I note the detailed points made by the noble Baroness, Lady Brinton. Like the noble Lord, Lord Berkeley, I am struggling a bit with them. However, it seems to me that these amendments are generally sensible and important. The arguments in favour have been very well and movingly advanced. They would make this proposed legislation safer, as the noble and right reverend Lord, Lord Harries, suggested.
I shall take this opportunity to point out that our support for these and other amendments does not in any sense signify the Church of England’s support for the overall intention of the Bill. I am sure this applies to other Members of your Lordships’ House. Some suggestion has been made, not least in the media, that our position lacks clarity. Nothing could be further from the truth. We have every sympathy with and respect for—I cannot emphasise this too much—the honourable and compassionate motives that inspire the Bill’s proponents, as the noble Lord, Lord Cormack, indicated.
The church’s stance on assisted dying was made abundantly clear by the General Synod in 2012. When this subject was debated then, not a single member of it opposed a motion to keep the current law. Of course, some individual church members may and clearly do disagree but, to avoid any misunderstanding as we debate these amendments, that remains our corporate stance for reasons of principle and pragmatism that have already been very well rehearsed in this House.
Baroness Hayman (CB): My Lords, reference has been made to the GMC, and therefore I should perhaps draw attention to my interest as a member of that body, although I, of course, speak today purely personally and not on behalf of the GMC.
I want to address two issues relating to doctors. First, I support Amendment 15 on changing from a registered to a licensed medical practitioner, which is an important safeguard and correction.
However, I have severe concerns about Amendment 13. The right reverend Prelate said that he thought it would make the Bill safer for patients. I have to
disagree. I think it would make the Bill impractical and restrictive. The reasons for that are partly the reasons outlined by the noble Baroness, Lady Brinton. People who are desperately ill who receive a diagnosis one or two years before their death very often think about moving. They sometimes move to be near relatives or into a care home, but moves even half a mile up the hill, as I learnt recently, can mean the severing of a long-term relationship with a GP practice. It is impractical and unfair to ask people who have moved in these circumstances to rule themselves out of access to the provisions of this legislation.
It is also impractical in terms of doctors themselves. We were taken back to the days of Dr Finlay in many ways by the speeches of the noble Lords, Lord Carlile and Lord Cormack. Very few people these days have a decades-long relationship with a single general practitioner. I am very nervous, because my legal education ended in 1969, of taking on the noble Lord, Lord Carlile, but he spoke about the realities of multiple partners in general practices in the National Health Service today. Certainly, my experience in my new practice is that you will be seen by any one of a number of partners there. However, the amendment says very specifically that the person must have been registered with one of the two doctors,
“for medical care for at least six months immediately prior”,
not at the practice but with that specific doctor. That is very difficult for people to comply with.
Equally, like patients, doctors also move. They move to different parts of the country, and they retire. You can imagine many circumstances in which reading and applying those specific provisions would simply rule out for patients the ability to access this legislation. For that reason I oppose this amendment.
Lord Harries of Pentregarth: Would the noble Baroness be willing to accept a different kind of amendment which took into account the situations she mentioned? Of course, she is quite right that people might move from their general practice into a care home, but it seems that it would be very easy to devise an amendment which took account of that. There would have to be perhaps two or more general practitioners who agree over a period of time.
Baroness Hayman: I am grateful to my noble and right reverend friend. The difficulty is trying to put this in the Bill, to deal with all the different circumstances that will arise with individuals or with practitioners. I would be much more comfortable with that, because I think we are all on the same page with regard to not wanting someone who has had absolutely no contact with their doctor, because of all the issues which we know arise. However, I would much rather that those sorts of issues were dealt with in guidance, both from the GMC and the Secretary of State. It would then be much more possible to make sure that there would be equality of access for patients.
Lord Turnbull (CB): I will add one point to my noble friend’s argument which is absolutely telling. One can be registered with a GP and never see them for 20 years. You might be a very fit 40 year-old, but you could suddenly get a devastating diagnosis of
cancer and wish to talk to your GP. Although you are registered with them, that GP does not know anything about you at all.
Baroness Young of Old Scone (Non-Afl): I will add to that last point, for which I am grateful. I have been a supporter of the principles of the Bill for almost the whole of my adult life, and I have had the same GP for 26 years. Every year I insist that he looks at my living will form, and we then have a very robust argument, because he is against the principle of assisted dying, and I insist that he takes account of my wishes in that living will form on an annual basis. I know that were I to be in a situation where I would require and wish to take advantage of the Bill, were it to become an Act, I would not be in a position where I could expect him to give me that support. We have been very clear with each other over the past 25 years. I do not know what the position of his colleagues in the practice is, but I am abundantly clear that when that point is reached, I will want to have a GP or a specialist consultant who is able to take a good medical history and read my notes, to understand what medical practitioners over the last 25 years have said about me, and to reach a valid professional judgment about whether my wish—I make that point; it is not the GP’s wish or the family’s wish—to take advantage of this provision is based on a good medical prognosis. It is not beyond the wit of the medical profession to do that even if they do not intimately know me. I hope that we will see that in the Bill.
Baroness Hayman: I am grateful for both interruptions because they allow me to say what I omitted to say—that the other change as regards the doctor and the practicality occurs when you are registered with a doctor who has a conscientious objection. The other problem is with,
“at least one of whom has diagnosed the terminal illness and treated the person in relation to that terminal illness”.
The person who diagnoses and the person who is giving ongoing treatment are not necessarily the same person. Therefore this clause is dangerously worded at present.
1.30 pm
Lord Low of Dalston: My Lords, I wish to make three brief points. The noble Baroness, Lady Campbell, has told us that disabled people are worried that disability will be equated with terminal illness and that they will be made the subject of “do not resuscitate” notices—indeed, that this happens or, at least, has happened in particular cases. Like all of us, I hugely respect the sincerity of the noble Baroness and appreciate the strength and eloquence of her advocacy, but I genuinely believe that the fears that she has expressed, that this Bill will make the situation worse for disabled people, are misplaced.
I say this for two reasons. First, it is very important that we should be clear that the disabled person has to ask before they can be offered the facilities of this Bill to end their life. Secondly, they need to make an act of conscious choice before they avail themselves of these facilities. With all the safeguards in the Bill, it will actually make the situation of disabled people better.
Thirdly, it is further argued that, in consequence of these fears, disabled people are strongly opposed to this legislation. However, in actual fact, a recent YouGov poll found that 79% of registered disabled people—that is nearly four-fifths, very much in line with the rest of the population—support assisted dying for adults of sound mind with a terminal illness. So, for all these reasons, with the greatest respect, I believe that the arguments that have been advanced on behalf of disabled people are misconceived.
Baroness Campbell of Surbiton: My Lords, I feel urged to come in here after the noble Lord, Lord Low, with whom I have worked and whom I have known for many years. We have discussed this subject on numerous occasions, and noble Lords will imagine that we have had some quite heated discussions. I shall add a little bit of information to add clarification. The disability community is made up of people with terminal illnesses. Outside the House today, as noble Lords will know if they have gone out to talk to them, are people sitting in their wheelchairs with terminal conditions saying, “No, this is not about choice—this is not about me asking”. They have often been in situations when they have felt so low that they felt that they had no options; their social care and healthcare was bad and they wanted to die. They could have taken advantage of the Bill proposed by the noble and learned Lord, Lord Falconer, because they have a terminal illness. There are at least six people outside these walls today in the freezing cold who have a terminal illness.
