomas More’s Utopia appears to recommend euthanasia, his book was intended to be a work of satire.
In the past, supporters of assisted dying often felt compelled to introduce a rationale, as with Plato, who said:
“Mentally and physically ill persons should be left to death; they do not have a right to live”,
or Nazi Germany, which replaced the Hippocratic oath with an oath to the health of the Nazi state. Among those whom they put to death were crippled children and patients described as “useless and unrehabilitative”. Noble Lords should note the language. There is a historic tendency to make judgments as to the merits of those whom they wished to kill.
This Bill ignores the aspirations of those who want to live but who fear approaching old age, illness and death. That fear can only be exacerbated by the perception that public servants are to be accredited with a licence to kill them. What a glorious dawn it was that saw the end of capital punishment. As a young man, I remember feeling an enormous release. How dispiriting now I feel that we are considering once again a proposal to empower agents of the state to bring lives to an end.
A thread running through the centuries-old debate is a consensus that the issue is not easily resolved by laws and lawmakers. Our forebears often recommended forgiveness for those who helped the stricken towards a merciful end. In essence, that is what we have now. Since noble Lords better qualified than I remain unconvinced that acceptable legal safeguards are in place, I conclude that this Bill not only lowers the value that society places on human life, but takes us into unknown and dangerous territory.
2.04 pm
Lord Aberdare (CB): My Lords, I support this Bill. The primary reason is purely personal and I can speak only on a personal basis. I would certainly wish to have the option provided by this Bill if I ever find myself in the quite limited situation that it addresses, although I fervently hope that that will never be the case. I believe that I am responsible for my own life and how I live it, including the right to end it if I find it no longer bearable.
My mother and mother-in-law both had long-drawn-out deaths, which in the case of my mother-in-law was accompanied by great suffering. In the end, both took the only way out that they could by starving themselves to death. Neither would have benefited from this limited Bill, but their experience has been crucial in forming my views. So have the stories I have heard of so many others who have endured deaths of almost unimaginable pain and misery for themselves and their families because they have not had it in their power to end it and cannot legally call on others to help them. I think particularly of an article that Prue Leith wrote in the Telegraph some time ago about the death of her brother.
A key question for me is whether the safeguards in the Bill are strong enough to protect vulnerable, elderly, sick or disabled people, or those who may be open to some form of coercion to persuade them to die. To be eligible for an assisted death, a person must have a prognosis of six months or less of remaining life. They must be mentally competent, have a “clear and settled intention” to die, have made their decision voluntarily without external pressure, be well informed about alternative options and be given time to reconsider their decision, which can be revoked at any time. All those requirements must be certified by two doctors acting independently. One of the merits of the Bill is that these judgments have to be made before the death can take place, rather than any suspicious circumstances having to be investigated afterwards.
In my judgment, the proposed safeguards seem to provide an adequate basis to ensure that the Bill can be used only in the limited circumstances for which it is designed. No doubt they will be thoroughly tested and I hope improved in Committee, which I welcome. No one can have listened to many of the powerful, deeply felt and well informed speeches today on both sides of the issue without seriously re-examining and retesting their own views. Similar arrangements to those in the Bill have worked well in Oregon for 17 years. The number of assisted deaths, at 0.2% of all deaths, is not out of line with what one might expect as reasonable. Research shows that the law is working safely. Other states are beginning to follow Oregon’s lead.
We have been clearly told by the Supreme Court that the present law is not working and that parliamentary guidance is needed. This Bill gives people in the very last stages of life the option of making a voluntary decision to shorten the process of dying that they feel they can no longer bear. Above all, the Bill seeks to offset the appalling cruelty of forcing people and their families quite unnecessarily to endure an agonising
final period of life in the face of their often desperate pleas to help them to end their suffering. It is surely time to listen to those pleas.
2.08 pm
Lord Winston (Lab): My Lords, this is an eloquent and emotional debate. It has to be emotional because, essentially, the decisions that we make in this debate are largely emotional ones. Unlike the noble Earl, Lord Glasgow, I do not think that this is a small Bill; it has massive implications. I have spoken before in your Lordships’ House about the experience of my mother. She was a brittle diabetic who, in the last six years of her life, was regularly admitted to hospital, often unconscious, in various degrees of decay. She was a brilliant woman, an amazing public speaker, a great mayor of a borough of London and an extraordinarily good thinker. But no one would have thought that had they seen her in bed in one of our local hospitals. She was never in a single hospital; she went to at least three during her diabetic episodes. What I am going to say about her experience under the National Health Service is not specifically directed at any one hospital, it is a universal experience, which is widely seen by many elderly people who cannot impress themselves on others in the ward.
In the four-bedded ward where she was last admitted, two patients were lying in their own excrement and urine for at least an hour, even though when I was visiting I pointed it out to the nursing staff. Food was supplied, but not actually fed to the patients who could not feed themselves. In my mother's case, she often missed her insulin as a diabetic and of course not having regular food did not help her diabetes. Drugs were frequently not given. But the key issue is shown very simply by a matter-of-fact thing that we see again and again with old people who are addressed invariably by their first name and not given respect in hospital as old people.
The problem is the attitude of staff, and attitudes such as this will get significantly worse with the increasing pressures that we are bound to have in healthcare in our National Health Service. No matter what the noble Lord, Lord Aberdare, has just said, you cannot regulate against attitude, nor can you regulate against the attitude of patients who feel increasing anxiety in hospital or when they are not well.
Perhaps I might indulge myself briefly to tell noble Lords about my mother's death. For the last two or three years of her life we decided absolutely, given that there was modest and not inadequate medical care, that we would leave her at home and see to her ourselves and rotate regularly being with her. There was a 40-minute moment before her death when my mobile phone rang and it was my youngest son, Benjamin, who was with my mother in her bedroom. He said, “Dad, I don't think Granny is very well”. “Tell me what is wrong”, I said. He said, “She’s not speaking”. I said, “It’s possible, Ben, that she might have died”. He said, “What do I do?”. I said, “Stay there. I will drive as fast as I can and will be with you in the next 30 to 40 minutes. Just stay with her. You’ve been
immensely privileged and so has she because she loved you very much and you are the last person she saw and she is the first person you have seen in this situation”.
I got there, and my point is that we have been talking intensively in this debate about the dignity of a planned death. I do not believe in that planned death being dignified. There is much more dignity in many ways in being able to ensure that people wherever possible die with their relatives around them in an unplanned death in the way that my mother died, with her youngest grandson present.
2.12 pm
Baroness Richardson of Calow (CB): My Lords, most of you will know that I am a Christian and an ordained Minister of the Methodist Church, but I am speaking today personally because I cannot speak for my church. In fact, it would be impossible and perhaps improper to do so because there are different opinions within that church, firmly held, as there are between all churches, faith communities, the public in general and the medical professions.
We are honourable people. We all know the same things and look at the same issues. We all face similar situations in the deaths of our own families and friends and yet we come to different conclusions about what compassion means in these situations. That is why this is a difficult debate today, but it is also why it is essential.
If the Bill is not passed, that does not mean the end of assisted dying. It will still go on unregulated, unrecorded and capable of causing great guilt and shame to those who are caught up in it and who risk suspicion and prosecution. The dying will still request and plead for help in getting rid of a body that has become a burden to them. Sympathetic doctors and distraught families will collude in bringing about death. Some will take matters into their own hands and die alone so as not to implicate others. Some will die sooner than they need to because they fear losing the capacity to be able to act later. Compassionate people will still risk prosecution and police and courts will still agonise over the motives of surviving family members.
I am a Christian. I believe in the sanctity of life. I believe that life is a gift of God to be used responsibly with respect and generosity for the good of others. We live in relationships and a community and our choices affect others as well. When the Bible says there is,
“a time to be born, and a time to die”,
we are not passive players in that. We manipulate conception, we permit abortion, we interfere with the processes of birth and we postpone death by surgical intervention and drug therapy, yet we refuse to allow the means which are there to reduce the length of the dying process, even when days of suffering and distress are not alleviated by devoted care.
Many people have spoken about the fear that the elderly and vulnerable will be put under pressure to die and not to be a burden. Of course, that is totally wrong and would be an abuse of the intention of the Bill. But it is not a reason for it not to be passed. It is the reason for it to be addressed vigorously in Committee so that we can make it as strong as it could be.
I am entirely in agreement with my noble friend Lady Warnock. Why should it be considered shameful for me to wish to protect my family and friends from the burden of watching me slowly die? If I am diagnosed with a terminal illness from which I will certainly die in a few months, I would wish to protect my family from having to watch me, from putting their lives on hold and making a rota to make sure that somebody is with me at all times. I would want to protect them from having to bear my anger, frustration and sheer peevishness, which often accompanies pain. How much better it would be to be able to say goodbye, give thanks, forgive and heal resentments, and share the precious moment of death together, and not for me to be left out of the wake that will happen when I have died. Is that not something that we would all choose to do—to die at home with our family around us? For the elderly, death often comes as a friend and for the religious it comes with hope and promise.
This Bill is an enabling Bill. For those who do not meet its qualifications or meet its qualifications but choose not to die, it is irrelevant. But for those people who want to die and wish to do so within the law, it is crucial. It will not be accessed by great numbers of people, and as we have heard already from the experience of Oregon, many of those who request help and have been given permission to use it do not feel the need to do so because they have been given the security, comfort and greater confidence to continue to live. But we need to make the regulations as strong as we can to put the safeguards in so that others may not fear this, and we need to do it in Committee.
2.18 pm
Lord Maginnis of Drumglass (Ind UU): My Lords, it is no secret that I oppose this Bill on the basis of both my religious faith and on my ordinary day-to-day sense of moral values—values, or what in my part of the world we used to call oul dacency. Am I not correct in thinking that that old decency is being incrementally eroded for mere financial and statistical convenience? Has intellectual arrogance totally usurped what in less interactive times was the natural progression of life?
Capital punishment ended in the 1960s but, if I remember correctly, its restoration was voted on a number of times right up until its irrevocable end back in 1998. It had involved those who had committed horrendous crimes, but we ultimately acknowledged that ordinary human judgment was inadequate to make decisions that meant the difference between life and death. I remember Enoch Powell and I being the only two in our party who consistently voted for the abolition of the death penalty or its continued abolition. It is almost 50 years since this nation decided that it was inhumane to convict people for attempting suicide, not with any view towards encouraging such an action but, again, in the realisation that our human judgment was inadequate to allow us to condemn others in such a situation.
