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Assisted Dying

My Lords, it is a great pleasure to open this debate so close to Sir Terry Pratchett’s courageous and—dare I say it?—entertaining Dimbleby lecture. I may not reach the same audience as Sir Terry, but we seem to have pulled in quite a lot of people today. Using humour to cope with huge sadness, anger and despair is a rare gift. The theme of that Dimbleby lecture was shaking hands with death and coming to terms with it in the individual’s own way. As Sir Terry said, "My life, my death, my choice". As death is a personal matter, I do not expect the Government to get involved in telling people how to conduct their affairs when they are dying—quite the reverse. I expect the Government to recognise that we now have a confused legal situation around death and dying that is very threatening to a growing number of people. They have a responsibility to try to facilitate some resolution of the confusion. A responsible Government—this one or another—should not wash their hands of these difficult issues and simply say that it is up to Parliament to sort things out, especially when Parliament has demonstrated that it cannot do that unaided. The theme of my remarks today is why the Government need to bring in some wise and independent help to break the parliamentary gridlock. Why do we need an independent inquiry or review? First, we have a mounting set of contradictions that produce far too much confusion for many citizens. Most people want to die in their own home with their family around them, and at a time of their choosing. Instead, 60 per cent of people still die in hospital. A growing number of very determined and reasonably well off British people slip over to Switzerland to die at a time and in circumstances of their choosing. More than 700 brave souls have registered with Dignitas to keep their options open. A few have managed to persuade doctors to help them on their way illegally—probably in less than 1 per cent of deaths. Some people just give up and effectively starve themselves to death, sometimes rather painfully, but we do not know how many of those there are. We have legislation that gives us the right to make living wills to stop doctors treating us, but we have little confidence that healthcare staff will always respect our wishes. Doctors’ leaders have satisfied themselves that they have a satisfactory system for giving patients doses of drugs that may kill them, but that that is okay if it is only a secondary consequence of relieving pain. That is what I call the nudge and a wink approach to putting you out of your misery—very British. With this confused situation, it is hardly surprising that year-on-year, we see a steady flow of mercy killing cases appear in our courts. Some of them look similar in circumstance but end up with different outcomes in decisions to prosecute or in court outcomes. In the recent Gilderdale case, the judge criticised the CPS for prosecuting. That does not bode well for the DPP's new guidelines. Personally, I think that Keir Starmer has done as well as anyone could expect with the poisoned legal chalice passed to him by Parliament and the Supreme Court. We know that the law in this area is a mess because the Law Commission told us so in its review of murder law in 2006. It recommended that a further review was needed on mercy killings and other connected issues, such as assisted suicide, which would include assisted dying. The Government have declined to take up that recommendation but should, in my view, reconsider their position. That is a brief summary of the policy and legal confusion, but there is also a lack of symmetry between governed and governing. Survey after survey for a decade or more has shown that the public want some form of change to legalise assisted dying for terminally ill people who are competent to make that decision. The recently published 2010 British social attitudes survey showed that 82 per cent of the public support assisted dying. Parliament—Commons and Lords—lags behind public opinion on this issue but, as in so many areas, the plates are shifting. In 2006, 33 per cent of participating Peers voted in favour of the Bill on assisted dying of the noble Lord, Lord Joffe. In 2009, 42 per cent of Peers who took part in, or listened to, the debate on an amendment to the Coroners and Justice Bill to safeguard those who assist people going to Switzerland to die voted in favour of it. In the Commons, a higher proportion of MPs now seem to support change than in 1997, when Joe Ashton brought forward his Bill on doctor-assisted dying. I do not expect the Government to bring forward legislation, but they should try harder to bring some greater order to the increasingly chaotic policy and legal situation. The position continues to change in other countries. We now have the experience of the Netherlands, Luxembourg, Oregon and Washington State to draw upon, with Montana likely to join them soon. The DPP’s guidelines are unlikely to produce stability. The Government’s own end of life strategy is incomplete in this area and will continue to cause the issue to be raised. Now Sir Terry Pratchett has suggested a practical way forward for helping doctors out of the quandary in which they find themselves: a medical legal tribunal to which people who want assisted dying can apply. That is not much different from the situation now, where applications can be made to the High Court to switch off a brain-dead patient’s ventilator. Of course, we still have the Law Commission’s recommendation lying on the table. There is a lot of material for an independent review to get its teeth into. There is a raft of medical, legal, ethical and other knots to untangle, as I have indicated. This is territory that in an earlier time we would have handed over to a royal commission. I do not much mind what one calls such an inquiry, provided its terms of reference are wide enough and its membership carries public confidence and avoids sectarian capture. I have made no attack on those who have different views from mine. I hope that other noble Lords can be dispassionate, support this approach on a non-judgmental basis and encourage my noble friend the Minister to get his colleagues to consider seriously the idea of an independent inquiry.