There are many people with terminal illnesses in the disability community, and those people have come together to demand that on this Bill we should slow down and think again. They have campaigned for choice and autonomy all their lives, and now they are saying, no, this is not about choice—and we have to listen to them. So please do not tell me that this is not about disabled people. It is very much about us because we are the people with experience of these issues. With the greatest respect, many people who are campaigning for this measure have not experienced these issues. They are people in control of their lives. They are people who fear becoming what they see us as. So I ask, please, that disabled people should be very much a central part of this debate. We have to listen to what they say, even if we do not like what they have to say.
I wish also to make a point of clarification. There seems to be a misunderstanding among noble Lords that I think that terminal illness is about having a chest infection. If I thought that, I would think that I was dying at least three times a year. I am not talking about that. I am talking about life-threatening terminal situations, such as muscle deterioration in the throat, whereby you can no longer eat or drink. That is what I have. Part of the GMC’s guidance on terminal illness concerns that process. I refer also to muscle deterioration within the lungs so that you can no longer breathe. That is terminal. Muscle deterioration around the heart is terminal. COPD is terminal. People with these conditions are part of the disabled community. They are out there—go and talk to them. Answer the letters from disabled people who say that this is not about choice. Ask them why they are saying this. Do not make assumptions about them. This is why I felt that I had to intervene at this point.
Lord Low of Dalston: If people with terminal illnesses do not wish to take advantage of the provisions of this legislation, what is there about it that forces or requires them to do so?
Baroness Campbell of Surbiton: My Lords, the answer to the noble Lord’s question is that they fear that they will take advantage of this legislation when they are at their lowest with no choice. The noble Lord, Lord Low, will understand as much as I do about terminal situations where you do not have choices. These people have said that they do not want this Bill because they know that they might take advantage of it.
Lord Alton of Liverpool: Before my noble friend completes her remarks, has she had a chance to read the briefing that was sent to Members of your Lordships’ House only yesterday by the disabled people’s charity Scope, which says—this reinforces the point she has just made—that in the US state of Washington, where assisted dying is legal,
“61% of those requesting to end their lives did so because they felt a burden on friends, family or care-givers”?
Scope says in its briefing to your Lordships in support of the amendments we are considering:
“The definition in the Bill of ‘reasonably expected to die within six months’ would capture many disabled people”.
Baroness Campbell of Surbiton: I think that was a question to me from the noble Lord, Lord Alton. The answer is, yes, I did know about Scope’s role. In fact, Scope approached me to ask me to emphasise issues around prognosis in the debate today.
Lord McColl of Dulwich (Con): My Lords—
Lord Hunt of Kings Heath: My Lords, this has—
Lord McColl of Dulwich: I have been trying to intervene for some time. I strongly support the amendment on terminal illness tabled by the noble Baroness, Lady Finlay, but noble Lords will be pleased to know that most of what I was going to say has already been said so I will not repeat it. It was said very ably by the noble Baroness, Lady Campbell of Surbiton, for whom I have the greatest admiration and with whom I have worked for many years.
There is an aspect of the definition of terminal illness that I should like to deal with. Under the benefit rules, an attendance allowance or a personal independence payment can be made under special rules if somebody has a terminal illness. The definition is therefore important. My understanding is that, for the purposes of receiving one of those benefits under the special rules, someone is defined as being terminally ill if they have,
“a progressive disease and his death in consequence of that disease can reasonably be expected within 6 months”.
This definition is set out in Section 66 of the Social Security Contributions and Benefits Act 1992. Are we going to say that anyone who receives one of these benefits would be eligible for assisted suicide on the basis of their physical health? I raise this as a genuine question because the Personal Independence Payment Handbook, issued in August 2014, also states:
“Awards made under the special rules for terminal illness will be for 3 years”.
This seems to be rather at odds with the expectation that the person is reasonably expected to die within six months.
To get this benefit, individuals have to get a completed DS 1500 form from their doctor, as has been mentioned. In a forum discussion on the internet, many of the individuals who got the benefit as a result of this form were definitely of the view that they would be living for more than six months. I am concerned that in future they might be encouraged to consider assisted suicide because they would fall within the definition of the Bill. The form was also referred to in the House of Lords report on the Bill of the noble Lord, Lord Joffe. I quote one doctor, who said:
“A simple bit of practical evidence is one of the benefit forms that are filled in for patients assigned to the doctor thinking that the patient has six months to live. I would not like to count how many of those forms I have signed in my life for patients still living after a year, eighteen months or even longer”.
Another doctor giving evidence to that committee about decisions on who had a terminal illness said that,
“doctors make arbitrary decisions about when a patient has reached a terminal stage. This can be when the patient is discharged from specialist care, when the patient moves from a curative state to a palliative state; some just use the position when what is known as the DS 1500 Form is actually prescribed, or some just use the point where patients have become bed-ridden or immobile”.
Surely we need something far more rigorous than someone being “reasonably expected” to die within six months when the consequence is that their life is actually ended. I fully support Amendment 20 of the noble Baroness, Lady Finlay, to remove the word “reasonably”.
Baroness Meacher: Perhaps I may pick up the point about a six-month prognosis. The point there is that one’s life is ended. The whole point of the Bill is that one’s life is not ended simply because one starts the process at the point when one receives the six-month prognosis. It is all about having autonomy and a sense of control over one’s own situation, so that when life becomes unbearable one can then take that control.
Lord McColl of Dulwich: I thank the noble Baroness for that clarification. I note that in August 2011, 13,400 individuals receiving attendance allowance in England and Wales were considered terminally ill under the benefits definition. That would be a substantial group of people who might reasonably be eligible to have their death hastened by assisted suicide. We need to be very clear what we are talking about in relation to a terminal illness and, at the moment, there is a lot of room for ambiguity. Ambiguity does not lead to safeguards.
Lord Warner: Can I seek clarification from the noble Lord? What he is trying to do is challenge the point that I was trying to make. I should like to make clear to the Committee the point that I was trying to make—which I do not think was the point he was trying to rebut.
My point about Section 82 of the Welfare Reform Act is that it bases public policy on the assertion that it is reasonable to ask doctors to make a judgment on whether someone is likely to be terminally ill and die
within six months. It does not say that we expect 100% perfection from those forecasts. My point was that Parliament has decided in legislation that it is reasonable to have a definition of terminal illness that we can expect the generality of the medical profession to understand and apply on a reasonably consistent basis. In my judgment—the noble Baroness, Lady Hayman, may be able to correct me—it would be a breach of medical good practice and possibly an offence for doctors knowingly to sign those certifications if they did not clinically believe that the person was likely to die within six months.
1.45 pm
Lord McColl of Dulwich: My Lords, I would not dream of trying to rebut anything that the noble Lord said.
Lord Alton of Liverpool: My Lords, I support what the noble Lord, Lord McColl, said. He is one of the foremost medical authorities in your Lordships’ House. We know that many of the royal colleges and the British Medical Association, speaking for 153,000 doctors, say that it is not possible to legislate safely—which is the point that the noble Lord, Lord Cormack, made.