Now we are faced with a challenge by those who sometimes feel that we have a responsibility to hasten to death those who are most vulnerable: the aged, the ill, the lonely and the neglected. However one seeks to
dress it up as a service to society, we, with some new intellectual self-assurance, are apparently no longer to be constrained by our own human frailties. How much more could we achieve? In fact, how many of us contribute or work to sustain the hospices that understand the aged, lovingly nurse the ill, comfort the lonely and tend the neglected, some of whom may say “I’d be better dead”? Our humanity, and whatever else drives and motivates our behaviour, should lead us to question our role and responsibility in such circumstances.
I doubt that I am unique in so far as I have never had, in almost 77 years of life, anyone say to me that he or she wanted to die or would want help to commit suicide; perhaps I am fortunate. In more than 90% of the letters I have received in the past week, the writers have asked me to vote against the intellectual arrogance of those who presume to play God.
I am a simple old village schoolmaster. I do not say so out of any sense of false modesty; I mean that I am not a philosopher or statistician. However, I know that I am subservient to a greater power than I possess as an individual or that I believe doctors possess. I know that many of my colleagues here feel as I do, and I am rather alarmed that we do not feel able to admit that we subscribe to a higher power when we think about life, death and our responsibility to our fellow man.
My wife and I have a family; thank God they are a good family. We have been blessed. However, do we in your Lordships’ House really want to promote legislation that facilitates the worst elements of family carelessness and greed? Should we not be promoting a more humane society and a more compassionate message? Whoever you are, whatever your problems, is it not our responsibility to make you think in your last days and hours that you are valuable and have a place? It is not our role to abbreviate that.
2.24 pm
Baroness Howarth of Breckland (CB): My Lords, after four and a half hours of eloquent debate, what do I think? Do I understand the dilemmas that are faced in this profound question: to choose the place of your death against the sanctity of life? If this profound question is causing us difficulty, what difficulty is it causing to the general public? Because many of the arguments have been made, I want to address this debate from a different angle: how, whatever we take forward, we convey it clearly and accurately to the general public.
Like everyone else, I had a huge postbag; I think that it has been matched by equal marriage and, before that, hunting. From that, it was quite clear that, alongside those who supported the Bill because they thought that they had a right to end their life—never mind whether there was six-month prognosis or other boundaries, it was about their right to end their life—the other end of the spectrum was about the terminally ill, who feared that the Bill would give credence to anyone being able to take their life if they had a serious illness. We have to do a great deal to get that clarified, not only among the general public but among professionals. Noble Lords will also all have had letters from professionals who have profound personal experiences.
Most moving today have been the personal stories, on both sides of the argument, from individuals who have felt this very personally.
I ask myself how I can free myself from any personal prejudice in order to come to some clear understanding of the concept. I am a Christian, but do I believe that suffering outweighs compassion? What do “suffering” and “outweighing compassion” mean? That is another profound philosophical argument that theologians have written volumes about.
Do I think that pain should be constant? I had a bit of bone slide into my spine 18 months ago, as many noble Lords will know. It was the sort of pain that I did not know existed. That pain taught me two things. It taught me that pain makes you extremely vulnerable. I, fortunately, was not near the end of my life, but if I had had six months to live, was ill and in severe pain, there was a point at which I might well have said, “I really cannot endure this level of pain any more”, because the drugs I was on had no effect whatever. I think I was poorly treated, but that is a different issue. The question is whether we feel vulnerable.
I felt that I had lost all my dignity. Screaming on a bed of pain when you are used to being in control of your life taught me that people who are sick and are coming to the end of their life lose their dignity. However, as the noble Lord, Lord Winston, said earlier, dignity is the one thing that we really should afford to people in this situation.
Then I thought, “If we have to weigh up these issues, surely the answer is in the health service”. We heard from around the House earlier about doctors’ different views of the health service. Although I have shared an office with her for 15 years, I disagree profoundly with my dear noble friend Lady Warnock. It is difficult for people not to feel like a burden. Just for those few months when I was ill, I felt a terrible burden on the people who cared for me. If you are old and think that you are near the end of our life, if you have a bit of money and your family need a house, there is a tremendous pressure not to be a burden.
We have to balance that with the fact that we are about to encounter a demographic avalanche. The numbers of elderly people and sick people are increasing. How will that affect the way that we view people in the future? One of the problems that concerns me more than anything else is that we become economic units rather than individuals.
My four minutes are up, and all I would say is that we still have to think through the issues very carefully. I do not like the Bill as it stands. I have known many people who have lived longer than six months after being given six months to live. We need to take a lot of time to look at the unintended consequences and our own prejudices.
2.30 pm
Lord Sherbourne of Didsbury (Con): My Lords, I have been in your Lordships’ House for nine months, and this is by far the most important subject to have come to us in that time. I support the Bill because I believe in the principle that, with the right criteria and
with the right safeguards and procedures in place, people who wish to end their lives should be allowed to make that decision for themselves. It should be their choice, and I am uneasy about saying to them, “No, you cannot decide this for yourself. We know better”.
Of course, I respect and understand the concerns that people have about the Bill. I understand, but do not accept, the argument that although the Bill could bring relief from intolerable suffering for individuals, there may be wider adverse consequences for society. I understand the fears that some people have about the “thin end of the wedge”, although I think that issue lies firmly in the hands of Parliament. I also very much understand that people have concerns about the details of the Bill. Are the safeguards strong enough? Are the procedures sufficiently precise?
However, today, I want to touch very briefly on one aspect, which was triggered by an article in yesterday’s Telegraph by the Chief Rabbi, Rabbi Mirvis, who opposes the Bill. He said:
“There is no greater value in Judaism than the sanctity of life … It is a gift from God and it is not ours to cut short. Life has an absolute value”.
He carefully used the word “absolute”—in other words, it is not qualified or diminished in any way and not relative. I stand to be corrected, but I have no reason to believe that the Chief Rabbi is a pacifist and I presume therefore that he believes in self-defence. If one believes in self-defence, you have to decide at what point the taking of life is justified to defend life; and, in deciding that, you engage in some form of utilitarian calculation. I question the Chief Rabbi’s use of the word “absolute”; as the noble Lord, Lord Alli, said earlier, there are no absolutes. Indeed, as we all know, there are many distinguished people with deep religious convictions, and many in this House, who support the Bill.
When the Chief Rabbi says there is no greater value in Judaism than the sanctity of life, we understand and totally respect that he would never contemplate ending his own life—
Lord Winston: Has it occurred to the noble Lord that self-defence is the preservation of life?
Lord Sherbourne of Didsbury: I understand that. The point I was making was that when you engage in self-defence, you are in the process also of risking and taking life for that objective. That involves a calculation.
When the Chief Rabbi says there is no greater value than the sanctity of life, we understand that he would not contemplate taking his own. But are these people who could never contemplate taking their own lives because of their convictions saying that people who do not share those convictions should nevertheless be bound by them? Surely not, if you believe in religious freedom. All of us have our own moral beliefs, and it is society’s job to decide where morality and the law should overlap and then to shape the law accordingly. That is what this Bill seeks to do.
The Bill is so important, and the practicalities so crucial, that it needs to be scrutinised in detail. I hope therefore that it will receive a Second Reading.
2.34 pm
Baroness Butler-Sloss (CB): My Lords, I strongly agree with the last sentence of the noble Lord who has just spoken. I oppose the Bill but think it is extremely important that it should go to Committee. I declare that I am a vice-president of the Exeter and east Devon Hospiscare.
Many people, as many as 70% to 80%, support the Bill, according to the statistics. However, there must be many noble Lords around the House who, like me, have received an enormous quantity of mail about this. The interesting thing is that 95% of the mail that I have received has been against the Bill, expressing very considerable concerns or giving examples of why the writer is worried about the Bill. It is also interesting to remember that most of the royal colleges—in particular the Royal College of General Practitioners, whose members are the most likely to be involved in this—and the British Medical Association are against the Bill.
I did not read the Supreme Court decision in Nicklinson as in any way supporting the Bill. What it said of course, as previous speakers have said, is that we in Parliament should look at the issue. The President of the Supreme Court made the interesting point that the Bill would not help the applicant, Mr Nicklinson. Indeed, it would not help those who are most disadvantaged and crippled by serious disease or injury—for instance, those with locked-in syndrome. Anyone who could not administer it himself or did not have some device that, by a flicker of the eyelid, would do it, would not actually be helped by this Bill. From listening to the debate, which has been utterly fascinating and deeply moving, it is quite clear that we in this House are looking at a very difficult balance, which requires very careful safeguards.
My view is that the safeguards in the Bill itself are utterly inadequate. The safeguards that so many people have asked about need to be in primary legislation and not left to a Secretary of State to produce in regulations. I will just very quickly go through some of the points where the Bill is defective. How on earth are people going to find a doctor to be the attending doctor if their own GP is opposed to doing it—and the college of GPs is opposed? You will almost certainly not find a doctor who knows the patient. Then you have to find a second doctor, and both of them have to be in the minority group of those who support assisted dying and are prepared to help to kill. Is there not the real danger that there will not be an exhaustive assessment of the determination to die or a proper look at how vulnerable the individual is or at whether they may feel they have an obligation to die as they have got to an age where their family would like to have the money rather than paying for them? In order to find compliant doctors, will we end up with a sort of tick-box system?
There are also no criteria about mental ability to make the decision. How do you decide whether someone is in the first stages of Alzheimer’s? Will there be an assessment by a psychiatrist? There is nothing there. There is no register of lethal drugs and no audit of doctors carrying out assisted dying. The question marks are there and should be addressed in the primary legislation. It is absolutely clear from the commission of the noble and learned Lord, Lord Falconer, that this is certainly seen by most people as the first step.
2.39 pm
Lord Clinton-Davis (Lab): Like many noble Lords, I have received a torrent of letters urging me to vote for the Second Reading.
Passionate views are held on both sides of the debate, as has been notably evident today. But eventually one has to support or oppose the Bill. Unhesitatingly, I favour the plea made by the noble and learned Lord, Lord Falconer, for this Bill to become law. There are deficiencies. They will be addressed in Committee, I am sure. A large movement, not only of suffering patients but also of their advocates from all professions and walks of life, shares this view.
