>HOME >euthanasia Joffe Bill:Friday, 12 May 2006. Friday, 12 May 2006. House of Lords Friday, 12 May 2006. The House met at ten of the clock: the LORD CHANCELLOR on the Woolsack. Prayers? Read by the Lord Bishop of St Albans. �� Column 1184-1189 http://www.publications.parliament.uk/pa/ld200506/ldhansrd/vo051010/text/51010-04.htm#column_12 Assisted Dying for the Terminally Ill Bill [HL] 10.08 am Lord Joffe: My Lords, I beg to move that this Bill be now read a second time. The Bill follows previous Bills of the same nature brought forward in 2003, 2004 and 2005. None was proceeded with in order to allow a Select Committee, chaired by the noble and learned Lord, Lord Mackay of Clashfern, to consider the issues. The committee took evidence over nine months in the United Kingdom, the state of Oregon in the USA, the Netherlands and Switzerland and reported in April last year. After the Take Note debate on the Committee's report, I introduced this Bill, which had its First Reading on 9 November last year. The Bill is modelled on the Oregon Death with Dignity Act, which has been in force in Oregon for eight years and has operated satisfactorily with no credible evidence of abuse. I am pleased to be in a position to say that the Bill is supported by a majority of the members of the Select Committee, including two former Ministers of Health. The Bill would allow a doctor, at the persistent and informed request of a terminally ill patient who has capacity and is suffering unbearably, to prescribe medication for self-administration by the patient in order to end his suffering by ending his life. To judge from the many letters I have received from opponents of the Bill?some adorned with swastikas, and with many references to the Holocaust?it is clear that there has been much misrepresentation about what the Bill permits and much ignorance about what it does not permit. There appears to be a belief among some of those opposing the Bill that it allows doctors arbitrarily to kill terminally ill patients; that it applies to patients without mental capacity?Alzheimer's being frequently quoted; that the Bill and its supporters are opposed to palliative care; and that it applies to all patients rather than only to terminally ill patients. Nothing could be further from the truth. The current law has the following defects. It results in unnecessary suffering by a significant number of terminally ill patients who are denied the right to end their suffering by ending their lives and the right, as they see it, to die with dignity. It is ignored by some caring doctors who, from time to time, moved by compassion, accede to persistent requests by suffering patients to end their lives. That results in grave risks to those doctors' careers, reputations and possibly freedom. It is also ignored by loved ones who face a terrible emotional burden when helping with such a request. It places patients at risk of making spontaneous and ill-formed decisions to end their lives. It influences patients with progressive physical diseases to end their lives earlier than they need to, such as Dr Turner, because they fear that at a later stage they may not be physically able to do that. 12 May 2006 : Column 1185 Finally, it results in patients leaving the United Kingdom to die lonely deaths at Dignitas in Zurich, without any legislative safeguards whatever. The Select Committee unanimously concluded in its report that there is a small but significant number of determined patients, generally having strong personalities and a history of being in control, who are unlikely to be deflected from their wish to end their lives by more or better palliative care. As a result of our current laws, these dying patients are forced to suffer therapy against their wishes. Under the law as it stands, helping someone to die, even if that person is suffering unbearably from a terminal illness and has asked the doctor to help him to die, is a crime and is punishable under the common law of murder or the Suicide Act 1961 by a mandatory life sentence, for murder, or by up to 14 years' imprisonment for aiding or abetting suicide. However, we know that, despite the law, there is a number of patients whose caring doctors assist them to end their lives. Professor Clive Seal of Brunel University, in a study this year, concluded that such cases may amount to a little more than 900 deaths in England and Wales. In the eyes of the law, those compassionate doctors are murderers. In considering whether the law should be changed, regard must be had to a key unanimous finding of the Select Committee that: "While the most careful account must be taken of expert evidence, at the end of the day, the acceptability of assisted suicide is an issue for society to decide upon through its legislators in Parliament". Let us start with the experts. There is a strong division among them. For example, the Royal College of Physicians was in favour of neutrality when it gave evidence to the committee but later, after a consultation process, decided to oppose the Bill. The British Medical Association was against the Bill when it gave evidence, but subsequently changed to a position of neutrality. The Royal College of Nurses was against the Bill, but a survey in the Nursing Times found 60 per cent of nurses in favour of the law being changed. As