However, I recall that when my late father was dying and I went to spend time with him during the last part of his life, the doctor told me that I should make long-term provision for long-term care. After he left the room it was the nurse, who was the wife of one of the policemen who worked in the Houses of Parliament at that time, when I was in another place, who said to me, “David, you don’t need to make long-term provision. In my view, your father will be dead before the end of this weekend”. Needless to say, it was the nurse rather than the doctor who got it right.
Many noble Lords will have read the briefing from the Royal College of Nursing, which arrived only today. It says:
“Terminal illnesses are often extremely unpredictable with periods of improvement and deterioration. This can make it extremely difficult to pinpoint when someone might die … we remain concerned that diagnosing that a patient is expected to die within six months could result in inaccurate judgements through no fault of the medical practitioner”.
That is the point that that noble Lord, Lord Warner, has just made. It could lead to litigation against doctors and nurses if we do not put in far better safeguards than the Bill provides at present.
Lord McColl of Dulwich: I thank the noble Lord for that intervention. I have been in practice for very many years and I still am. One of the things that always struck me was how wrong I was about trying to predict when a patient would die. I well remember a typical case of a lady who was only 28. She had inoperable cancer of her throat. She was in great distress, with pain and distressed breathing. I saw my job as a doctor to relieve all her symptoms, whatever the cost. I said to her, “If you like, I can put a needle into your vein and titrate you with heroin”. Heroin is a marvellous drug. You have to dilute it in a large volume and not use the small volumes in the ampoule, because if a gun goes off you might suddenly give them too much too quickly. I titrated her and asked her to tell me when all the symptoms had gone.
Eventually she said, “Yes, that’s fine”. It was a huge dose of heroin. I had no problem about giving it. The strange thing was, not only did it not kill her, it gave her a new lease of life. It is unrelieved pain that is the killer.
Lord Berkeley of Knighton: The noble Lord said earlier that he gave his patient a huge dose of heroin. He used the words, “whatever the cost”. If it had killed her, would the noble Lord feel that he had assisted, maybe nobly, in her dying?
Lord McColl of Dulwich: The problem is that when you give these very powerful drugs, the symptoms are relieved but the patient is subject to the complications of being in bed for a long time, including clots in the veins of the legs. These may dislodge, go to the lungs and kill them, or they may develop pneumonia because their breathing is not quite as effective. Those are the complications but I resist the idea that I am deliberately killing them; I am deliberately relieving all their symptoms.
Lord Elton (Con): My Lords, the point has been made, as though this closes the need for a definition, that a definition in the form DS 1500, which the noble Lord, Lord Warner, and many others have referred to, has already been passed by Parliament. I merely want to say that the need for precision when it is a question of providing social services benefits in cash or in kind is much less demanding than the need for precision when the question is pulling the plug on somebody’s life. Therefore, it is not unreasonable to return to this issue.
Lord Empey (UUP): My Lords, one is reluctant to become involved in a debate when so many noble Lords with senior medical and legal experience have been putting forward their interpretations. However, I want to deal with a couple of matters. With this amendment, the noble Lord, Lord Carlile, is clearly adding that a medical practitioner will have to have significant knowledge of the patient.
I want to speak on this issue because I feel that the Achilles heel of the whole Bill is that it is built on sand. It works only on the assumption that the medical profession will deliver it, whereas it is obvious to most of us that the vast majority of the medical profession do not want to deliver it. That leads us to what may be the essential contradiction or conflict in the amendment. A number of noble Lords have said that specifying six months would be an overburdensome requirement. Therefore, we have the dilemma that either you have a medical practitioner who knows the patient, knows the condition and knows how that patient is likely to react to certain drugs, or you have a complete stranger who comes in and makes a judgment on the spot, having read a medical file. I fear that a rent-a-doctor procedure will develop and will distil down to those who are prepared to do it, and that, in my view, will create a whole series of new problems.
I want to raise another point regarding these amendments. We talk about having conversations, discussions and processes. I represented an inner-city
constituency for more than 25 years and my question is: with whom and at what time are people going to have these discussions, conversations and processes? At the moment, nurses hardly have time to feed patients on their ward, let alone to involve themselves in very complicated and difficult conversations, discussions and processes.
Therefore, looking at the modern-day NHS and all the pressures that it is under, to some extent we are adding a further pressure without the active support and consent of the medical profession. Also—this is the one thing that I worry about more than anything else—we are changing for ever the potential relationship between a doctor and a patient. In an inner-city area, the ordinary person will say, “Oh, here comes Dr Death. How can that person help me on the one hand and put my lights out on another?”. I fear that that is how this will be distilled down to street level.
In the amendment, the noble Lord is clearly trying to put in place the safeguard that the patient will at least be dealt with by somebody who knows him or her. I understand that and accept the rationale for it. However, there are practicalities, which have been raised by others. With inner-city practices, it is hard enough to get the patient to go to a doctor in the first place, but if they think that that doctor could at some point in their lives, as they would say, sign them off, will the amendment achieve the worthy objective for which it is meant?
The word “control” has been used a number of times. I think the noble Baroness, Lady Meacher, and others used it. One can see that people would want to have control over their lives. It could happen to any of us. But in the real world out there, many people who are seriously ill may not have the means. They do not have access to the courts, money or knowledge. Control may be all right for those of us in this House, but it is not always available to the ordinary person in the street. That is where I believe there is a fundamental weakness in this. Without the act of involvement of the medical profession who really want to do something, we are forcing them into a corner. It will inevitably boil down to a handful of doctors who will go around the country signing off people they do not know.
Baroness Finlay of Llandaff: The noble Lord made some cogent points in relation to this group of amendments. He made me wonder whether he thinks the solution may be that the discussions could happen earlier but the provision of the assistance to end life should be much later. The timeframe could change. Discussion of whether someone is terminally ill could start much earlier, and could therefore take more time, but the delivery of the lethal drugs could happen much later. For clarity, they are not morphine or heroin. The drugs are a massive overdose of barbiturates, which is completely different and would never be used therapeutically. That is the way that you end people’s lives under the Oregon and other legislation. That might be a solution. I also ask the noble and learned Lord, Lord Falconer of Thoroton, whether he would consider that type of solution in looking again at the clause.
Lord Empey: Those are things that we have to probe in Committee. That is what Committee is for. The amendment of the noble Lord, Lord Carlile, has many worthy objectives. If the proposal that the noble Baroness, Lady Finlay, has just enunciated works, and if the professionals who know their business feel that it is more helpful, that is terrific. That is exactly what this Committee is for. I therefore commend what she said.
Baroness Symons of Vernham Dean: My Lords, I wanted to make exactly the same point as that made by the noble Baroness, Lady Finlay. I will not repeat it, but I ask my noble and learned friend to consider carefully the point that she just made about the actual timing of giving any drugs that would terminate life.