I have to declare, tragically, an interest. I took my place here in the House of Lords in May 1990. My beloved son-in-law, who was then 34 years of age, struggled to be present. He had a suicide pill with him, and that brought him some comfort. He really suffered. He died a few days later.
Then there was Jo Beecham, whom we saw on television. She is now 50. She is a much loved family friend. She wrote in the Guardian and appeared on Channel 4, and explained that she keeps a cachet of lethal, so-called medication by her side. She speaks out in favour of this Bill. There are people on the other side who feel equally strongly. I dare say that in some cases they have come to their views because of their faith. Although I do not share their point of view, I respect it. There are so many locked in this prison of hopelessness. Tragically, I saw two aunts who died in anguish. I will never forget the dreadful experience of seeing them during that time.
Palliative care can bring some relief but cannot ensure a compassionate death. This Bill has strong safeguards to prevent, as far as possible, the exploitation and abuse of vulnerable adults and pressure being put on them. I have no doubt that those safeguards can be strengthened. There is on offer for our fellow suffering humans a freedom from further acute emotional and physical pain towards the end of life when it is without quality or hope. Jo Beecham movingly inquired of her doctor, “What would you do if I were a dog?”. In my view, that said everything.
2.43 pm
Lord Hylton (CB): My Lords, I am convinced that both the supporters and the opponents of the Bill are sincere in their views. They should therefore respect each other even if they are unlikely to persuade the other side. For me, Shakespeare summed it up when he put these words into the mouth of Edgar, speaking to Gloucester in King Lear:
“Men must endureTheir going hence, even as their coming hither: Ripeness is all”.
Since those days, great inventions in medicine—for example, anaesthetics, antibiotics, palliative care—have reduced the amount of endurance and suffering that we face. Yet with the benefit of modern medicine, we should not prolong life unnecessarily.
My concern is that this Bill is likely to destroy trust—trust, for example, between patients and doctors, and between family members, whether they are carers or beneficiaries under wills or just disinterested relatives. The story of Jarndyce v Jarndyce shows what can
happen after a death. We could in future face similar problems and manoeuvres before death. I am impressed by how strongly medical opinion opposes the Bill. It has caused serious alarm also to many living with handicaps or serious disabilities. Those with chronic or progressive diseases are particularly concerned. Hitler consigned people with severe learning difficulties to the gas chamber, yet a smile from a person with such a disability can be worth a hundred words from those with full capacity. That is the experience of the L’Arche communities that I have known.
Highly qualified people have questioned the adequacy of the proposed safeguards. I suggest that we should uphold the humanity, equality and good care for all. This means not allowing the Bill to become law. It should have a Second Reading, so that it can be further tested in Committee.
2.46 pm
Lord Davies of Stamford (Lab): My Lords, I shall be very blunt. I tend to think anyway that the more important the subject, the more important it is to be direct, clear and unambiguous.
Unless we are killed by a violent accident or taken away by a massive heart attack or stroke, most of us are likely to have a slow death—slow enough to present us with certain theoretical choices. At the present time in this country, we would have two legal theoretical options available to us. One might be to mobilise the whole of medical science and technology with a view to maintaining ourselves alive for as long as possible. That is something which, when the medical profession is determined to achieve it, has some remarkable achievements to its credit. Ariel Sharon was kept alive for many years in an oxygen tent on a life-support machine, and Nelson Mandela for many months. Most people would say that they would not wish to have such an end, which is perhaps quite fortunate, because they are most unlikely to get it if they wanted it. First, the National Health Service could not afford it; secondly, partially perhaps as a result of that fact—I do not know—the general tendency of the British medical profession is not to admit terminal patients to intensive care and to discharge patients from intensive care when they reach the terminal state. I asked some Parliamentary Questions a few weeks ago about the numbers involved, and it is very striking how few people die in this country in intensive care beds compared, for example, with the United States.
In practice, there is just one choice, and it is the choice of palliative care. Palliative care is delivered with great dedication by doctors and nurses all over the country. I have some knowledge of that, having been for many years a patron of a Macmillan nurses hospice in Lincolnshire. Nevertheless, there are two particular problems about palliative care. Towards the end, when symptoms become too distressing and people are vomiting blood, short of breath, doubly incontinent and in great distress, terminal care, if death has not already supervened, tends to end in terminal sedation. Terminal sedation is a euphemism for giving the patient a dose of an opiate—usually diamorphine—or perhaps a barbiturate. It would not be sufficient to kill the patient, because that would be illegal in this country,
but sufficient to send the patient into a permanent coma. Then no further means of life support are supplied. There would be no oxygen, no antibiotics, no dialysis—in any case, hospices are not usually equipped to provide that kind of intensive support—and not even any food or water. There is no intravenous feeding at all. I have known patients who took 14 days to die in those circumstances; my mother took several days to die in that terminal coma.
The problem with the terminal coma is again two things. First, it is not always entirely honest. I suppose that many doctors try to explain the scenario to their patients very honestly. Maybe the Supreme Court’s views, expressed the other day, on the necessity of consultation will have some effect, but I suspect that the very last words that many patients hear are more often, “I’ll give you something to make you feel better”, rather than, “I’m going to put you into a coma from which you will never awake”. The latter, unfortunately, is more transparent and frank, but I understand why doctors are reluctant to say it.
The other thing that worries me is the hypocrisy of the situation. It is impossible, under the circumstances I have described, to pretend that doctors have no responsibility for determining the method or time of death of their patients. They do that the whole time. They do it indirectly or passively in the way that I have described. That kind of double-think or hypocrisy is, I say to the noble Lord, Lord Hylton, and others who have made this point, exactly the kind of thing that is likely to undermine confidence in the medical profession in this country. It is very undesirable.
There should be a second option available to us, which I make it clear I would almost certainly choose. That is the right to choose one’s moment of death—to be conscious right up to the last moment if one so wishes and to have one’s family available. I say to my noble friend Lord Winston that, if possible, if you do it in that way—if you know that you will be able to kill yourself at a particular moment of your own choosing, in your own way—you can make sure that all your family are there. That is a very important point for many of us. Then you will not have a situation with a family holding on for days while the patient is in a coma, waiting for the moment. Some of them will probably miss it because they have gone out to get a meal or something of that kind, which would be very distressing for them, quite apart from being very sad for the patient.
Therefore, I believe that the alternative that would be provided by the Bill would be the most dignified way of dying. It is certainly the way that many of us would prefer. It would not be at the expense of the choice of the traditional palliative care method that I have just outlined if patients preferred that. It would be additional. The Bill is permissive: it does not withdraw or abolish any options that currently exist, and I hope it will find favour with your Lordships’ House.
2.51 pm
Lord Carey of Clifton (CB): My Lords, I, too, echo the opinion of the noble and learned Baroness, Lady Butler-Sloss: this has been a fascinating debate and there is more to come. There have been inspiring and powerful speeches on both sides.
The noble Lord, Lord Baker of Dorking, drew attention to the article that I wrote last week in the Daily Mail about my change of mind on assisted dying. I regret enormously the shock that I have given friends, some in this House, who disagree with my conclusions, but how can I really repent of a decision that I believe more closely models and reflects God’s mercy and love? I have noted in recent years that those who accept the traditional prohibition on assisted dying tend—this used to be what I did—to conflate and simplify the terrible physical, mental and spiritual experiences of those who make that long and costly journey to Dignitas in Zurich and the normal experience of terminally ill people in our hospices. Like noble Lords, I have the greatest admiration for the work of our hospices, but even the best palliative care does not meet all needs. Dr Rajesh Munglani, the well known expert in pain management, writes that he frequently sees cases of excruciating pain that are unresponsive to powerful analgesics and can be alleviated only by very heavy sedation, to the point of unconsciousness.
I have, frankly, been shocked by the experience of those with whom I have discussed this. Let me give an illustration. Joan—not her real name—wrote to me about her act of assisting her close friend to die. Her friend was a woman suffering unbearable agonies, double incontinence and helplessness. She begged and pleaded with Joan over a number of years to help her to die. She was too ill to travel to Zurich. Joan very reluctantly agreed and, one evening, helped her friend to die. It was not an easy death because the lady was unable to swallow easily and the dose went down with difficulty. After the death, she phoned the police, was arrested and went through the experience that the noble Lord, Lord Blair of Boughton, illustrated. Eventually the DPP dropped the charges against her, but it is such cases that drive the demand for change.
Opinion polls show that at least 80% of the British population think that terminally ill adults should have the choice of an assisted death. That number includes many Christian people who believe, as I do now, that being a Christian is quite compatible with supporting the Bill. We need to bear that 80% in mind when we hear the noble and learned Baroness, Lady Butler-Sloss, saying, rightly, that our mailbag illustrates almost the other side of this. That figure of 80% of the population means that all our churches should listen to the heartlands and to what people are saying to us.
When suffering is so great that some patients, already knowing that they are at the end of life, make repeated pleas to die, it seems a denial of that loving compassion which is the hallmark of Christianity to refuse to allow them to fulfil their own clearly stated request—after, of course, a proper process of safeguards has been observed. If we truly love our neighbours as ourselves, how can we deny them the death that we would wish for ourselves in such a condition? That is what I would want.
As to those who chide me—and they have—by saying that my argument and change of heart are light on theological backing, let me tell them what my theology is all about. It is about accompanying those very sick and dying people to that place where they feel most abandoned, where they are already experiencing their own Calvary or Golgotha, and where they need
us to be with them to help them find peace of mind and to help them on that journey. If that is not theology of the best and purest kind, I do not know what is. That is why I support the Bill.
2.56 pm
Baroness Morris of Bolton (Con): My Lords, in a debate last December, I said that legalising assisted dying would mean licensing doctors to involve themselves in deliberately bringing about the deaths of some of their patients. The noble Lord, Lord Beecham, in a very moving speech, said that I was wrong, as the Bill of the noble and learned Lord, Lord Falconer, deals specifically with self-administering drugs. However, it is clear that, under the draft legislation, a doctor would become inextricably connected to the process of assisting a patient’s suicide by obtaining the approval of their patient and the supply of life-ending drugs. If this was not the case, we would not have such a Bill before us. That is why doctors’ opinions are so important when we consider amending the law. Most doctors do not want that responsibility and nor do their professional bodies. The Royal College of Physicians has stated explicitly that a doctor’s duty of care for patients,
“does not include being, in any way, part of their suicide”.