for society, which is the really important matter, public opinion polls over 25 years consistently show that between 71 per cent and 87 per cent?the latter, incidentally, emerging in a poll in the Daily Telegraph?of society supports assisted dying. Marketing Research Services reviewed the surveys for the Select Committee and concluded that they did not form a very useful guide to public support for legislative change, but recognised an apparent groundswell of public agreement for euthanasia that it felt could not be dismissed. My noble friend Lord Moser, who is widely recognised as a leading expert on such surveys, reviewed the same surveys and will outline his conclusions later in the debate. If your Lordships, like me, have been inundated with letters opposing the Bill, you may have thought, "Perhaps public opinion is against the Bill". Public opinion surveys show conclusively that that is not the case. The letters come from some of the relatively small 12 May 2006 : Column 1186 number of deeply committed Christian worshippers and are the result of a massive political campaign by the Churches, led by the Catholic Archbishop of Cardiff, which included the dissemination of 500,000 leaflets or DVDs asking recipients, among other things, to write to Peers and MPs to express their opposition to the Bill. The irony is that research and public opinion surveys, including a 2004 NOP survey, have found that about 80 per cent of Christians of all denominations support assisted dying?a disparity on which right reverend Prelates may wish to comment. It is also a source of comfort when receiving those letters that only 1 or 2 per cent, I should imagine, of the 500,000 have responded. The principle underpinning the Bill is one of personal autonomy?the right of each individual to decide for himself or herself how best he or she should lead his or her life. In the NHS, it is called patient choice and is a fundamental principle. It allows patients to request their doctors to desist from further life-sustaining treatment so as to allow them to die, but does not include the right to ask them for assistance to die by prescribing appropriate medication. To many, the distinction between those two cases is invisible. Central to the Bill is that it applies only to terminally ill adult patients who have capacity. An informed decision must be made by the patient. Self-administration by the patient is essential. There is a conscientious objection clause for all health professionals. Voluntary euthanasia and mercy killing are not permitted. More than 20 interrelated safeguards ensure that vulnerable members of society are not put at risk. The process begins with an adult patient requesting a doctor in writing to assist him to die. As I said, there is then an array of safeguards to be traversed, as set out clearly in the Bill and the Explanatory Notes, including examination by and consultation with two independent doctors, one of whom must be a consultant; a reference, where capacity is in doubt, to a psychiatrist; a consultation with a palliative care specialist; and, finally, if the patient persists, a declaration asking to be assisted to die signed before two witnesses, one of whom must be a solicitor or public notary. Only then, and after a minimum of 14 days have elapsed since the initial written request, may the doctor prescribe the medication, after advising the patient once more of his right to revoke the declaration. It is then for the patient to decide when and if to ingest the medication. If he decides to take the medication, the prescribed documentation must be sent to a special monitoring commission set up by the Secretary of State. The committee estimated that if the Oregon experience was replicated here, we might expect 650 deaths in England and Wales out of the 500,000 or so annual deaths. The committee also received evidence that many patients do not take the medication, but that it gives them great reassurance to know that it is available in case they require it. The Bill is very different from the legislation in the 12 May 2006 : Column 1187 Netherlands, which is far more widely drafted; allows voluntary euthanasia; and is not restricted to competent and terminally ill adult patients. Accordingly, the evidence of some developments in the Netherlands is of little relevance to the Bill. On the recommendations in the Select Committee's report, paragraph 269(b) contains a procedural recommendation that if another Bill of the nature of the previous Bill was introduced, it should, following a formal Second Reading, be sent to a Committee of the Whole House for examination. However, the Bill's opponents have refused to follow this recommendation, which is why we are here today on this sunny Friday. We have carefully considered the remaining recommendations, all but two of which have been incorporated fully or partially into the Bill. Two recommendations are, however, so contrary to the concept of personal autonomy that we cannot accept them: in paragraph 269(c)(v), "unrelievable" or "intractable" suffering is preferred to "unbearable" suffering; and paragraph 269(c)(vi) proposes that the patient must actually experience palliative care before taking a final decision. As these do not relate to the principles of the Bill, we naturally expect to debate them