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Assisted Dying for the Terminally Ill Bill: Select Committee Report

My Lords, I start by paying tribute to our chairman, the noble and learned Lord, Lord Mackay of Clashfern, whose qualities of sagacity and discretion combined with the saving grace of humour are well known to this House. I do not believe that we could have had a better leader when considering this difficult and controversial subject. I came to the work of the committee as one who generally supports the objectives of the Bill, a point of view I acquired—if that is the right word—from my mother, who was born in 1909. I mention that merely to indicate that the ideas set out in this Bill are not new. I should like also to draw attention to the support for some of the ideas in the Bill of the noble Lord, Lord Joffe, expressed outside Parliament. That is in sharp contrast to the views within Parliament, particularly in the House of Commons. While our chairman has highlighted the less than ideal sophistication of some of the polling methods used, nevertheless the general trend of opinion polls shows increasing support for the ideas set out in the Bill. Interestingly, 47 per cent of people might be prepared to break the current law to assist a suffering terminally ill patient to die. Over recent years, sentences in the courts seem to show understanding of the difficult choices which some people have faced in this respect. Turning to opinion within the medical profession, it is clear that support for some form of assisting terminally ill patients to die has risen over past years among both nurses and doctors. The attitude expressed to us by the BMA in its evidence was neutral on the grounds that it was for society as a whole to determine such matters. Obviously it recognised the difficulties that such legislation might pose for some professionals, in particular those frequently involved in end-of-life care. Any new Bill would need to provide a watertight conscience clause. The Royal College of Nursing gave evidence against the Bill but it is fair to say that this approach may have represented the feelings of the council rather than of the membership as a whole. An independent survey of nurses by the Nursing Times in 2003 showed that two-thirds of nurses supported a change in the law. One of the aspects of the Bill—to which the noble Lord, Lord Carter, referred—which I found unsatisfactory was the lack of attention paid to the role of nurses in end-of-life care. Their role might need more recognition in a new Bill. The evidence from Oregon and the Netherlands does not suggest that nurse-patient relationships have been damaged or changed by legislation in those countries. My third point is the apparent conflict—at least for some—between palliative care and the approach taken by the noble Lord, Lord Joffe, in his Bill. I am aware that the noble Baroness, Lady Finlay of Llandaff, a distinguished practitioner and teacher of palliative care—who, I believe, follows me in today’s debate—may well express different views, but I can see no such conflict, and nor do we find evidence of it elsewhere. It may be that palliative care is less well developed in Holland than in the United Kingdom—that may be connected to the fact that most people there die in the care of their GP—but Dutch doctors are certainly working hard to acquire palliative care skills. Meanwhile a most welcome development in the UK is the increased training of GPs in end-of-life care of their patients. A wide spectrum of alternative treatments is highly desirable. Fourthly, I want to address the frequently expressed fear that any legislation along the lines of the Bill of the noble Lord, Lord Joffe, would be a danger to disabled people or to those who might think they ought to die so as not to be a burden on their families. Again, I think that the case is quite the contrary. Evidence given to us suggests that some severely disabled people who need to go into hospital already fear that doctors may assume, for example, that the disabled person would not want to be resuscitated in the operating theatre—a totally unfounded assumption made in a lordly fashion on behalf of patients—whereas the whole point of these proposals is that it is the patient who decides these matters, not the doctors or the families, who are excluded by the Bill from playing any part in the process which might lead to assisted suicide or voluntary euthanasia. That leads me to my next point—namely, the character of those who seem to choose to take advantage of legislation giving patients choice in the manner and timing of their death. They tend to be people who have always exercised a high degree of choice in their manner of life and wish to do the same in respect of their manner of death, particularly where death by self-administered medication is involved. It pains me to be at odds with the right reverend Prelate the Bishop of Oxford, speaking on this point this morning, but in a secular society people of all walks of life value the freedom to choose how they live their lives. Apparently they are also willing to grant to others, or to claim for themselves, the same freedom to end those lives if they become intolerable by reason of terminal illness or unbearable pain. After all, suicide is not a crime. My last point is a simple one. The Bill considered by the committee forces no one who disapproves of it to take advantage of it. Experience elsewhere suggests that not many people would take advantage, but it does give some people in specified and desperate circumstances the freedom to choose to die, even if they are not able to commit suicide unassisted. I hope that the House agrees the Motion before us today and that, in due course, we may return to debate a new Bill which will change the law. I would prefer that the Bill contain provision for both assisted suicide and voluntary euthanasia, if only to test the opinion of the House of Commons and to make it think as hard as we have thought on these matters. It is time for Parliament to face up to these issues.