It is undeniable that there are harrowing stories of painful and distressing deaths; we have heard many today. I am not without sympathy for the intent behind the Bill. However, I fear that its very existence, with its inadequate safeguards, could lead far beyond where its supporters envisage, as has happened in other countries, to a situation where voluntary death is normalised and expanded. I worry, too, about the pressure put on the elderly and the vulnerable, and about their state of mind.
When I was 18, I broke my back in a riding accident. I was in great pain and, after being taken off morphine injections, I was prescribed distalgesics. I had been very active but now did not know whether I would ever walk again and feared becoming a burden to my parents, who were elderly. So I became very clever at not taking all my tablets and keeping a store of them, just in case. I do not think I would ever have taken them; I just wanted to be free from the pain and I was obviously depressed—an important theme picked up by my noble friend Lady O’Cathain. I was lucky: a wonderful nurse befriended me and helped me to feel positive and, after a long time, I got better.
What if, instead of me stockpiling distalgesics, a Bill to assist suicide had been on the statute book and I had been in that frame of mind? I know that my circumstances were very different from those envisaged under the Bill, but they are not too different from some of those young people who seek support to end their lives in jurisdictions that have changed the law, which started off, not too long ago, with the same intention as the noble and learned Lord, Lord Falconer. Those jurisdictions which decriminalised assisted dying and euthanasia did so because assisted dying took too long. In Oregon, some people have taken up to four days to die, and six people have woken up after being given their lethal dose. None of them had a second go.
I told my story to illustrate how, when you are in desperate pain and question the quality of your life—which is the driving force behind most patients who
seek physician-assisted suicide in countries where it is legal—that is when you are at your most vulnerable and your mental state most fragile. It is then, more than ever, that you need the best possible medical care and the full and unambiguous protection of the law.
3.01 pm
Lord Brown of Eaton-under-Heywood (CB): My Lords, I do not suggest for a moment that those in favour of the Bill, as I am, have any monopoly of compassion, wisdom, insight or humanity on the question before us. I recognise that there are powerful arguments and deeply held convictions on both sides of the debate. However, by the same token as the Supreme Court in its recent judgment recognised that, essentially, it is for Parliament rather than for judges whether and if so how to change the present law, I urge that, in circumstances such as these, with strongly held views on each side, Parliament itself should pay particular regard to the views and feelings of the public at large and, in this instance, should try to accommodate what, from my postbag and the statistics, is the substantial majority, who clamour for change. It is clear that many people are deeply unhappy with the law as it stands. We defy their views at our peril. The peril is that we lose respect for the law. That is indeed a slippery slope.
I shall say a brief word on the particular relevance of the Supreme Court case touched on by other noble Lords today. The court was concerned with two appeals which dealt with very different situations from those addressed by the present Bill. The first, main appeal concerned two catastrophically handicapped patients: the late Mr Nicklinson, his appeal being continued posthumously by his wife after he had painfully starved himself to death because his earlier appeal had been dismissed; and another man, both paralysed. Neither of them faced imminent death, but both were desperate to end their lives, which, after many years of suffering, they were each finding intolerable. The other appeal concerned somebody who wanted to end his life by going to Dignitas in Switzerland. He needed assistance from one of his carers, and he was trying to get the court to force the DPP to issue clear guidance in relation to healthcare professionals.
As your Lordships will readily see, neither appeal therefore concerned anyone in the very limited category of cases addressed by the Bill today: the terminally ill, those who can truly be said to have reached the final stage of their lives and are desperate to bring the misery of the dying process to a close. Although not directed specifically to our situation, the general tenor of the judgments—I have read them all—seems to me clearly to support the very modest and limited objective of the present Bill. None of the judges thought the present law satisfactory; all of them recognised the importance of personal autonomy—the right to choose at the end of life, as during life.
I would not want to hide the fact that some members of the court did send out, in addition, a clear message that Parliament really needs also to address the further questions raised by the Nicklinson kind of case. To
that extent, at least, the noble and right reverend Lord, Lord Harries of Pentregarth, is right. The noble and learned Lord, Lord Neuberger, said,
“there seems to me to be significantly more justification in assisting people to die if they have the prospect of living for many years a life that they regarded as valueless, miserable and often painful, than if they have only a few months left to live”.
He added that, although it was understandable that in the case of those shortly to die the decision whether to permit them to be assisted should be left to doctors, it might well be preferable in cases such as that of Mr Nicklinson to have the decision taken instead by a High Court judge following a judicial process.
I rather agree with that but, with respect, that is for another day for argument on a very different Bill, which may well come but is not before us. The present Bill, I repeat, is confined to those already dying. I cannot accept that the relief of their particular plight requires or could easily accommodate the full panoply of the High Court process. Either way, the question of safeguards should be left to Committee; the Bill should be given its Second Reading.
3.05 pm
Baroness Hayter of Kentish Town (Lab): My Lords, we have heard today the views of some doctors, but we know that their views are not unanimous. Indeed, the position of the Royal College of Surgeons was decided by just 26 members of its council, not by a ballot of its members. The BMA is against, but the BMJ is in favour. The churches have helpfully supplied their views but, as we have just heard from the noble and right reverend Lord, Lord Carey, they are also not unanimous.
I say, with enormous respect, that whatever the position of medics or clergy, the decision is not for them, much as we welcome their input and advice. Medicine has let us plan our families and, mercifully, medicine has helped our coming into the world, making it much less painful for our mothers. For our departing this world, are we really to be denied the help of health medicine—as it was, for a time, denied to women in childbirth? Historically, some Christians believed, as Genesis says:
“In pain you shall bring forth children”.
Early medics thought that chloroform could complicate births, with a very respected professor, Professor Meigs, saying at the time that painful contractions during labour were,
“natural and physiological forces that the Divinity has ordained us to enjoy or to suffer”.
Luckily, Queen Victoria would have none of that and gratefully accepted chloroform for the birth of her ninth child. The rest, as they say, is history.
The lesson, of course, is that it is the patient—in this case, the dying and their families—who we should hear: those such as Grace Hall, who saw her granddad and aunt suffer, so wants people to have life-ending medicine to self-administer when they choose; Joanna Carrie, who would like to have it there for herself; Kathleen Muir, herself a devout Christian, who does not want to hear of people having to throw themselves down stairs in order to die; Don Lane, who saw his
father suffer terribly; Mr Hood, whose wife Camilla died of lung cancer; Pearl Prisley still, in her words, “torn apart”, by not having helped her father,
“the strongest and bravest of men, a war hero”,
when he begged her to end his misery; and Garth Weston, haunted by memories of his mother’s final pain as she prayed each night not to have to face another day. The lesson surely for us is to listen to those voices.
3.08 pm
Lord Crisp (CB): Speaking 70th—or perhaps 69th—I feel privileged to have listened to so many outstanding and moving speeches today, with more to come. They have certainly given me a great deal of food for thought. Although I disagree with the Bill, I agree that it should go to Committee for full scrutiny to see whether we can find a positive way out of the very difficult problem that we are addressing. The noble Lord, Lord McColl, put it well earlier by saying—I paraphrase him, because I did not write it down—that we are trying to balance the wish to improve the situation of some people dying in great pain and anguish with what he described as the foreseeable dangers of passing the Bill.
There are very good and important principles on both sides of this argument but, in the end, it will not be decided by reference alone to principles but by looking at the consequences, the details and the practicalities. As I see it, there are some obvious benefits and beneficiaries from the passing of the Bill. First, there will be a small but significant number of people who are able to receive assistance with dying. I am sure that not everyone would be able to receive and benefit from palliative care and that is very valuable. Secondly, there will be another group of people comforted by the thought that this ultimate option will be available to them. Thirdly, I am sure that there will be others whose conditions are not covered by the Bill but who will be comforted by the thought that this is a step towards a wider right to assisted dying. I thought that my noble and right reverend friend Lord Harris of Pentregarth made the point well when he said that the arguments about autonomy apply equally to voluntary euthanasia.
If there are clear benefits, what are the downsides? First, there is a real risk that some people will be pressurised—overtly or covertly, intentionally or, crucially, unintentionally—towards choosing an assisted death. In saying this, I agree with my noble friend Lady Warnock that feeling that your care and continued living are a burden on others is a legitimate reason that someone may choose to end their own life. However, it is also a reason why people may feel unreasonably pressurised into doing so. Sadly, we know that abuse and exploitation of older people exists. I suspect that we have all had e-mails and letters describing people’s feelings and fears about precisely this.
Secondly, there is the insidious impact on the valuing of life and therefore on how society sees disabled and dying people. My noble friend Lady Campbell explained this very well. The point has also been made about people being depressed. I would add the other side of that equation, one which we all know from working and caring for older people and people in the last stages of their life: the importance of offering them
reassurance and morale boosting and making that, wherever possible, a positive experience. We should also take account of the cultural point made by the noble Lord, Lord Mawson, which I do not think has been picked up by anybody else: that people from different cultural backgrounds within our society will see this differently and behave differently, and that pressures will therefore be applied differently. The noble and learned Lord, Lord Falconer, made an excellent opening speech but he dismissed these fears rather lightly. I would like to see him acknowledge them properly and give us his estimate of how large these risks and problems would be.
Thirdly, I add my voice to those worrying about the impact on nurses and doctors. This will change the relationship between clinician and patient. Do we understand properly what that impact will be?
Finally, I note and agree with the points made by the noble and learned Lord, Lord Mackay of Clashfern, and the noble Baroness, Lady O’Neill of Bengarve, among others. This is about assisted suicide and that is, at best, only part of dying with dignity. I am sorry that the slogan of “dignity in dying” has rather been taken as the marketing slogan for this debate. After all, how society looks after people in the last stages of life and how we think about death are profoundly important issues for us, going well beyond the remit of the Bill. I hope that we will return to those issues in this House on other occasions.
3.13 pm
Lord Elder (Lab): My Lords, I rise to make a couple of points. One is a sort of technical point about Second Reading and where we are with the Bill. The other is a much more personal point, as others have done before me.
On the technical point, I very much hope that the Bill will get a Second Reading today. Comments were being passed on our mail. It seems to be very well targeted, as other people seem to have had an entirely different experience. At least 80% of the mail that I have had is in approval of the Bill. I do not quite know what is happening out there but I think that the writing of letters is quite a sophisticated process. However, we may be in danger of not having got across to people what the process in this House is about.