fully in Committee. I shall now address some of the concerns raised by the Bill's opponents, all of which are speculation about what might happen, and which can be tested only by reference to the experience of countries where assisted dying is lawful, after making due allowance for differences in culture. It was for this reason that the Select Committee visited Oregon, the Netherlands and Switzerland. I will touch briefly on some of these concerns. We naturally respect the deeply held convictions of all those who share a concern about the sanctity of life. The Bill does not seek to interfere in any way with the belief and conduct of those who oppose it, but I question the right of those who object on faith grounds to seek to impose their beliefs on those who do not share them?the overwhelming majority of society. There are two components to the slippery slope argument. One is that, by starting with a small number of deaths, assisted dying will gain momentum until the number has multiplied many times over. In Oregon, out of approximately 30,000 deaths each year, there were only 38 assisted dying deaths in 2002, 42 in 2003, 37 in 2004, and 38 in 2005. Nothing could demonstrate more clearly that there has been no slippery slope in Oregon. As the Bill remains comparable to, but with even more safeguards than, the Oregon legislation, there is no reason to fear that there will be a slippery slope over here. The second component of the slippery slope argument is the fear that the limits of the Bill will be tested in practice so that more and more patients are brought within its remit. This has not happened in eight years in Oregon, and there is no sign of it happening. All the committee and all the supporters of the Bill strongly support the provision of more and better palliative care. On our visit to Oregon, it was reassuring to note that palliative care has flourished there since the introduction of assisted dying 12 May 2006 : Column 1188 legislation. The number of patients who use hospices increased from 2,000 in 1988 to 15,000 in 2005 and, according to the evidence that we have received, the expansion was probably accelerated by the legislation, rather than the reverse. There is no reason to believe that palliative care will not significantly increase and improve if the Government provide the necessary funding. Lack of funding, not the introduction of assisted dying, will be the constraint on development. The potential danger of assisted dying to vulnerable members of society has simply not emerged in Oregon. There is no credible evidence of any abuse; Ann Jackson, director of the Oregon Hospice Association, confirmed this to Members of both Houses only last month. As for the concern about decreasing trust in doctors, if between 71 per cent and 80 per cent of the public are in favour of assisted dying, it is difficult to follow the argument that they should lose trust in their doctors for doing what they are actually in favour of. A YouGov survey in November 2004 found that 83 per cent of patients would trust their doctors the same or more if there were assisted dying legislation. It will be clear to the House that the coverage of the present Bill is more tightly drawn and restrictive than the earlier Bill considered by the Select Committee, dealing as it does only with assisted dying and explicitly excluding any form of euthanasia, whether voluntary or otherwise. So in some ways it is climbing up the slope rather than descending down it. In that context, I shall make my personal position clear. When I gave evidence to the Select Committee about the original Bill, I expressed my personal conviction, which was honestly held at the time, that I would welcome a widening of the scope of the legislation. I no longer hold that view. One of the advantages of the Select Committee process was the opportunity to see different regimes in operation, and to hear a wealth of evidence from those who have thought deeply about the issues and are intimately involved in them. At the end of the process, it is now my firm view that the extent of legislative change that I put before the House today, which we shall now contemplate and should broadly welcome, will have the most advantage and carry the least risk. I would not support further extension into the field of euthanasia, or support assisted dying for patients who are not terminally ill. Others, of course, may have different views, but after three years of legislative effort on the subject, I have no intention of pursuing this issue beyond the ambit of the present Bill. As detailed Explanatory Notes have been made available in the Printed Paper Office, and as I have already outlined the key provisions of the Bill, I shall touch only briefly on two specific issues, the first of which is Clause 1(a)(ii), which authorises assisted dying. The great majority of patients will end their lives by orally ingesting the prescribed medication, but provision is made in this paragraph for the small number of patients?we estimate perhaps 5 per cent?who are unable to swallow, such as some motor neurone disease patients, to be provided with the necessary means for them to end their lives. The clause 12 May 2006 : Column 1189 would enable the patient to self-administer by, for example, pouring the medication into their feeding tube. The