I wanted to make one other small point about something that the noble Lord, Lord Warner, said earlier about thinking that doctors were overoptimistic about survival rates. My own experience of this, which the noble Lord, Lord Carlile, referred to at the beginning of this debate, was exactly the reverse of that. Right at the beginning of a very late diagnosis of leukaemia, my husband was told that there was only a 20% survival rate for that form of leukaemia and he was unlikely to be in that 20% because of the late diagnosis. Five years later, he received a letter, having gone through the dark hours of the night wanting to end his life in very much the way that the noble Baroness, Lady Campbell, alluded to in others but has obviously steadfastly and gallantly resisted herself. The letter said that, in fact, the survival rate had not been 20%, as he had been advised, but 47%—more than double what the survival rate was meant to be.
I simply make the point that terminal illness is hard to define, whatever we put into legislation. The fact is that medical science is moving fast, particularly in the treatment of cancer. These definitions are enormously difficult and I would ask noble Lords to reflect on the fact that survival rates can be very much higher after a relatively short period of time.
2 pm
Lord Warner: My noble friend referenced me in saying that doctors were overoptimistic. What I said was that one review of evidence has found that fewer than one in four patients outlived the prognosis when their clinicians predicted survival of six months or less. I said that that research rather suggests that doctors have a tendency to be overly optimistic about how long people will live, because it shows that when people thought they had six months to live, actually a large number of them failed to get through the six-month period.
Lord Hunt of Kings Heath: My Lords, like the Government, the Opposition are not expressing a view on the Bill, and we have a free vote on this side of the House. I ask the Minister to help me with an interpretation of the meaning of Amendment 13, particularly in relation to the meaning of the provision that one of the registered medical practitioners has to have had the person registered with them for at least six months. Does he take that to mean that a patient has to be registered with a general practitioner for the provisions of the Bill to apply? I am assuming that when patients
are under the treatment of other doctors, such as hospital doctors, they are not registered with them. This is important. If I am right—and I am expressing no view on the merits of the amendment—it would be helpful to the Committee to know from the noble Lord, Lord Carlile, what would happen in circumstances where, for reasons which have been set out by other noble Lords, a person is not registered or has been removed, sometimes forcibly removed, from the list by the GP under the arrangements that apply. It would be helpful if he could clear up that point.
Lord Carlile of Berriew: I am happy to clear it up. My understanding—and I am happy to be corrected by the Minister if I am wrong—is that if I am nominally registered with Dr A, who is in a practice with Drs B, C and D, and I go for treatment and am seen and treated by Dr D, I am being treated by a doctor with whom I am registered. That is because my registration with a doctor in a practice includes registration and treatment by any other doctor in that practice.
Lord Hunt of Kings Heath: That is a very helpful response. Can the noble Lord explain the circumstances in which a patient is not so registered? At any one time there are thousands of patients who are not registered.
Lord Carlile of Berriew: If a patient is not registered, they are not registered. If a patient goes as a temporary resident—as I think the term used to be; I am not sure if it still is—to see a particular doctor, a general practitioner, they are then registered for the period of the temporary residence, which from memory is, or at least used to be, one month, and which may be renewable for the purposes of that treatment.
To deal with the broader aspects of the noble Lord’s question it might be worth making the further point, while I am on my feet, that it is very difficult to imagine that a patient would be in the situation described in the Bill but had not been treated for at least six months by a practitioner, such as the practitioner who was treating their cancer. That is the general experience that people have.
Lord Faulks: My Lords, I do not have anything to add on that particular point.
This has been an excellent debate which has gone to the heart of some of the most difficult parts of the Bill. Why is six months the right period? Of course, we have heard plenty of informed opinion about how difficult it is to make a prognosis of any accuracy. In Amendment 21, a period of six weeks is suggested as a better period. It may be that that enables a clearer prognosis to be given, but it seems extremely short for the various practicalities and safeguards to give the Bill any real meaning. Inevitably, six months is something of a compromise; the question is whether it is a satisfactory compromise. It will not, of course, suit everybody.
It is something of an irony that one of the spurs behind this Bill and our debates is the Supreme Court’s decision in Nicklinson, which was concerned with the desire of two men with locked-in syndrome—an almost totally paralysing but not terminal condition—to request assistance to die. The Committee might like to be
reminded that the President, the noble and learned Lord, Lord Neuberger, commenting in the judgment on the Falconer commission and the six-month period, said:
“That would not assist the applicants”.
I am sure that that is not in dispute. He went on:
“Further, I find it a somewhat unsatisfactory suggestion. Quite apart from the notorious difficulty in assessing life expectancy even for the terminally ill, 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”.
These are very difficult questions and I look forward to hearing the answer from the noble and learned Lord.
Lord Falconer of Thoroton: I am again grateful for a very good debate. I agree with the noble Lord, Lord Faulks, as ever, that this goes to important issues in the debate. I accept the definition given by the noble and right reverend Lord, Lord Harries, of these issues, which go to the safeguards.
In looking at the safeguards, it is important to put into context the safeguards in the current draft of the Bill: two doctors, independent of each other, certifying that the patient has a terminal illness which they reasonably expect will end their life within the next six months; the two doctors, independent of each other, certifying that the person has made a voluntary decision, that they have the capacity to make that decision and that it is their firm and settled intention that they wish to take their own life in those circumstances; and that decision is not to be given effect without the consent of the Family Division of the High Court of Justice. Those are the safeguards.
Let us look at the proposals in the light of those existing safeguards. First, the noble Lord, Lord Carlile, proposes, in effect, that a person must have as one of the doctors a general practitioner with whom he or she has been registered for the last six months—I understand that registration is a concept that only has relevance to a general practitioner. That proposal, as the noble Baroness, Lady Brinton, has pointed out, appears not to deal with people in the following circumstances: somebody who, for example, moves to live near their relatives, then gets ill and is not registered for six months; somebody whose general practice, for example one run by a sole practitioner, packs up; or somebody who, for example, has a general practitioner who has a conscientious objection to the use of the provisions of the Bill.
If Parliament were to pass a Bill giving people the right to an assisted death, I venture to suggest that it would be a very odd conclusion that your ability to access that right would depend on the adventitious circumstance of whether, for example, you had moved one month before to be near your son and daughter, as my own stepmother did. That does not seem a sensible basis. However, a very powerful thread in this—which has been mentioned in particular by the noble Lords, Lord Cormack and Lord Empey—is the idea of a doctor who does not, as it were, properly consider the merits of an individual case but is, as suggested by the noble Lord, Lord Empey, available for hire. That is
something that I would wish to avoid as much as possible. I venture to suggest that there may be three ways to deal with it.
First, I would expect the medical bodies to produce guidance. That can be given effect to, because a High Court judge would have to be satisfied that an appropriate process had been gone through. In addition to that, I note that, according to Clause 3(7), the independent doctor has to be “suitably qualified” in that he,
“holds such qualification or has such experience in respect of the diagnosis and management of terminal illness as the Secretary of State may specify in regulations”.
I would anticipate that the Secretary of State would be able to make in regulations provisions that make it clear that the independent doctor could not be the sort of doctor that the noble Lords, Lord Cormack and Lord Empey, and others referred to. If there are better ways of dealing with the doctor for hire situation, I am very willing to hear and discuss them and bring them forward at the next stage, but I am absolutely clear that the way in which the noble Lord, Lord Carlile, is suggesting it be dealt with is unworkable and unfair and cuts at the heart of the Bill.