If the Bill gets a Second Reading, the House is about to rise for two and a half months and there will be few sitting Fridays between then and the House rising for the general election. The chances of this Bill going through Committee, Report and Third Reading, even before it gets to the Commons and assuming that it is passed here, means that in reality any Bill based on this draft is a very long time away. An awful lot of the people who are writing in, at least from some of the letters that I have been getting, somehow think that this is going to solve a short-term problem which they have in their family and which they are worried about. It is not going to do that. We should try to be clear that this is the very start of what is bound to be a long and complicated process, even if it is supported.
Having said that, my main point draws on personal experience, as so many others have. Twenty-five years ago, I was dying of heart failure and I remember it
very vividly. I was too exhausted to speak or to listen to people speaking. I had to take three hours in a darkened room to recover from anything. I was hoping that I would get a transplant, which indeed I did—and here I am. However, I have always reflected on that period and thought, “Well, I wasn’t in pain but I knew that I was very time-limited”. If I had been in pain and there was a realistic prospect of continuing to live like that for another three or six months, what choices would I have wanted to consider? The fact of the matter is that I do not know what I would have done, to be honest. But I like to think that I would have had the choice, so that it would have been up to me as an individual to say, “I am sorry, but enough is enough. I want to finish it”. I would have wanted to be empowered in that way.
I am reflecting on a condition which would have given me no chance of long-term survival. In these circumstances, it is entirely sensible to look at empowerment of the individual. I think that is what the Bill does. I hope that it will be considered in detail in Committee and that we make real progress on it. I also hope that we are realistic about how long it will take but, at the end of the day, we have an opportunity here. The House of Lords is many things. People ask what we do but this is exactly the kind of debate which this House has but which is very difficult to have in another place. If we manage to get some coherent legislation through which is rational, compassionate and humane, we will have done a very good service to public life in this country.
3.17 pm
Viscount Colville of Culross (CB): I, like many noble Lords, have received a lot of letters. One of them in particular struck me. It was written by Professor Alan Thomas, who is a consultant in old age psychiatry at Newcastle University. He works with old people and vulnerable people with mental illness. He is an expert in assessing the capacity of people to make competent decisions about their healthcare. He wrote to me:
“My frequent experience is that many doctors do not know how properly to assess whether somebody is able to make decisions about their healthcare. The poor quality of such assessments is a daily frustration to me and to my colleagues”.
He added his concern about the Bill and said:
“My expert opinion is that large numbers of the vulnerable, especially those with mental illness and/or old people, are not competent but will be deemed to be competent, and killed”.
His comments go to the heart of the matter to me. If we are to give doctors the power to help kill us, we need to be absolutely sure that they and the patient know exactly what they are doing.
I agree with the concerns expressed by my noble and learned friend Lady Butler-Sloss that there are not enough safeguards in the Bill. Clause 3 specifies that the declaration has to be countersigned by two medical practitioners but it leaves who those practitioners are down to the codes of practice in Clause 8. Surely it should be in the Bill. The Mental Capacity Act, as mentioned in Clause 12, specifies that you have to prove that a person lacks mental capacity, the assumption being that everybody has a mental capacity unless proven otherwise. For a decision as serious as assisted dying, doctors need to be certain that the person has
mental capacity—a much higher hurdle to jump. At the moment, if there is any doubt about whether a patient has mental capacity, a multidisciplinary team meeting is held which includes a doctor—usually somebody who knows them quite well—a relative and, possibly, a psychiatrist. I fear that even if the codes of practice mentioned in Clause 8 specify that these people should be involved in making the decision, it is going to be hard to get them involved. Many noble Lords have mentioned the concerns of the BMA and the RCP, which say that although they support a good death, they oppose assisted suicide.
Even if you put a psychiatrist into the Bill or into the codes of practice, it could be hard to actually get them involved with the decision. The Oregon Death with Dignity Act 1994 has a clause that refers a patient to a psychiatrist if concern exists that the patient has a psychiatric disorder, including depression, that might impair their judgment. However, according to the Oregon state health department, whereas in 1999 10 patients out of 27 who were given PAS had psychiatric evaluation, in 2013 only two out of 71 were assessed by psychiatrists.
Psychiatrists can be central in coming to a correct decision about a person’s mental capacity. A terminally ill person’s mental health can be altered by the drugs that they are taking, a stay in hospital and, crucially, the onset of depression, as other noble Lords have mentioned. Depression can leave a person with an unchanged mental capacity but, as we all know, it can also radically change a person’s mental state.
In a 2008 article in the BMJ, the authors reported that in Oregon, of the patients who were terminally ill and requested aid in dying, more than 50% met the criteria for depression or met the criteria for anxiety that they were depressed. In an article for the Journal of Clinical Oncology, authors discovered that the risk of requesting euthanasia for patients with a depressed mood was 4.1 times higher than that for patients without a depressed mood.
Patients can also be deceitful about their state of mind so psychiatrists will often need to make another assessment, maybe a month later. I quite see that this sort of period can make the delay too long for many terminally ill patients, but when people are making the most important decision of their life, everyone involved must know exactly what they are doing. I disagree with the Bill and I do not support it, and I am not satisfied that that is what is going to happen.
3.21 pm
Lord Browne of Belmont (DUP): My Lords, there is much talk of compassion and choice in this debate but we must not lose sight of the core question before us. Are we prepared to license one group of people—in this case, doctors—to involve themselves in deliberately ending the lives of another group—in this case, those who are terminally ill? That would represent a major change to the criminal law of this country. I put it to your Lordships that before we can seriously contemplate going down that road, we need convincing evidence that the law that we have is unsatisfactory and that what would be put in its place would be better. On neither count has any convincing evidence been provided.
In a civilised society we do not license an action by law simply because we can empathise with it in exceptional circumstances. None of us would want to see a father who injured an intruder while defending his family sent to prison. None of us would want to see a mother imprisoned because in desperation she stole money to feed her starving children.
We would expect to see our laws against assault and theft maintained to protect all of us, and to see exceptional cases to be dealt with exceptionally. That is what happens with the law on assisting suicide. The law makes it clear that encouraging or assisting another person's suicide is a punishable offence, and it makes anyone minded to behave in this way think very carefully before proceeding. As a result, instances are fairly rare and they tend to be those where there has been serious soul-searching and where the assistance given has been genuinely compassionate and reluctant. In such cases, the law provides discretion not to prosecute. However, that is a completely different matter from creating a licensing system for such acts within the National Health Service. Would we create a similar licensing regime for other criminal acts in exceptional circumstances? I think not, so why are we contemplating it in this case?
The evidence of how such laws work overseas is, at best, dubious and, at worst, alarming. At best, we can look forward to rising death rates from legalised assisted suicide. Oregon’s rising death rate is worrying enough; it equates currently to around 1,100 assisted suicide deaths annually in England and Wales if we had a similar law here. Neighbouring Washington is showing an even more alarming trend: its death rate from legalised assisted suicide has more than tripled in four years, and is now rising so steeply that one cannot help wondering whether Oregon has been providing an untypical and unreliable picture.
Embracing assisted suicide is a problem not just because it depends on perverse constitutional logic that undermines sensible, flexible approaches to hard cases, nor simply because of the scale of the deaths that it would facilitate. It is a huge problem because of the nature of the deaths in question. Here we come to the nub of the issue: the quest for a dignified death. In the 16 years that the law has been operational in Oregon, 22 serious complications—I do not intend to elaborate on those complications today—are known to have occurred. Six people have regained consciousness and not been counted as physician-assisted deaths. If the same percentages of complications occurred in England and Wales, on the assumption of the same rate of assisted death as in Oregon, 47 people would suffer from serious complications and 13 would regain consciousness each year. Is this death with dignity?
It is fascinating to look at the way that members of the public reassess their support for assisted suicide when acquainted with these facts. This is illustrated by the ComRes poll commissioned by CARE that was published this morning, which demonstrates how 73% support to 12% opposition becomes just 43% support to 43% opposition when people are made aware of the public safety considerations. I have no doubt that those who support the Bill have noble intentions, but I must say that I regard it as a dangerous piece of legislation.
3.26 pm
Lord Sheikh (Con): My Lords, not only am I opposed to the Bill but I am completely opposed to the principle of assisted suicide. The Bill would completely change the state’s role in people’s lives, the role of doctors in care and the way in which we look at the ill and the sick. The duty of a doctor is one of care and protection of life. A doctor is trained to do that. The doctor/patient relationship is an important one. A change in the law that effectively puts state-sanctioned killing in the hands of doctors would completely change the way that the public look at health professionals.
What is more, we would be asking doctors to make a life-or-death decision regarding matters on which they could not be completely sure. First, it is impossible for a doctor to know for certain how long a person will live. This has been proven many times. Secondly, the Bill makes no legal framework for psychological assessment or coercion. Suicide is as much about state of mind as it is about state of health.
On the subject of psychological well-being, it may be that outside pressures are being exerted on a person. There may be pressure from people who have a financial agenda. The right to die can easily become a duty to die. The law should not affirm that some lives are not worth living. A vulnerable person may start to think that they would be better off dead, but those tempted to think about that need protection and care, not the right to die. No life is less worth living than another. Life is sacred.
In my own experience, I have found that illness can bring families together. Before my mother died she was very ill and indeed she felt that she was a burden. But in caring for her my family was enriched. She died with us by her side, feeling close to her family and close to God.
The insecurity of the vulnerable would only be worsened by the passing of the Bill. This is a moral choice between right and wrong, between life and death. What we are talking about today is a dressed-up version of suicide. Suicide was illegal in this country until 1961 and is still contrary to most established religions. Indeed, it is those religions in which vulnerable people find solace in their final years.
This Bill is talking about ending the lives of the terminally ill, but we cannot pretend that this will end here. If you concede this for the terminally ill, you make it more difficult to argue the case against it for others, such as those who are disabled or are non-terminally ill. I suspect that those in favour of this Bill are well aware of this fact. This is about setting a precedent.
We could spend a long time talking about the necessary safeguards to make this change of law more acceptable, but no safeguards will make it acceptable fundamentally to change the way our society looks at the vulnerable. Most medical associations and colleges are against legalising assisted suicide. I would like to add that it would be against the spirit of the Hippocratic oath.