key point about self-administration, as set out in paragraph 246 of the Select Committee's report, is that responsibility for the ultimate act rests with the patient. I give early notice of two amendments to the clause which I propose to move in Committee. These were drawn to my attention by opponents of the Bill, for which I thank them. I now realise that, by including "or appropriate" after "impossible", I have opened up the possibility of the doctor interpreting the provision of means exception too widely, and I intend to seek to delete the words "or appropriate". To set the matter beyond any possible doubt, I also intend to include an explicit prohibition against ending a patient's life by lethal injection or act of euthanasia. I also draw attention to Clause 14(2)(d), which would enable the Secretary of State to provide a code of practice for the guidance of doctors and others acting in accordance with the Act. This code would cover, inter alia, the prescription, dispensing and control of the medication and the provision of the means of self-administration. In conclusion, I would underline that the Bill is modelled on the Oregon legislation, which has been operating satisfactorily for eight years. The noble Earl, Lord Arran, who visited Oregon as a member of the Select Committee, will be dealing in detail with the evidence given in Oregon. As a caring society, we cannot sit back and complacently accept that terminally ill patients who are suffering unbearably should simply continue to suffer for the good of society as a whole. We must find a solution to the unbearable suffering of patients whose needs cannot be met by palliative care. The Bill provides that solution, in the absence of any other, and, based on the successful model in Oregon, we can move forward on this sensitive matter with confidence, secure in the knowledge that the Bill would not impose anything on anyone; it merely provides an additional end-of-life option for terminally ill patients, which they are free to accept or reject as they, and only they, decide. I commend the Bill to the House. Moved, That the Bill be now read a second time.?(Lord Joffe.) 10.30 am ��Column 1189-1193 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-02.htm Lord Carlile of Berriew rose to move, as an amendment to the Motion that the Bill be now read a second time, to leave out "now" and at end insert "this day six months". The noble Lord said: My Lords, it is always a pleasure to follow the noble Lord, Lord Joffe, who has made a measured and powerful speech in support of the Second Reading of his Bill. I am sure that the whole House would wish to join with me in wishing the noble Lord many happy returns of the day, it being his birthday. I have to confess that I hope to give him as a present more down time in his life. I feel that I should start with a word about procedure, as there has been much misleading material promulgated about the procedure which I propose 12 May 2006 : Column 1190 your Lordships' House should follow today. It has been suggested that dividing the House at the Second Reading of a Private Member's Bill is in some way a breach of conventions of this House, and some have suggested that it is not proper. I have of course consulted the House authorities. I have also taken the advice of senior Members of this House with decades more experience here than I. I have had it confirmed to me that what I seek to do today is a proper course. There is no long-established convention that the House does not divide on the Second Reading of Private Members' Bills. In reasonably recent years, it happened once in 1990, twice in 1991, twice in 1992, twice in 1994, four times in 1995, once in 1997 and once in 1998. That it has not happened since 1998 is perhaps a reflection on this House. The frequency of so dividing plainly is influenced by the controversiality of the Private Members' Bills introduced, of which there has been a clear diminution in recent years. The point is that when appropriate this House can, does and, I would respectfully suggest to your Lordships, should divide. The procedure is proper and I hope that we can get on with the real debate. The public, it seems to me, wish to vote on this difficult issue, as our postbags show. However, public opinion polls and, indeed, private opinion polls are fragile things. I would urge the House to heed those classic words of advice by Edmund Burke that we, particularly as unelected Members of a House of Parliament, should, like elected Members of the other place, be pillars of what is right and not the weathercocks of perceived public opinion. I agree with the noble Lord that some of the letters on both sides of this debate have been intemperate. They are to be regretted. As he said, they are characterised by ignorance. The most insulting of them?as anyone who has spent, as I did, years in the other place will know?are almost always anonymous and, in my practice, thrown straight in the dustbin if people are not prepared to put their name to them?unless they contain a remarkable piece of visual art, which is very rare. However, I feel that I should say one further matter about my approach to this debate. Yesterday, on page two of The Times, there was a story suggesting that the noble Lord was saying that three noble Lords opposed to the Bill have broken their word to him that they would not oppose the Bill. By innuendo, there was a clear accusation that I was one such and, in my view, a clear innuendo that the noble Baroness, Lady Finlay, was another. Who the third was suggested to be, I do not know. I have been able to ascertain through conversation with the noble Lord, Lord Joffe, that that story did not emanate from him. It was untrue. It was never checked. It was defamatory. No one broke their word. The Times has apologised generously today. I am pleased to tell your Lordships that whatever else happens in this debate, someone will gain. The Times has generously agreed as a recognition?