Lord Carlile of Berriew: I have a serious question for the noble and learned Lord, which I am sure he will answer seriously. The thrust of what I am saying in my amendment, with my noble colleagues who have signed it, is that the gateway that is provided in Clause 2 should be subject to two doctors—doctors who can be shown to have some considerable knowledge of the person’s case. Is he willing to accept that principle?
Lord Falconer of Thoroton: I do not accept it in the way that the noble Lord has formulated it. I say that there should be two doctors who have properly, on good evidence, considered the case. It may well be that neither of those doctors has been engaged in the long-term or even short-term care of the person. But I would be satisfied with the gateway involving two doctors who have gone through a proper and rigorous process, and I disagree with the noble Lord when he says that they have to have known the person for six months. Indeed, I do not think he is even saying that because registration over a six-month period would not necessarily involve any contact whatever with the general practitioner.
Lord Carlile of Berriew: I am grateful to the noble and learned Lord, who has made a helpful response, up to a point. If the Bill were to go further, would he be prepared to enter into discussions on the clear basis that Clause 2 would have to be amended to ensure, first, that there were two doctors involved in that gateway—whatever the gateway is, because we are going to consider another group shortly that is relevant—and, secondly, that it should be shown that at least one of those doctors has had detailed past consideration of the patient’s case? It seems to me that that sort of measure is the only way of ensuring that we do not have a Shipman-type situation.
Lord Falconer of Thoroton: The first point about the two doctors is dealt with in Clause 3, because the second doctor has to certify that he is content.
The noble Lord is getting frightfully agitated. If he looks at Clause 3, he will see that it requires certification by a second, independent doctor.
Secondly, the noble Lord asked whether I would enter into discussions in relation to putting in the Bill that one of the doctors has had to be involved in the care of the patient. No, I would not because I think it is satisfactorily dealt with in the Bill as it stands, for the reasons I have indicated. I will answer the noble Lord, Lord Jopling, first, and then go to the noble Lord, Lord Maginnis.
Lord Jopling (Con): I am concerned very much about this problem of doctors for hire. Does the noble and learned Lord not agree that there is another way, on top of the ones he has described, of dealing with this problem? If he looks at my Amendment 36, he will see it suggests that no doctor should sign a declaration of this sort more than once every four years. I am intent on establishing the principle; whether it is four years or less, I am perfectly happy to have discussions and hear what other people say. But surely to deal with the problem of doctors for hire you could put a limit on the frequency with which a doctor could sign these declarations. The noble Baroness, Lady Murphy, who I believe is not here today, has put down another amendment, Amendment 37, which proposes a timescale of very much less—I think that, for one of the doctors, it is once every two months, which I think is far too frequent. I would be perfectly happy on Report to put down another amendment, if the noble and learned Lord would give it a fair wind, which would put a limit—let us say two or three years—on how often a doctor could sign such declarations, which, after all, will be pretty rare events.
2.15 pm
Lord Falconer of Thoroton: I am very happy to discuss with the noble Lord the idea of there being some limit. I have thought carefully about the limit issue. My inclination is against a limit for the following reason: that there might be doctors—for example, those engaged in the treatment of particular sorts of cancer, covering a particularly wide area of the country—for whom, if the Bill is passed, a limitation of the kind that the noble Lord has suggested, whereby somebody could not countersign a declaration if they had signed one in the previous four years, does not sound appropriate. However, I am completely engaged on how one seeks to deal with the issue of doctors for hire. I would be more than happy to discuss it, but I do not want to give a misleading impression. My current thinking is that it would not be a good idea to put a limit on it.
Lord Maginnis of Drumglass (Ind UU): I was to some extent motivated to intervene at this stage because the noble and learned Lord alluded to the noble Lord, Lord Carlile, as being “agitated”. I thought, “That’s a word that perhaps the noble and learned Lord, Lord Falconer, would consider”, because it appears that, as we have moved through this debate, he has moved more and more to provision for the exceptional case; for example, if somebody does not have a doctor, or they do not have a doctor for a certain length of time. No good legislation should be brought forward on the
basis of extraordinary cases. If those matters arise, the legislation can be amended, but I am very worried that we are arguing a flawed case based on extraordinary circumstances that may arise.
Lord Falconer of Thoroton: I could not agree more with the approach that underlies what the noble Lord, Lord Maginnis, has said. That is why, although I accept and admire the spirit in which it is offered, I do not think that it is a sensible amendment, because it would lead to so many situations that would then not have been covered by a Bill which, on this hypothesis, had been passed. It would therefore be a very bad idea to accept it. I acknowledge and accept the idea that you should not pass a Bill that then leads to problems, which is exactly what the amendment would do. However, I anticipate that the noble Lord would say that he had the precise reverse in mind.
Lord Cormack: I am most grateful to the noble and learned Lord for giving way, and particularly for the references that he has made to the points made by the noble Lord, Lord Empey, my noble friend Lord Jopling, and me. In response to the noble Lord, Lord Jopling, he understandably poured some cold water on the four-year limit, but would he accept that a limit of a reasonable time would help allay the fears that my noble friend Lord Jopling, the noble Lord, Lord Empey, and I all have?
Lord Falconer of Thoroton: As I indicated to the noble Lord, Lord Jopling, I am more than happy to talk about it. The example of the cancer specialist or the motor neurone disease specialist makes me instinctively, having considered it quite carefully, against the idea of any limit, but I am more than happy to discuss it.
Baroness Cumberlege (Con): My Lords, I listened with great care to what the noble Lord, Lord Empey, said. The noble and learned Lord has been very helpful in saying that he will negotiate with people and talk further about this. Could he not think a little more widely, because there is real concern about the medical profession as a whole being involved in this? I am also concerned about the nursing profession and other clinical specialists who could be involved. As I read the Bill, it makes room for that.
Professionalism is such an important element in the work of all those people who work in the NHS. Professionalism is indicated by the values, behaviour and relationships that underpin the trust that the public have in doctors, nurses and other clinicians. One reason why I am against the Bill is that I think it is so damaging to the medical and other professions. I have listened to my noble friend Lord McColl, the noble Baroness, Lady Finlay, and others. The commitment of the people in that service is outstanding. We know that doctors are the most trusted of all the professions. The trust is there because we know the intention of those people in treating us. We know that they come committed to cure, to treat, to alleviate pain and to be compassionate. The Bill goes against that.
Does the noble and learned Lord, Lord Falconer, not think that we could be a bit more imaginative? Building on the amendment of the noble Lord, Lord
Pannick, which was passed at the previous Committee sitting, could we not have a person appointed by the court to carry the drug, medicine, dose or poison—whatever you want to call it—and actually administer it? If a nurse or a doctor finds that the patient cannot quite administer it, because they are compassionate people, will they not help that person to do it? Are they not then in real danger of cutting across the whole tenet of the Bill?
Perhaps the noble and learned Lord will talk to some of the rest of us. I have tabled amendments to enable that to happen, but we will probably not get to them today. Will he not widen his vision of the Bill to see whether he can protect the medical, nursing and other professions by building on the amendment of the noble Lord, Lord Pannick, to have a person appointed by the court?
