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Address in Reply to Her Majesty’s Most Gracious Speech

My Lords, I follow the right reverend Prelate in congratulating my noble friend Lord Adonis on his excellent maiden speech and welcoming him to the House. I also congratulate my noble friend Lord Warner on his ministerial promotion, and say how glad I am that he is back at the Department of Health. It is on an area of health and social affairs that I would like to focus this afternoon. Throughout this debate on the gracious Speech, most noble Lords who have spoken have said that this is certainly not a government running out of steam. On health alone, about three major Bills will come before your Lordships this Session. I have one point of caution for my noble friend Lord   Warner, which is that I hope that the ministerial team in the Department of Health will devote as much energy to seeing that those measures that have already come into force are taken forward, with the sort of clarity and energy as one would expect, as they will spend in the time   on new legislation. It was my experience during the campaign that everyone recognised the huge improvements made in healthcare by the Government, but did not always feel that local   delivery necessarily matched up to national aspirations and policy. Having said that, I welcome the proposed new measures to be introduced on health improvement, particularly the proposals to restrict tobacco use in public places. On that important public health topic, I suspect that the Government may have been encouraged to act by the important international examples that have taken place, particularly the successful introduction of similar measures in the Republic of Ireland in the past year. I suspect that another influence has been the continuing pressure for action by individual Members of both Houses of Parliament. Noble Lords will remember the noble Lord, Lord Clement-Jones, introducing his Private Member’s Bill on tobacco advertising in the previous Parliament. After a great deal of hard work by individual Members of your Lordships’ House, that became official government policy and, eventually, an official government Act. Some of the same factors may apply to the issue to which I want to draw noble Lords’ attention, which is assisted dying. I would like to spend a few minutes on   that complex and difficult but fundamentally important subject. As the House will remember, assisted dying for the terminally ill was proposed by the noble Lord, Lord Joffe, in two Bills considered by it during the previous Parliament. The second Bill was sent to a Select Committee chaired by the noble and learned Lord, Lord Mackay of Clashfern, who was once Lord Chancellor. I was privileged to be a member of that committee. We worked hard on the Bill of the noble Lord, Lord   Joffe, for about eight months and produced a unanimous report right at the end of the most recent Session. The report was published on 4 April. Not surprisingly, it was somewhat lost in the pre-election fervour of that week and the subsequent campaign. The committee called for an early opportunity for our report to be considered by your Lordships. We also recommended that if a similar Bill were introduced in   this new Session, it should have a formal Second Reading and then be considered by a Committee of the whole House. I very much hope that both a take-note debate on the Select Committee report and a new Bill will appear on our Order Paper very shortly. This was the second committee in your Lordships’ House on assisted dying in which I have taken part. A decade ago I was a member of the Select Committee on Medical Ethics, chaired by the noble Lord, Lord Walton, which in 1994, again unanimously, recommended firmly   that there should be no change in the law. That earlier committee concluded that to alter the law to admit any form of voluntary euthanasia would remove a cornerstone of law and social relationships, even in circumstances when a terminally ill person had asked for assistance in dying. The principles behind the Walton committee’s conclusions remain strongly held by many people. I am sure that there will be further opportunities to debate those principles both in the take-note debate and later, as well as other broader ethical issues that arise in this Chamber. My concern this afternoon is not to discuss fundamentals but to draw the Minister’s attention to the changes of the past 10 years which have certainly altered my views on this subject since I was a member of the Walton committee. The Government should consider them carefully when responding to any new Bill that is introduced. The first, and perhaps most important, change is that today we can draw on practical international experience. In the past decade, several countries and one state of the United States have legally introduced different types of assisted dying. Some jurisdictions permit voluntary euthanasia by physicians and others allow assisted suicide by individual patients. Members of the Select Committee were able to visit the Netherlands, Switzerland and the state of Oregon to see for ourselves how different systems worked. Personally I found those visits reassuring. After several years of practice, and contrary to widespread speculation, there was no evidence of a ““slippery slope””, and the number of people who took advantage of the new laws seemed to be very small and rather stable. On all our visits, although there remained quite vocal local opposition, I was impressed by the general feeling of those we met that the availability of assisted dying had given patients greater choice and reassurance at the end of their lives. The overarching view was that the human rights of individual citizens had been improved. Universally, as your Lordships know, there is greater attention to human rights and individual autonomy in medical practice, and it is those changes of emphasis that   have partially influenced the opinions of many healthcare professionals in this country. For example, in its evidence to the Select Committee, the Royal College of Physicians, which on that occasion represented the Academy of Medical Royal Colleges, told us that it had moved from opposition to earlier proposals to one of neutrality on the Bill of the noble Lord, Lord Joffe. In another session the chairman of the General Medical Council told us that if the Joffe Bill had become law,"““it would present no insurmountable problems for the GMC””." The representatives of the Royal College of Nursing remained opposed to change when they appeared before us. However, since then, I have been interested to read the animated debate at the RCN annual conference, which showed a much greater variety of opinion among nurses than RCN leaders had suggested to us. It seems likely that opinion is changing in that profession as well. Overall, health professionals now take the view that permitting assisted dying is a decision for society as a whole. It is for Parliament, not the medical practitioners or health care professionals, to decide. To gauge the views of society—in so far as one can—the Select Committee decided not to commission our own public opinion surveys, but to set up a review of the surveys that had taken place in the past two decades. That review by Market Research Services concluded:"““It is evident that there is a great deal of sympathy at least for the concept of euthanasia and it seems likely that the level of sympathy has grown in recent years””." Certainly NOP polls commissioned by the Voluntary Euthanasia Society in 2002 and 2004 showed 80 per cent support for the proposition that,"““a person who is suffering unbearably from a terminal illness should be allowed by law to receive medical help to die, if that is what they want””." Interestingly, since the Select Committee report was published in April, YouGov conducted a poll during the general election campaign showing that 45 per cent of respondents said that they would be more likely to support an election candidate who supported the specific provisions of the Joffe Bill than one who did not. However, I am sure that much more work needs to be done on testing public attitudes to a change in the law and the complexities of social policy that arise. I had hoped that that Select Committee could use focus groups or more in-depth discussion to approach the general issues of assisted dying rather than simply relying on question and answer polls, but time and resource constraints prevented that happening. None the less, the Government should note the consistently positive response of the public to proposals for a change in the law. The increasing support combines with the changing attitude of healthcare professionals and the evidence of practice in other countries to work together to create a very different environment from that of 10 years ago when your Lordships previously considered this proposal. We have been told by the Government from the Prime Minster downwards that in this Parliament they will ““listen and learn””. I hope that when a new Bill on assisted dying is introduced in this House, Ministers will carefully follow that maxim, and consider very carefully indeed the position they should take in the changed world of 2005. I look forward to my noble friend’s reply tonight, but I would neither hope nor expect it to be definitive.