[Interruption.] I hear a ring tone that goes with the noble Earl's socks. 12 May 2006 : Column 1191 I am pleased to tell your Lordships that The Times has generously agreed as a recognition of the defamation that there will be one gainer from this debate at least. The charity, Marie Curie Cancer Care, will receive a substantial four-figure sum from The Times in recognition of the wrongness of what it did yesterday. Why should we vote at Second Reading? The noble Lord, Lord Joffe, reintroduced his Bill last year. It went to a Select Committee, chaired, if I may say so with huge respect, brilliantly by the noble and learned Lord, Lord Mackay of Clashfern. There was a substantial report. There was a take note debate in which the concerns of the committee were reflected. There will be many more speakers in this debate and I do not want to take up too much time. But, in summary, I say to the noble Lord that his Bill in its revised form, despite a puzzling six months between First Reading and Second Reading?so we are now debating Second Reading towards the end of this Session?does not take fully into account all the concerns expressed by the committee. The noble Lord knows that it has absolutely no chance of becoming law in this Session in the real and practical world in which political people should live. Every word that we in your Lordships' House utter costs public money. It seems to me right that your Lordships' House should not spend further time on a costly but pointless exercise on a Bill that, in my view, cannot be made acceptable by amendment. The only point in giving this Bill a Second Reading is if it can be made acceptable by amendment. In answer to something that the noble Lord said earlier, I come to this from an entirely non-religious viewpoint. If I am anything religious I am a monotheist utilitarian, which is not terribly religious, is it? In any event, the religious ethical aspect will doubtless be dealt with by the most reverend Primate the Archbishop of Canterbury and others. There are three main points therefore that I want to make briefly. First, despite protestations to the contrary, everyone in your Lordships' House knows that those who are moving this Bill have the clear intention of it leading to voluntary euthanasia. That has always been the aim and it remains the aim now. Despite the small amendments that the noble Lord told us of a few moments ago, the difference between Clause 1(a)(ii) and voluntary euthanasia is but a casuist's smidgen. The Bill introduces for the first time into this country the concept of doctors abandoning therapy for deliberately causing a person's death. The fact that a person in law gives the instrument of death to another person who ingests it still includes them as the person causing death. Anyone who, like me, has spent 35 years round the criminal courts would not dare try to make this distinction in front of a judge or a jury in a criminal court. I and many others find that, whether religious or not religious, morally objectionable. I include in that moral objection the vast majority of physicians and general practitioners, as their respective royal colleges, 12 May 2006 : Column 1192 the Disability Rights Commission and, as I understand it, the Royal College of Nursing have now said. In my view, they are right. This is morally indefensible legislation. Having visited the Netherlands as part of the committee chaired by the noble and learned Lord, Lord Mackay, I came away even more concerned about what I saw there than before I went. The Netherlands?let us be realistic about this?is a country where euthanasia is used as an alternative to an expensive palliative care system that it does not have. We are told that the Netherlands is now contemplating possibly using euthanasia on babies with learning difficulties who have absolutely no autonomy of their own. In my view, the Netherlands system is very troubling. I do not accept that the Oregon system?on which I have read the evidence; I did not go there?is an acceptable system either. We heard on the radio this morning that one of the things that happens in Oregon is that people can opt for euthanasia and then keep lethal drugs, presumably in their refrigerators, to use just in case they feel like it at some time in the future. What kind of a system is that? So I find the system as proposed morally indefensible, but in any event we do not need it in this country. The tireless noble Baroness, Lady Finlay of Llandaff, who, I am delighted to say, is soon to become president of the Royal Society of Medicine? Noble Lords: Hear, hear! Lord Carlile of Berriew: ?is a leader in the palliative care field. I