Lord Falconer of Thoroton: I could answer that, but the noble Baroness has tabled a later amendment. I am not at all unsympathetic to what she is saying—although I think that it is adequately dealt with by the Bill—but I do not think that it is appropriate to be taken into that debate when we are dealing with other amendments. I am sorry, but I do not think that that is an intervention to which I should appropriately respond, because other people have made contentions in the course of the debate. With respect, to hive off into the noble Baroness’s later amendment does not seem a sensible way to conduct our business. I am sorry.
Baroness O’Loan: I should like clarification from the noble and learned Lord. I think he said that Clause 2 required two practitioners, but on my reading it requires only one. If there is one practitioner and a person is diagnosed with a terminal illness, the terminal illness is, if you like, the gate into everything else in the Bill. That I have a terminal illness allows everything else to follow. If one doctor diagnoses a terminal illness, there is the possibility that that doctor may do so at the behest of relatives. The motives of those relatives may be benign or malign. If the person gets a diagnosis of that kind from a medical specialist, that may change their whole perspective on life. The mere fact that someone has said to them, “You are terminally ill. You are going to die in six months”, when that has not been said before, may lead them to think, “Perhaps I should seek assisted suicide”.
That may be quite an unintended consequence of limiting this, but at least if we have two doctors, in some form or another, as suggested by the amendment of the noble Lord, Lord Carlile, surely there would be some protection. As I read the Bill as it stands, there is very little protection for the vulnerable person who is lying in bed and seeking some way to find a way through this. Terminal illness and serious pain have a number of effects. One is to cloud judgment and another is to sap the zest for life. That zest, as the noble Baroness, Lady Finlay, and others have said, may well be restored by palliative care, which relieves the pain, as the noble Lord, Lord McColl, has said. This is such an unsatisfactory provision that I should like the noble and learned Lord to confirm whether I am right.
Lord Falconer of Thoroton: I think the noble Baroness is wrong. I thought that I had said Clause 3 but maybe I did not. Clause 3(3) requires two doctors to sign the person’s declaration that the person,
“is terminally ill … has the capacity to make the decision to end their own life; and … has a clear and settled intention to end their life which has been reached voluntarily, on an informed basis and without coercion or duress”.
If I inadvertently said Clause 2, I meant Clause 3 and I apologise. It involves two doctors. We could go into the debate about vulnerability again, but with regard to clarification on whether two doctors are required, I think the Bill is utterly clear.
Baroness O’Loan: I just want to understand which clause we are debating. I thought we were debating Clause 2, which refers to a registered practitioner. As I said, I know that there are other safeguards that the noble and learned Lord is trying to write into the Bill, but the reality is that the realisation of this clause in a person’s life may have significant unintended consequences. I simply wanted to ask the noble and learned Lord whether there is one doctor in Clause 2 or two.
Lord Falconer of Thoroton: It is obviously my fault for not properly explaining this. As I understand the noble Baroness’s point, she is asking whether only one doctor has to decide whether the person is terminally ill.
Baroness O’Loan: No, I am talking about the point at which we open the gate and make the Bill apply. I know that in subsequent situations the process develops. I think that one of the weaknesses of the Bill is that the processes are kind of confused. At this stage of the Bill, though, is there one doctor who will say to the person, “You are terminally ill, with six months to live”, so that all other discussions can then take place and you can move towards seeking the declarations and that sort of thing? I just thought it might be helpful to be clear in my mind what we are talking about.
Lord Falconer of Thoroton: That is a fair point. The process is that one doctor says the person is terminally ill. The patient declares that they want to take their own life and then the second doctor has to confirm both the terminal illness and the firm and settled intention, voluntariness and capacity. I am not quite sure what further point the noble Baroness is making. She is right that Clause 2 refers to the initial doctor and Clause 3 refers to the second, but the process involves two doctors. I can take it no further than that, I am afraid.
The next point that was raised about the safeguard was the suggestion that we reduce the period from six months to six weeks. I completely accept that there are uncertainties from time to time about diagnosis. A judgment has to be made as to whether someone is terminally ill and may be reasonably expected to die within six months. I do not believe that that is an impossible task for a doctor to embark upon. As the Minister said, a judgment has to be made on what the right period is. I anticipate that the mood of the Committee is that six weeks is much too short. As a matter of judgment, six months feels right
after hearing considerable evidence in the commission, and it also feels right having heard the debate just now.
The fact that diagnoses and predicting the length of time that you have to live are difficult—they are difficult whether the amount of time is six weeks or six months—does not lead me to believe that the Bill should not go forward, or that we should vacate the field in giving people that right. As the noble Lord, Lord Berkeley of Knighton, said, in this area we are not dealing with certainty. The question is whether, in the absence of certainty—and no provision can give certainty—we should be saying that because you cannot have certainty you cannot have the Bill. In my view, the right conclusion is that even though you cannot have certainty—everybody agrees with that—you should nevertheless have the Bill. Having listened very carefully to the choice between six weeks and six months, and obviously having considered something in between, six months appears to be right in relation to this.
2.30 pm
Baroness Finlay of Llandaff: I am grateful to the noble and learned Lord for having finally got on to the timeframe issue and for his acknowledgement that, on a balance of probabilities, things are more likely to be accurate within a shorter timeframe than at six months. Does he accept that it might be worth considering uncoupling the time in which the discussions can occur from the time within which the prognosis indicates that it is eligible for the lethal drugs to be taken to the patient? That was the question that I asked the noble Lord, Lord Empey, and on which the noble Baroness, Lady Symons, came in, but the noble and learned Lord has not answered that question at all.
Lord Falconer of Thoroton: I apologise to the House for taking so long to get on to the point about six months versus six weeks. I very carefully considered whether one should say that, once you have a diagnosis of six months to live, you should be able to have the discussions but only be able to take the drugs within six weeks. I am strongly against that.
Baroness Finlay of Llandaff: I—
Lord Falconer of Thoroton: If I may finish, the reason I am against it is that once the diagnosis is given by the doctors, there is a process that will take a considerable time, and that once the court has approved the process and said that somebody should do it, it should be for them to decide when they do it. It would be an unsatisfactory and, I suspect, an unenforceable process to have to go back and get a doctor to say that you have six weeks or less to live. I thought carefully about that point before it was raised. It is not referred to in any amendment and I assumed that nobody had properly considered it. I am against it.
Baroness Finlay of Llandaff: If I may come back on that, does the noble and learned Lord recognise that those discussions are currently being had with patients, day in and day out, up and down the country? It is not as if the Bill, as some noble Lords implied, would be the way in which people start talking about their dying
because it should be a routine part of clinical practice, as laid out in the GMC guidance. However, I do not think that he has yet answered my question on whether there would be merit in uncoupling those discussions and that process from the time at which the drugs were delivered. If I hear him right, he is saying that when you are in that zone of complete uncertainty and could toss a coin on it—you might die within six months or, as the noble Lord, Lord McColl, said, within three years; indeed, in the case of some of my patients you might die within 10 years, as it happens—the fact that the doctor has mistakenly said that he believes you are terminally ill would suddenly give the message that you should be considering having an assisted suicide. That would probably start to trigger these discussions. That is the danger in not uncoupling them.
Lord Falconer of Thoroton: I thought that I had answered the question but I will answer it again. A doctor has concluded that he or she reasonably believes that you have six months or less to live; another doctor has confirmed the diagnosis; and the courts have concluded that it is an appropriate case for an assisted death. Thereafter, my view—I should be clear about this—is that you should be entitled to have an assisted death as prescribed by the Bill. I am therefore against the decoupling of the beginning of the process from the time at which the drug could be taken.