I shall conclude by sharing with noble Lords a conversation I once had with Dame Cicely Saunders when I met her as I have supported St Christopher’s Hospice. As noble Lords may be aware, Dame Cicely
Saunders is widely recognised as the founder of the hospice movement. She recognised the important role that hospices had played in palliative care, but she emphasised to me that there is so much more to be done to improve palliative care. Instead of taking the easy way out and debating ending the lives of people who are suffering, I believe our time would be better spent discussing how the state, the medical profession and society at large could better take care of people who are vulnerable in the final years of their lives.
3.31 pm
Baroness Neuberger (LD): My Lords, as many noble Lords know, last year I chaired the panel reviewing the use of the Liverpool care pathway. It is important that we found no evidence that it had been used to hasten people’s deaths, but it was nevertheless clear that many older people, who often have complex physical and emotional needs, were frightened that it might be used in that way. The sense of vulnerability of older people, particularly in hospital, emerged time and again. Indeed, the Liverpool care pathway review only highlighted on a small scale what came out of the Mid Staffs inquiry: that where care is less than good, it is older people, particularly the most vulnerable, who receive the worst care and are the most frightened. They should be able to trust their healthcare professionals, and now, for reasons of poor care, sometimes they do not.
That is why I do not believe that the decisions about who should receive medication to terminate their own lives should rest with doctors or our healthcare system more generally. Indeed, it is unclear that doctors themselves want to be the gatekeepers for this. Although I do not entirely oppose the prescription of drugs for the ending of people’s lives in very limited circumstances, the Liverpool care pathway review and my pastoral experience have taught me to be very careful indeed about the involvement of healthcare professionals in this matter, and I would prefer to see an examining magistrate, or High Court judge, as the person who scrutinises whether a person is of sound mind and is clear that they want to do it and is not being pressurised by relatives or others. I totally take on board what my noble and learned friend Lord Brown of Eaton-under-Heywood said about the decision of the Supreme Court in the Nicklinson case, but nevertheless I think the principles apply. In that case, my noble kinsman-in-law, who is the president of the court, said:
“Indeed, it appears to me that it may well be that the risks to the weak and vulnerable could be eliminated or reduced to an acceptable level, if no assistance could be given to a person who wishes to die unless and until a Judge of the High Court has been satisfied that his wish to do so was voluntary, clear, settled and informed”.
An examining magistrate might also apply.
Secondly, there is the timeframe of six months. I speak as the daughter of a mother who had a prognosis of a few weeks but was in the care of the North Camden palliative care team for five years. There are many others around of whom that could be said. Six months seems arbitrary and, as the noble and right reverend Lord, Lord Harries of Pentregarth, said, possibly even unkind because suffering that is longer than six months is suffering that we should take even more seriously.
Thirdly, it does not seem to me that the requirement in the Bill that someone comes with the drugs and is with you while you do it or takes them away if you do not is the right way to go forward. My pastoral care experience is that those who want it want it for reassurance, a form of comfort blanket, if you like. They want to have the wherewithal there should they become desperate. This proposal goes nowhere towards that. If people are worried about the drugs afterwards going on to the open market, we should remember that people who have palliative care at home often have far more dangerous drugs around and no one worries that much about them.
I believe that although there is an argument for allowing people to have the wherewithal to kill themselves in very limited circumstances, this Bill does not provide sufficient safeguards and leaves too much power in the hands of doctors. I therefore oppose the Bill as it stands, but not the nub of the principle within it.
3.36 pm
Lord Shipley (LD): My Lords, I am not a lawyer nor am I a medical professional. I have no strong religious faith and I have had no preconceived views on this Bill. I believe we should give it a Second Reading, first, because the Supreme Court has asked us to clarify the law and, secondly, because opinion polls show a large majority in favour of a change in the law. We have a duty to consider the Bill further at Committee stage when we can examine the detail.
My position is that in principle I believe individuals have a human right to exercise their own choice to end their own suffering. It is a right I would like for myself, to be taken with my family. But that human right for me does not mean that it must transcend the human rights of others to safety and security under the law. No person should feel threatened by any change in the law. As we consider the Bill, this issue should be paramount in our minds.
I have deep reservations about the Bill as it stands. The safeguards seem very weak. Surely it is not enough to have only the promise of an undefined code of practice to be issued by the Secretary of State. I think we run the risk of unintended consequences.
I shall raise some specific issues that we need to clarify. How will it be known that there is a reasonable expectation that an illness is terminal within six months? Why are only two doctors required? Who will select those doctors? How will it be known that a patient’s mental capacity is unimpaired, particularly if the doctors do not know the patient? How will it be known that a patient is making an informed decision free from pressure or coercion? And, crucially for me, why is there is no judge or examining magistrate involved in the case?
The President of the Supreme Court has said that a High Court judge should consider the evidence and be satisfied that a wish to die is,
“voluntary, clear, settled and informed”.
That is very different indeed from permitting assisted suicide within the NHS. Why does the Bill disregard this fundamental principle and leave all decision-making within the NHS? In any case, despite some notable individual exceptions, the medical profession has indicated
its significant opposition to the Bill. The difficulty is that, without the support of the medical profession generally, it is hard to see how the Bill can proceed without very major changes. I agree with the BMA that legalising assisted dying could have a profound and detrimental effect on the doctor/patient relationship. I agree also that it is unacceptable to put vulnerable people in a position where they feel that they have to consider precipitating the end of their lives. In a loving and supportive family relationship, I know that appropriate safeguards may of course prove adequate, but the Bill as currently drafted needs radical revision in Committee.
3.39 pm
Lord Gordon of Strathblane (Lab): My Lords, obviously this is going to be a very long debate, but frankly we do not talk about death nearly enough. After all, it is going to happen to us all. As Mark Twain said, death and taxes are the only two certainties in life. We seem to spend an inordinate amount of time finding out what our prospective Members of Parliament think about taxation, but given the timescale referred to by my noble friend Lord Elder and the fact, regrettable or not, that this is now firmly on the political agenda, it might be at least as important that people should find out at the next election what their MPs think about death and assisted suicide.
My quarrel with the Bill starts with its title. It is not about assisted dying but about assisted suicide. An assisted dying Bill would provide for the universal availability of palliative care, good medical care and good medical discernment of the moment when you no longer impede my natural progress towards death. The usual phrase,
“not officiously strive to keep alive”,
is often quoted. There is, however, a vital Rubicon between not impeding progress towards death artificially and deliberately taking life, to which the noble Lord, Lord Hameed, referred earlier. That, frankly, is a Rubicon that I do not think society is genuinely prepared to cross because it is the cement which holds society together. Once you allow it in one case, it will spread like wildfire.
The same thing applies to our attitude to suicide. We treat people who attempt to commit suicide with compassion and understanding, but we certainly do not encourage them to do it. Indeed, we inaugurate measures throughout society to try to prevent people committing suicide. If a doctor or a nurse, or indeed any one of us, were walking across one of the bridges and found someone trying to clamber over the edge saying, “I’ve got only six months to live. I don’t want to live. Help me”, none of us would feel that shoving them off was the appropriate response. We would try to talk them down and persuade them that life is worth living after all.
The present law likewise says that we should never deliberately kill other people. This proposed Bill makes an exception of people with certain conditions. What does that say about those people? It says in effect, “Look, we don’t really think your life is worth living, so we are giving you the chance of ending it”. That is not a great encouragement to those who are in that
condition and who at that point need all the support and love that society can give them rather than inviting them to turn their backs on society.
There is also the point that many of the very deeply distressing cases which we are all aware of—I do not pretend to have an answer to how we should deal with the problem—are not covered by the Bill. Reference has been made to the comments of the noble and learned Lord, Lord Neuberger, in the Supreme Court on why we do not make this available to the chronically ill, who are going to suffer for a lot longer than the terminally ill. There is no logic to simply restricting it to the terminally ill. I can almost guarantee that before this Bill leaves the House of Lords it will be changed, and if not it will certainly be changed in the Commons, and if not then certainly within a year. This is going to go much wider than the proponents of the Bill ever imagine it would.
It is very important to realise that overt pressure from outside is not the main problem we are trying to guard against, but pressure from within oneself. Noble Lords have alluded to that feeling; people feel that they are becoming a burden, and therefore—as I think the noble Lord, Lord McColl, said earlier on—you feel that you should do the decent thing and just slough off this mortal coil. We do that at our peril.
I am surprised that more weight has not been given to the joint statement of all the faith communities. This is perhaps one of the very few occasions on which they have all come together, despite their different backgrounds, and have come out unanimously against the Bill. We ignore at our peril the experience of centuries that is contained in those faith communities. It is also important to notice that, although there are divisions, the official position of the medical community is firmly against the Bill. They do not want to be involved in killing—they are involved in care. Frankly, as a patient, I do not want my doctor to be involved in killing, even if it is not me.
It is also important to note that the relationship with GPs will be changed. There is also a danger—I put it no higher than that—because we should be finding a cure for the disease, not killing the patient. If we make killing the patient the easy and cheap option, that might just remove some of the urgency of finding cures, which I hope we can do for even the most intractable diseases.
It is time that we moved on to the next speaker. I am certainly in favour of giving the Bill a Second Reading, because it should be debated more widely and for a longer period of time.
3.45 pm
Baroness Murphy (CB): My Lords, I am afraid that the noble Lord, Lord Gordon, will be disappointed that I am one of those members of the medical profession who would be proud to be associated with the Bill. I certainly would not desist from becoming an expert under a code of practice to administer medication to those who had requested it, if the Bill was passed. Many members of the medical profession feel, as I do, that at the moment the provisions are fudged, the system does not work and it depends on regular, 24-hour hypocrisy to deliver the care that we are currently obliged to pretend that we give.
Last time we debated this topic in the House, I rather lost my temper—egged on, I have to say, by the noble Baroness, Lady Boothroyd—so I have promised myself that I will not do so this time. However, one of the things that trouble me about debates in this House is that we go endlessly for emotional anecdote, talking about our experience, or talking about other jurisdictions as if we have looked at the evidence. I have sat here as a simple medical scientist—I was a practising psychiatrist and academic for 30 years, working with elderly people in the most deprived community in south-east London—and I have to tell noble Lords that I do not recognise any of the fears from evidence.