am sure she would accept that there is always room for more resources, but the fact is that we have developed a palliative care system which is capable of meeting every need discussed in these debates, with relatively few more resources in global terms. My second objection is that this Bill and what is proposed is a legal minefield. It holds a great deal of promise for my learned friends in their struggle against falling fees in publicly funded cases. But so porous are the provisions in this Bill that I suggest to your Lordships that we would become more likely than now to see physicians, lawyers?because there are provisions here to involve lawyers?and, perhaps above all, relatives of the sick before the courts on criminal charges. My third objection is that the Bill provides a complete ethical nightmare. The chorus of doctors who object to this legislation speak of that ethical nightmare, and it causes real fear among very old people, many with disabilities and those with other serious illnesses because they cannot begin to understand?and nor can I?how ethical provisions could cover this matter. I shall quote briefly from a letter from a Mr Peter Hobbs, who lives in the Reading area, speaking of his Caroline: "I have a real concern that those whose moods are altered by their treatment, as Caroline's was, could, instead of receiving treatment to alleviate depression, simply be allowed to drift into a state where they decide to take their own lives". 12 May 2006 : Column 1193 No ethical guideline devisable by humankind could deal with that problem. I spent 10 years between 1989 and 1999 as an active lay member of the General Medical Council. Both on the Conduct Committee and the Health Committee I witnessed many times the problems even straightforward events can cause in ethical terms. I witnessed ethical problems arising from everyday elective surgery, a good example of which would be cosmetic surgery conducted as a matter of the patient's choice. That was an ethical challenge and it involved what at least some would say is mere alteration of the contours of a part of the body. This is an ethical challenge on a completely different moral and philosophical plane and I do not believe it is a challenge that any of us could meet. I look forward to many interesting speeches in the debate; having to be short concentrates the mind wonderfully, doesn't it? I invite noble Lords to pay special attention to the speeches of the most reverend Primate who, if I may put it this way, formed one third of a unique letter to The Times this morning. I believe that it was the first time there has ever been a letter signed by the leaders of three very large religious communities on a piece of legislation. I also invite the House to take special note of the speech of the noble and learned Lord, Lord Mackay of Clashfern, who is to speak late in the debate. He has been extremely careful in the way he has treated this issue, and I think he may have some powerful things to say to the House later. I beg to move. Moved, as an amendment to the Motion that the Bill be now read a second time, to leave out "now" and at end insert "this day six months".?(Lord Carlile of Berriew.) 10.45 am ���@Column�@1193�[1196 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-03.htm Baroness Jay of Paddington: My Lords, I congratulate the noble Lord, Lord Joffe, on introducing once again a very important Bill on a fundamentally important issue. As a member of the Select Committee and, indeed, of the Select Committee in your Lordships' House of 10 years ago, I am very pleased that he has now decided to follow the experience of the state of Oregon in its Death with Dignity Act. Those of us who had a chance to visit Oregon and to look at its procedures on the ground were impressed by what we saw. Perhaps I may say that until now I think we have followed an exemplary parliamentary procedure on this complex question. The original Private Member's Bill was considered in a very extensive Second Reading. A special committee of the House was then appointed. It took vast amounts of evidence, both in this country and abroad, which led to a unanimous report published just before last year's general election. It is important to note that, because of the timing of that publication, the report recommended that if a new Bill was introduced in this Parliament it should receive the customary Second Reading. I heard what the noble Lord, Lord Carlile, said about 12 May 2006 : Column 1194 procedure and no Bills being taken to a Division on their Second Reading since 1997. I believe the one that was taken to a Division in the 1997?98 Session was on the welfare of pigs; I suggest that the Bill before us is probably more important. There have been some 105 such Bills since 1997?98 and, again, as is customary, this Bill should be referred to a Committee of the whole House. The noble Lord, Lord Carlile, said that there was a great deal of ignorance and confusion about this issue. I suspect that some of that could well be eliminated in the way suggested by the noble Lord, Lord Joffe, in his opening remarks if we could deal with some of the substantive detailed questions in Committee. I hope very much that that will be the basis on which we can proceed. I am surprised that the noble Lord, Lord Carlile, who is, as he