The noble Baroness says that these discussions are taking place at the moment. No, they are not; the discussions taking place are about how somebody wishes to die. It does not involve discussions about assisted dying in the context of my Bill because that is not permitted at the moment, so this is dealing with a new situation. My clear answer to her is that I am not in favour of the decoupling. My proposition is that if two doctors certify and the court says yes, once that process has been gone through, it is for the patient to decide the moment he or she takes the drug, and there should not be another process for a doctor to certify that the patient has six weeks or less to live.
I shall deal with the other points raised in this group. First, for reasons I just cannot understand, the noble Lord, Lord McColl, and the noble Baroness, Lady Finlay, suggest that where the Bill states,
“reasonably expected to die within six months”,
or less, the word “reasonably” is deleted. That seems unwise. In my view, it is appropriate that a doctor giving such a diagnosis has a proper and reasonable basis for doing so. I am against that change.
In the context of the amendment moved by the noble Lord, Lord Carlile, the noble Baroness suggests we refer to a “licensed” practitioner rather than a “registered” practitioner. Although I do not agree with the amendment moved by the noble Lord, Lord Carlile, the point that the noble Baroness, Lady Finlay, is making appears to me to be a good one. We should discuss, outside the Chamber, the precise language. The noble Baroness, Lady Murphy, has an amendment that puts the language in a slightly different way. We are all concerned to allow this to be done only by doctors who have the appropriate qualification and are in practice. I am happy to agree an amendment that reflects that.
The noble Baroness, Lady Campbell, made a number of powerful submissions in relation to how this affects disabled people. The noble Baroness, Lady Brinton, responded to them and made it clear that disabled people can have different views about the adequacy or otherwise of the Bill. I was very struck by the reference to “The Theory of Everything” and Stephen Hawking, who is, in fact, in favour of some process of assisted dying.
The underlying anxiety that has been expressed to me by disabled people is that if we pass an assisted dying Bill, we in some way devalue the lives of disabled people and put them more at risk. I do not believe that we devalue disabled people in any way by passing this Bill. I believe it is incredibly important that disabled people have exactly the same options as everybody else when they are terminally ill. I also believe that the safeguards in the Bill are much stronger than the existing safeguards in relation to decisions about treatment. I completely echo the point that the noble Baroness, Lady Brinton, made: this will not be forced on anybody. It is an option to be asked for, and even when asked for, it can be given effect only when two doctors have certified that it is appropriate and the High Court of Justice has said that it is okay. Having spoken widely to disabled people, I do not believe that it puts them more at risk than the population as a whole. Although I, like everyone else in the Committee, am very moved by what the noble Baroness, Lady Campbell, said, I do not accept the criticism that she makes in relation to the Bill.
I think I have dealt with all the main proposals. This has been a very worthwhile debate. The areas where I think further discussions would be of value are in relation to the “doctor for hire” proposition and how we properly identify the qualification required for a doctor. In relation to the other proposals, I am broadly against them.
Lord McColl of Dulwich: I shall just explain some of the worries that the noble Baroness, Lady Campbell, has.
Lord McColl of Dulwich: In a sentence, every time she goes into hospital, they say, “You don’t want to be resuscitated, do you?”. A lot of disabled people have that question put to them. Does the noble and learned Lord think the Bill is going to change that?
Lord Falconer of Thoroton: I will take that up. With regard to my Bill, if the situation were reached—the noble Baroness, Lady Campbell, referred to this—that somebody had very low air and decided to take advantage of my Bill, they would have to get two doctors to approve it and the High Court of Justice would have to say yes. That is a very different situation from the one that the noble Lord describes. My Bill gives much greater protection as regards somebody who is asking for death than the situation that the noble Lord describes. It is for that reason that I cannot understand why he says that my Bill might make it worse.
Baroness Masham of Ilton: My Lords—
Lord Carlile of Berriew: My Lords—
Baroness Masham of Ilton: Can the noble and learned Lord say if he thinks that pressure might be put on some vulnerable people from family members who want to save money?
Lord Falconer of Thoroton: The Oregon experience is that that does not happen, but the safeguards—two doctors, and the High Court judge approving it—are in my view sufficient to prevent the sort of abuse to which the noble Baroness refers.
Baroness Finlay of Llandaff: I am grateful to the noble and learned Lord for having responded to the question about the qualification of doctors, which is an amendment to the amendment in the name of the noble Lord, Lord Carlile. I will make just a couple of points in response. One is that I am glad to see that the noble and learned Lord recognises that the way the Bill is currently drafted is a problem and that you need doctors with experience, but I wonder how he will achieve that. Clause 3(7) requires, rightly, that the doctor holds an appropriate qualification. However, yesterday the Association for Palliative Medicine published the results of its consultation with its members, which had a very high response rate and showed that only 4% of palliative medicine doctors who are licensed to practice are prepared to have any involvement in this process. Therefore if the conscience clause is to have any meaning, it is something to which we need to return, and I welcome the noble and learned Lord’s commitment to engage in discussions over it. We will come to other amendments later, which I have tabled, on how we might solve the problem, but I do not think that we will get to them today. I beg leave to withdraw the amendment.
Lord Carlile of Berriew: My Lords, perhaps the Minister or the Chief Whip will correct me if I am wrong, but I understand that the position is that I should now wind up on my amendment after the noble Baroness, Lady Finlay, has dealt with her amendment to my amendment. I apologise to the noble Baroness, Lady Masham; I simply did not see her trying to intervene. I did not intend to be discourteous.
This debate has taken—it just disappeared from the screen—something like two and three-quarter hours, which is a clear indication of the importance of the issues we have been discussing in this group of amendments. I express my gratitude to noble Lords who have taken part, including of course to the noble and learned Lord, Lord Falconer, who has responded to this debate and intervened at various times in a helpful and constructive way. He suggested at one moment that I was agitated. Agitated—no; frustrated—yes. I will explain my frustration.
The noble and learned Lord, as far I can see throughout the latter half of this debate, has addressed Clause 3. The noble Baroness, Lady O’Loan, who is a distinguished and talented lawyer, saw straight through that and made it clear that we are dealing with Clause 2. That clause is about the gateway. Clause 3 is about the certification. There is a very serious point of principle
about the standards that there should be at the gateway. I make no apology for re-emphasising that it is my view—otherwise I and others would not have tabled these amendments—that the gateway to this whole process must have medical, intellectual, empirical and objective integrity. None of those words are tautologies. It is the sum of them that we need for this gateway.
I do not know how many of your Lordships have read Dame Janet Smith’s three reports on the Shipman case. It was one of the biggest compendious inquiries that there has ever been. This issue was not really adequately addressed, in my respectful view, in this debate. In a quiet and beautiful valley in the same part of Lancashire and Yorkshire that I was dealing with earlier—in fact, in Todmorden, which is just over the border, in that county that Lancastrians rarely name—Dr Shipman probably killed a couple of hundred people. He was regarded as a kindly, gentle general practitioner to whom you gave a cup of tea and whom you could invite into your house with confidence. I want to be sure—and I know that others in this House want to be sure—that the gateway is safeguarded against people like Dr Shipman, for the reasons illustrated so well in her reports by Dame Janet Smith.