And there is evidence. Only one jurisdiction in the world has adopted the legislation that we are proposing here today: Oregon, which has now had it for 17 years. There are not only the annual reports on Oregon, which have very clear statistics on the issues we are talking about, on depression, and so on, but there is also—I will also refute what the right reverend Prelate the Bishop of Bristol recently said—a lot of independent research evidence from people outside the direct system who have gone to look at it and have done serious research. I am concerned about serious research evidence, not the anecdotes. There has been talk about the risk or fear about the doctor-patient relationship, but the country in the world that has the best trust in its doctors is the Netherlands. That is research evidence.
Returning to respecting individuals’ choice, I have heard it said here today that we must set that aside because of the profound effect on others. However, we already accept people’s decision to reject life-saving treatments if they have the mental capacity, regardless of any effects their subsequent deaths may have on those they leave behind, and we are happy to allow doctors to assess mental capacity for that purpose. I have heard other noble Lords say how difficult it is, and no doubt in the future others will say the same. The fact of the matter is that the Mental Capacity Act and the Mental Health Act and a lot of other legislation regarding mental health patients are totally predicated on doctors’ ability to assess capacity, and they do so every day of the week. Therefore let us have none of that.
On the code of practice, no legislation on health and social care puts on the face of the Bill the detail of how the Act is to be implemented. We always ask for the professions, and of course the Department of Health involves the professions and the independent professional bodies in trying to deliver a code of practice that is acceptable to the professions which have to deliver the care. It will be the same in this Bill as in any other. I say that having spent a good part of my life on codes of practice for the mental health legislation.
I will make my last point on the issue of depression. The right reverend Prelate the Bishop of Bristol said that 60% had symptoms of depression. That is not true. One in six has some symptoms of depression. People who are terminally ill have symptoms of depression. However, that does not mean that they have a clinical depressive illness which can be treated, and there are ways of excluding that. Again, noble Lords will hear differently, and I ask them please to read the research evidence. We should make our decisions on evidence that exists today, not on supposition.
3.50 pm
Lord Graham of Edmonton (Lab): My Lords, we have sat through the beginning of this debate and have been privileged to do so. This House is unique in many ways. Of course, the topic is very important, but I cannot detect a partisan view in any of the speeches. Strong views have been expressed and the speakers have good experience, but kindness, understanding and tolerance have been shown. So it is a privilege for me to take part in this debate.
When I was having a cup of coffee earlier today, a colleague in the House said to me, “Have you ever seen such a big, long speaking list such as this?”. I said, “Yes, in 1998, when we debated the House of Lords Bill, which was designed to change the House radically—and I was number 184 in a list of 192”. I have good memories of that, which again was a matter of life and death to so many people.
I look across and see my friends the noble and learned Lord, Lord Mackay, and the noble Lord, Lord Cormack, who both struck the right note, saying that although they will give the Bill a Second Reading there are many things that they would want to raise in the proper stages—and that is how we should do it.
When I was looking for one or two things to say—and I certainly support the Bill—I was reminded that over another big issue I was able to say to the House of Commons that my constituents, by two to one, were asking me to support the retention of membership of the Common Market. There was a “Hear, hear”, and I said, “Yes, I received three letters, two of them in favour and one against”. On this issue we have had a deluge of correspondence, all of which I have read and replied to. The first avalanche came from those who were in favour of the Bill and the next avalanche, which is still going on, from those opposed to the Bill. Of course, we ought to know our procedure, and it is understandable if they do not, but a Second Reading should provide the House with an opportunity to improve a Bill if it can be done.
As I was driven into the House today by my driver, Lee, he said, “You seem agitated, Ted—you want to get there for 10”. I said, “You’ll get me there for 10, and it may go on until 7 or 8 o’clock tonight”. He asked me what the issue was and I told him, and he said, “My dad had liver complaints and was in agony in hospital, in a disgusting state. More than once, he said to me that he would like to die as soon as possible. Of course, I could not do that”. When I told him what I was going to debate, he said, “If I had anything to do with it, I would take advantage of a Bill like that”.
We have many views and there are many ways in which the legislation can be improved, and I look forward to the next stages.
3.54 pm
Lord Condon (CB): My Lords, in the past when we have considered this issue in your Lordships’ House and, indeed, in the build-up to today’s Second Reading, I have intuitively felt that I should support reform. Surely it is the compassionate thing to do. Clearly, reform resonates with public opinion; its time has come. However, in the past and again today, I just cannot overcome the reservations that I feel, which prevent me from supporting the Bill in its present form.
My reservations and concerns are narrowly focused on how the Bill would work, if enacted, and more broadly focused on the wider implications for society as a whole. Like other noble Lords, I am concerned about the absence of detail of how the new arrangements, if enacted, will be monitored and validated. At the moment, the law works. It is not perfect by any means, but it works. It allows suicide and discourages assisted suicide. The absence of advance licensing or approval of assisted suicide deters improper influence for whatever motivation, yet, as the noble Lord, Lord Macdonald of River Glaven, pointed out, the Director of Public Prosecutions has the scope to be compassionate and consider the public interest, taking all circumstances into account.
The Bill dramatically blurs that position. If enacted, the doctors considering the medical criteria in isolation may not be well placed to expose whether undue pressure has been exerted by family members or friends for whatever reason. “Doctor shopping” may well take place to find compliant doctors. Under the Bill, if a family member or friend alleged undue and improper influence, either before or after the death, the police would be placed in an impossible position, facing the dual criticism of either intrusive insensitivity in the new legal landscape or indifferent complacency, negligence and gullibility.
Even if I could overcome my specific concerns about the implications of the Bill, I would still have major concerns for society as a whole. Like other noble Lords, I cannot yet find a satisfactory answer to those who fear that the right to die will become a duty to die. I am persuaded by the moving testimony of so many people inside and outside your Lordships’ House that many sick, disabled and elderly people will feel diminished and downgraded by the Bill, if it becomes law. Once we decide that some lives are not worth living, I believe that there will be an inevitable, and probably irresistible, momentum to add other categories to the terminally ill in the list of those who can be assisted to die. Therefore, I cannot support the Bill in its current form. The recent Supreme Court decision may well have signposted a possible way forward—a judge-led approval process arrangement for the terminally ill facing imminent death who seek assisted dying. Such a system, with judicial involvement, would be required to satisfy more than just medical criteria and would provide greater safeguards against undue pressure and influence.
The Bill may not be the way forward unless we can dramatically improve it in Committee. A royal commission or similar endeavour may recommend a better balance between compassion for the terminally ill seeking assistance to end their lives while at the same time not damaging the lives of so many others who will fear that their lives are no longer valued and protected in the way that they were. As others have said, we owe it to society to find a way forward. There is momentum for change, but not necessarily with this Bill, unless we can significantly change it in Committee to provide better safeguards and wider reassurance.
3.59 pm
Lord Howarth of Newport (Lab): My Lords, I am against the Bill, but I think it right that your Lordships are debating it and the issues to which it gives rise. The
decision ought to be made eventually and in due course by the elected House, but the debate that has taken place in the nation at large has not yet been adequate to enable society and Parliament to come to a final view.
If I were terminally ill and in great distress, I would want to be assisted to die—or I think that I would. So I am not wholly opposed to the principle of physician-assisted suicide. However, that I might want that choice for myself is not a good enough reason for me to vote for the Bill. We are more than autonomous individuals; we are members of society. In many circumstances, there are things that we know that it is right to forgo for the benefit of others, and my legal right to be assisted to die would mean the vulnerability of others.
Safeguards are crucial and those in the Bill are wholly inadequate. The language of “coercion or duress” fails to capture the insidious, abusive pressures that family members and carers can bring to bear. The term “mental capacity” fails to capture the growing guilt and collapse of self-worth that may lead people to come to the view that they should not continue to be a burden to others. The doctors whose responsibility it would be to certify that the criteria have been met cannot be in a position to assess whether such pressures have occurred. I wonder indeed whether any effective safeguards are possible—but of course this ought to be examined in Committee. The very existence of a legal option of assisted dying would itself constitute an additional pressure.
Of course we should be deeply compassionate to the people in the predicament that this Bill seeks to address, but another form of compassion would be to invest in high-quality end-of-life care for all.
If the Bill becomes law we cross a Rubicon. We would have made it legal deliberately to terminate the lives of our innocent fellows before their natural term. To legalise is at least to go a long way to normalise, even to routinise. I am worried about a progressive coarsening of the sensibility of our society. I am sure that if the Bill becomes law it will distort the ethos of the medical and nursing professions. “Thus far and no further” may seem to be rock solid today, but it will crumble tomorrow. There will quickly be pressures of compassion and economics—so many dependent people, so little public funding available—to extend the scope of the legislation. It will be a short step to legislate for physician-assisted suicide for those suffering great distress with non-terminal illness, and then other short steps to euthanasia for infants born with disabilities or people with dementia. A course of events of this kind is what has been seen in Holland and Belgium, where, incidentally, reporting and monitoring have become lax. We have heard that in the state of Oregon the proportion of candidates for assisted dying who are referred for psychological evaluation has fallen.
I may give offence in what I am about to say and, if that is the case, I would very much regret it. However, I do not think that it is indecent, irrelevant or extravagant to note that history shows that periodically there are aberrations in societies from the norms of kindness and respect for life. There have always been spiritual, intellectual and political leaders available to justify the burning of heretics and witches, pogroms and genocides,
and the elimination of so-called degenerates such as homosexuals and mental defectives, as well as the enemies of the revolution. We have seen the horrors in Bosnia. We see today the horrors in Syria and Iraq. Civilisation is always fragile. We look back into history and look around our contemporary world at these psychosocial madnesses with horror. I would look forward with horror to a society in which it became normal to expedite the deaths of the very old, the gravely ill and the incapable.
That, of course, is not what the authors of the Bill wish for, nor does anyone in this House. However, the authors of the Bill invite us to take a crucial step along that path, which could lead us a very long way from where we want to be.
4.04 pm
Baroness Masham of Ilton (CB): My Lords, on a visit to Mexico some time ago I succumbed to Montezuma’s revenge, a violent type of diarrhoea and sickness. When the doctor came, he was the most important person in my life during that visit. I felt so wretched and helpless, because when a paraplegic becomes ill with something such as Montezuma, it is much worse than if one is able bodied. The doctor explained what Montezuma was. He was kind and understanding and he gave me the appropriate medication. I had full trust and confidence in him.
If the Bill becomes law, many countries that admire our health system might follow suit. I would then not have confidence that a doctor would want to get me better. He might think that the best solution was to give me, a paraplegic feeling terrible, a lethal injection to put me out of my misery. A few disabled people want assisted suicide, but the majority do not. They want to live. The Bill makes them feel vulnerable. There should be adequate care so that they can live decent lives and die a peaceful death. How much research has there been of the results of dying by lethal injection?
In 1970, many of your Lordships and Members of another place worked very hard on the Chronically Sick and Disabled Persons Bill, which became an Act of Parliament, to give disabled people a better life. We must not go backwards and give up treating them, considering them worthless human beings. The relationship that elderly disabled people and children have with their doctors should be one of trust and help; doctors should not becoming killing machines. We who live in the north shudder when we think of what Dr Harold Shipman did to many of his patients. He killed them in their own homes; they were not protected from that monster. There have been other patients killed with insulin by nurses in hospital.
The Bill could, with good intentions, lead to opening doors wider, with dangerous consequences. Dr Theo Boer, the veteran European watchdog in assisted-suicide cases, sternly warns the UK not to legalise euthanasia. He said that legalising assisted suicide is a slippery slope towards the widespread killing of the sick. He says that in his native Netherlands, where euthanasia has been legal since 2002, the number of such deaths doubled in just six years. This year’s total may reach a record 6,000. A surgeon has written to me—I received
the letter today—saying that, if the Bill becomes law, it could become a means of clearing elderly sick patients from hospital beds and killing off difficult ones to save money. Surely we must protect the vulnerable.
4.08 pm
Lord Harrison (Lab): My Lords, I support my noble and learned friend Lord Falconer’s Bill, as indeed I supported the Bill of his predecessor, the noble Lord, Lord Joffe. I thank my noble and learned friend not only for bringing this forward, but for being one of the finest parliamentarians I have had the pleasure and experience of observing over the past quarter century or so.
If this Bill fails, there will be more examples of the unfortunate man suffering from locked-in syndrome; of loved ones and relatives suffering from excessive pain and damaged dignity. Those who are against the Bill offer nothing to mitigate this needless suffering.
If this Bill fails, there will be more examples of people travelling to Zurich to end their lives and more examples of, “If I should die, think only this of me: that there is a part of Switzerland that is forever England”, when most—whose dignity is dying racked by pain and disease—simply want to die at home, surrounded by troops of friends and family fast by, and, yes, even the family pets.
If this Bill fails, this will still leave public opinion thwarted, ignored and repulsed. We will of course strive the harder to improve palliative care, pioneered by the noble Baroness, Lady Finlay of Llandaff, to whom we give very grateful thanks, but palliative care does not prevent, purge or rid us of the loss of dignity and pain, and the public will feel cheated yet again by politicians.
If this Bill fails, the law will still lack clarity in regard to medical staff who administer “easeful death”. Giving a double helping of morphine to the dying is compassionate but it is a sleight of hand in which we all collude. The modest Bill of my noble and learned friend Lord Falconer at least brings legal light and understanding in its narrow reach.
Those who oppose the Bill, so narrowly and precisely drawn, often cite the slippery slope. However, the slippery slope argument is the most slippery I know. Once invoked, it allows every naysayer to slip in and espy every potential misdemeanour known to man. Apologists for the Church of England often invoke the slippery slope argument as a signpost to caution. But this debate is held in a significant week. The Church of England, after 2,000 years, has finally recognised women as worthy of becoming bishops. Further down the slippery slope, I predict, the Church of England and other religious groups will admit, admire and celebrate gay and lesbian marriages in local C of E churches and at the very heart of our local communities, where such marriages should indeed be celebrated. Let us leave the slippery slope to the cheese rollers at their annual event on the slopes of Gloucestershire.
I conclude with one other element. The information given to us by the Church of England raises a very important issue concerning action on elder abuse. It invokes 500,000 of our older people being at peril through threats from friends and others. This is cited
as being true of England when in fact the original figure relates to the United Kingdom and therefore must be treated with care. When research was done in 2007 by the then relevant Minister, that figure of 500,000 became deflated to 342,400. I say that because this is a difficult subject and we must ensure that the data we use are accurate and proper when we are trying to apply the law.
It is right and proper that this Second Reading will be allowed and that we will be able to discuss this matter in a mature manner, using the expertise and knowledge in this House. That is why, today, I support my noble and learned friend Lord Falconer in his ambition, and there are many outside who support him too.
4.15 pm
Viscount Eccles (Con): My Lords, on a rather different historical note, this Bill owes much of its existence to the Voluntary Euthanasia Society, which was founded in the 1930s. The first Bill introduced into this House under the society’s aegis, fathered by Lord Moynihan, was the Voluntary Euthanasia (Legalisation) Bill 1936. Lord Moynihan was the leading surgeon of the day. The 1936 Bill, including its safeguards, bears a striking resemblance to this Bill. Its Second Reading debate makes fine, timeless reading. A Motion to defer meant that the Bill fell.
What has changed since 1936? Legislation has been introduced in several places, either as voluntary euthanasia or as voluntary suicide measures. The measure in front of us today is to legalise voluntary suicide. In 1936, the then Archbishop of Canterbury said about that Bill’s purpose,
“this Bill is merely to unlock the door, but if the door is … unlocked it will soon be opened wide”.—[
Official Report
, 1/12/1936; col. 488.]
Since today’s Bill in no way deals with the difficult cases cited by the Supreme Court, it is likely that the Archbishop’s analogy is as apposite as ever.
Then, a leading doctor, Lord Horder, said:
“The mental clarity with which noble Lords … are able to think and to speak must not be thought to have any counterpart in the alternating moods and confused judgments of the sick man”.—[Official Report, 1/12/1936; col. 493.]
The letters and representations that we have received show the very wide variation in circumstances faced by most of those who are dying and those caring for them. It is difficult to see how this legislation could be helpful to society. It is designed for such a small minority.
“there are no doubt some … straightforward cases in which the processes detailed”,
“could be carried out without much difficulty, but … there is a very much larger number of border-line cases in which the proposed action would be far more difficult”.—[
Official Report
, 1/12/1936; col. 495.]
The evidence we have received shows clearly that the highly complex and variable end-of-life circumstances faced by people are not amenable to simple solutions. This Bill’s attempt at simplicity means that it would not work well and would radically change the relationships between doctors and patients, and widen the split in
opinions within the medical profession, to the great disadvantage of the majority. Maybe we need to revisit the words of Lord Horder when he said:
“Be it observed that the good doctor is aware of the distinction between prolonging life and prolonging the act of dying”.—[Official Report, 1/12/1936; col. 490.]
Fortunately for us, science means that the medical profession could be in a much stronger position to follow Lord Horder’s guidance. Thanks to organisations such as Marie Curie and the striking advances in palliative care, while there is still much to do, a change in the law is not the way forward. This Bill, with its fundamental challenge to the relationship between doctor and patient in pursuit of individualism, is no way to go forward.
4.19 pm
Baroness Jones of Whitchurch (Lab): My Lords, I am pleased to have the opportunity to support this Bill this afternoon, and to add my thanks to my noble and learned friend Lord Falconer for enabling us to debate this important issue. Like others, I have received a huge postbag often with very moving testimonies and I have read them with great detail. I have to say that unlike other noble Lords the majority of letters I received were in favour of the Bill.
However, I felt that the arguments in the letters represented a big shift in thinking away from deference towards professionals such as doctors and politicians, and maybe even the church, and towards a stronger belief that individuals with their families should be able to exercise greater control over their own lives. There is an increasing reluctance to let others decide our fate. But we also have a particular responsibility to give leadership and guidance on this matter, not least because of the Supreme Court’s judgment. That is why this Bill is so welcome and so timely.
Today, we have heard a great deal of supposition and some rather alarming speculation about the motives of friends, families and doctors who would be impacted by the change in the law. But surely those who fear the consequences of such a change in the law can take comfort from the evidence that already exists. A number of noble Lords have referred to the Oregon example. There is a wealth of research that has demonstrated that the law works well there and safely, providing a safe choice to a small number of terminally ill people and a great deal of comfort for many more. Far from people feeling pressurised to die early, the safety net has given many people a renewed commitment to a life safe from fear. The small numbers who do opt for assisted dying clearly demonstrate that doctors are not using the powers inappropriately.
Incidentally, I do not recognise the rather jaundiced description of medical professionals in the UK that some have characterised today. As someone who sat on the GMC Fitness to Practise panels for many years, I know that the profession is not perfect, but an overwhelming number of doctors carry out their responsibilities with incredible care, compassion and diligence, and there is stringent regulation for those who stray. The requirement for two independent doctors to be involved should give us sufficient protection against a very small number of rogue doctors who, incidentally, characteristically act alone. However,
I have listened to the debate this afternoon, and I am sure that those protections could be enhanced in Committee.
In addition, for those who fear that the Bill will open the door to assisted dying on a mass basis, in Oregon there have been no attempts to widen the law beyond the initial remit. We should contrast that with the situation in which we now find ourselves in the UK. In 2012, a Commons debate on the DPP’s guidance on prosecution saw MPs unanimously accept the principle that amateurs who compassionately assist a loved one to die should not face automatic prosecution. That is the current position. But I do not believe that it is sustainable to allow amateurs to offer compassionate assistance to die while prohibiting the much safer option of proper medical assistance to deliver the same outcome. Many in the medical profession, for the highest of motives, share that view.
This is why I support the Bill. It will empower the terminally ill to choose the kind of death that they want rather than having to take matters into their own hands or operate with the help of amateurs with no medical support or supervision or, as we have heard, in a foreign country. The Bill represents true compassion towards the terminally ill and I urge noble Lords to support it.
4.23 pm
Lord Singh of Wimbledon (CB): My Lords, the Bill is flawed on many counts. In attempting to show compassion to a few, it neglects due compassion to many thousands of others. It has created immense fear in vulnerable people that they are being seen as a problem by society, with consequent damage to their sense of self-worth. Much has been said about autonomy in this debate—about our right to take decisions about our lives. But all too often it ignores the reality that what we do or omit to do affects others. This narrow view of autonomy is little more than an unhealthy obsession with self, which is considered one of the five deadly sins in Sikh scripture. The reality is that all of us are part of a wider society. What we say or do affects others. Importantly, our attitudes and decisions are influenced by those around us. Relatives, through what they say or omit to say, or simply by not being around, can affect the mood or even the will to live of the vulnerable.