Furthermore, I reject the arguments that have been mentioned that there are real, practical difficulties with this amendment. There may be a few cases—and when we have dealt with the principle, we can look at the detail—in which people move away either from the general practitioner’s practice that has been dealing with them or from the specialist who has been treating the illness that has been determined as terminal. However, in my view those cases are going to be very few in number, far fewer than has been suggested by some of your Lordships, and that should not be an inhibition at this stage to the establishment of a clear safeguard and principle of safety.
The point was made by the noble and right reverend Lord, Lord Harries, that we are talking here about safety. We should hearken very carefully to the comments made by the noble Baroness, Lady Campbell of Surbiton, in her first intervention. She happens to represent in an informal way in our House that very important constituency of disabled people. She has told your Lordships that many disabled people outside this House do not have reassurance that this Bill provides in its gateway sufficient safeguards. In itself, that seems to be a sufficient reason to determine whether we wish to have the principle in this amendment. Furthermore the noble Baroness, Lady Grey-Thompson, and indeed the noble Lord, Lord McColl, highlighted the fact that the Royal College of Pathologists has shown in many cases that the cause of death given was just plain wrong. That shows how important it is to have robust safeguards.
We had some references to forms that I must admit I am fortunate enough never to have read, relating to benefit rules. To me, referring to those forms is a complete absurdity in the context of this debate. Those forms are about whether people are going to be paid sums of money by the state for their maintenance. That is no doubt an important issue, but it pales into insignificance on the issue of principle that relates to one person helping another person to commit suicide with a huge and lethal dose of barbiturates.
I could make many more comments, but I note that it is now 2.50 pm. In my judgment, there is a real principle and there are a lot of people waiting for your Lordships’ determination of that principle. To me it is as simple as this: do we want the gateway to be safe or are we prepared to take risks with people’s lives? With that in mind, I believe that the opinion of the House should be tested.
2.49 pm
Contents 61; Not-Contents 119.
CONTENTS
Alton of Liverpool, L.
Berridge, B.
Bridgeman, V.
Broers, L.
Brooke of Alverthorpe, L.
Browne of Belmont, L.
Butler-Sloss, B.
Campbell of Surbiton, B.
Carlile of Berriew, L.
Carlisle, Bp.
Cavendish of Furness, L.
Cormack, L.
Courtown, E.
Cumberlege, B.
Deben, L.
Eaton, B.
Elton, L.
Emerton, B.
Empey, L.
Finlay of Llandaff, B. [Teller]
Gardner of Parkes, B.
Gold, L.
Gordon of Strathblane, L.
Grey-Thompson, B.
Guthrie of Craigiebank, L.
Harries of Pentregarth, L.
Hennessy of Nympsfield, L.
Higgins, L.
Hollins, B. [Teller]
Hooper, B.
Howard of Lympne, L.
Howarth of Newport, L.
Howe of Idlicote, B.
Hylton, L.
James of Blackheath, L.
McColl of Dulwich, L.
Maclennan of Rogart, L.
Maginnis of Drumglass, L.
Manzoor, B.
Masham of Ilton, B.
Mawhinney, L.
Mawson, L.
Neville-Jones, B.
O'Cathain, B.
O'Loan, B.
O'Neill of Bengarve, B.
Reid of Cardowan, L.
Sherlock, B.
Singh of Wimbledon, L.
Slim, V.
Stirrup, L.
Swinfen, L.
Symons of Vernham Dean, B.
Tebbit, L.
Temple-Morris, L.
Tomlinson, L.
Trefgarne, L.
Trimble, L.
Uddin, B.
Warsi, B.
Williams of Crosby, B.
NOT CONTENTS
Addington, L.
Afshar, B.
Arran, E.
Ashdown of Norton-sub-Hamdon, L.
Avebury, L.
Bakewell, B.
Balfe, L.
Barker, B.
Beecham, L.
Berkeley of Knighton, L.
Blair of Boughton, L.
Boateng, L.
Borwick, L.
Brabazon of Tara, L.
Brinton, B.
Brown of Eaton-under-Heywood, L.
Butler of Brockwell, L.
Cameron of Lochbroom, L.
Carey of Clifton, L.
Cashman, L.
Chester, Bp.
Clancarty, E.
Clinton-Davis, L.
Collins of Highbury, L.
Condon, L.
Cooper of Windrush, L.
Craigavon, V.
Davies of Stamford, L.
Dholakia, L.
Dobbs, L.
Donaghy, B.
Donoughue, L.
Doocey, B.
Dubs, L. [Teller]
Dykes, L.
Elder, L.
Evans of Bowes Park, B.
Evans of Temple Guiting, L.
Falconer of Thoroton, L.
Falkner of Margravine, B.
Farrington of Ribbleton, B.
Faulkner of Worcester, L.
Finkelstein, L.
Flather, B.
Flight, L.
Freeman, L.
Garel-Jones, L.
Giddens, L.
Glasgow, E.
Goodhart, L.
Gould of Potternewton, B.
Green of Hurstpierpoint, L.
Greengross, B.
Grender, B.
Hamwee, B.
Hart of Chilton, L.
Haworth, L.
Hayman, B.
Hayter of Kentish Town, B.
Healy of Primrose Hill, B.
Hollis of Heigham, B.
Howie of Troon, L.
Hughes of Woodside, L.
Hunt of Chesterton, L.
Irvine of Lairg, L.
Jay of Paddington, B.
Joffe, L.
Judd, L.
Judge, L.
Kennedy of Southwark, L.
Kerr of Kinlochard, L.
Kinnock of Holyhead, B.
Leigh of Hurley, L.
Lennie, L.
Lipsey, L.
Lister of Burtersett, B.
Loomba, L.
Low of Dalston, L.
Lucas, L.
McIntosh of Hudnall, B.
Mallalieu, B.
Massey of Darwen, B.
May of Oxford, L.
Meacher, B. [Teller]
Mitchell, L.
Norton of Louth, L.
Prashar, B.
Purvis of Tweed, L.
Quin, B.
Ramsay of Cartvale, B.
Rea, L.
Rebuck, B.
Rees of Ludlow, L.
Renton of Mount Harry, L.
Richard, L.
Richardson of Calow, B.
Rodgers of Quarry Bank, L.
Rosser, L.
St John of Bletso, L.
Sherbourne of Didsbury, L.
Smith of Finsbury, L.
Snape, L.
Stevenson of Coddenham, L.
Stone of Blackheath, L.
Taverne, L.
Taylor of Blackburn, L.
Tonge, B.
Tope, L.
Tugendhat, L.
Turnbull, L.
Turner of Camden, B.
Warner, L.
Warnock, B.
Warwick of Undercliffe, B.
Wheatcroft, B.
Wheeler, B.
Wilcox, B.
Young of Norwood Green, L.
Young of Old Scone, B.
The Deputy Chairman of Committees (Baroness McIntosh of Hudnall) (Lab): My Lords, I have to tell the House that in the first Division one noble Lord voted in both Lobbies. Accordingly, their vote has been discounted and the result of the Division was therefore: Contents, 106, Not-Contents, 179.