explained, a member of the committee, has tabled this amendment today. I mean absolutely no disrespect to the noble Lord because I know how busily he is engaged in many matters of enormous importance to this country, but he was unable to attend the great majority of the meetings of the committee and, indeed, did not visit Oregon with those who did and who were so impressed by the system there. I hope therefore that he will respect the collective view of the committee that a Bill of this nature which comes before us should be properly considered and not wrecked at Second Reading, as his amendment would achieve. I remind noble Lords of the other remarks of the noble Lord, Lord Joffe, on the responsibility of legislators in Parliament. Obviously, we will have a considerable discussion on what society may think about this issue and what it is that is reflected in public opinion polls, but I would emphasise that the democratic accountability of Parliament, whether in this unelected Chamber or in the other place, is a relevant matter which should be considered above the force of special interest groups, however many letters those groups may get together to write. I say that too with great respect and concern for the views of the right reverend Prelates and the most reverend Primate who are to speak in the debate. However much we may respect the opposition in principle to this Bill from those with religious faith and those of us who have a spiritual concern that perhaps may not be a formal religious faith, we live today in a diverse and predominantly secular society where the importance of individual human rights is increasingly valued. The Minister, my noble friend Lord Warner, made the point when winding up our previous debate. He also emphasised on that occasion that patient choice is a central theme in today's healthcare. The Select Committee heard a consistent message about patient choice. From the evidence we received we simply have to recognise that there are some people who, if they were terminally ill, would prefer to end their lives in a controlled and dignified manner rather than continue to receive care until a so-called natural death. To accept this evidence in no way undermines the importance of palliative care, which plays an enormously important role in modern medicine. This Government have rightly pledged to double their 12 May 2006 : Column 1195 investment in palliative care. No doubt, as in so many areas, change could move further and faster, but as an advocate for these services in the voluntary sector, in the hospice movement and in the NHS over the past 30 years, I am encouraged by recent progress. There is no dichotomy between my support for extending palliative care and my support for the Bill before us today. I can only repeat that the vast majority of terminally ill patients can be helped by palliative care; for the minority, they may experience either intractable suffering or simply prefer to end their lives. At no stage in any of the debates we have had?or, indeed, in any of the testimony to the Select Committee?did we hear those who promote palliative care as a universal panacea produce a convincing answer for that minority. Noble Lords: The time! Baroness Jay of Paddington: My Lords, I am afraid that I am going to persist for another 30 seconds because this is a Second Reading debate. The Bill of the noble Lord, Lord Joffe, offers a dignified and humanitarian choice for such people. Throughout his career, the noble Lord has been a very considerable advocate and a very great pioneer of the principle of human rights and, indeed, individual freedom. I very much hope that Parliament?and, indeed, perhaps, the Government?will swiftly follow him. 10.51 am Lord St John of Fawsley: My Lords, I congratulate the noble Lord, Lord Joffe, on introducing the Bill. It requires great courage to introduce a Bill of this kind, and he has shown it. If you do not have courage in politics, there is no assurance of achieving anything. I also congratulate him on his record on human rights and the work he has done in that area. If the noble Lord has received some abusive letters, it is a bore but it is a part of the small change of public life. You do not have to read a letter very far before you find that it is abusive?normally it starts before the "dear"?so throw it in the wastepaper basket and forget about it. The noble Lord, Lord Joffe, has achieved something very important: he has shown the relevance of this House to our social and moral issues. This House is the forum where these great issues can be intelligently and temperately discussed. We have no other institution where this can happen. It is one of the great glories of this House that this should happen here, where there is so much expertise, knowledge, experience and real concern. I am delighted that that is so. There is tremendous interest in this topic simply because the life of a great society depends on a common possession of moral principles. If those moral principles disappear, the society disappears with them. People are so concerned about this issue because, at a time of great moral change and uncertainty, one of the fundamental pillars of our society is being shaken. And now I leave issues of moral principle to the Bishops. I find it difficult to do so, but we all have to make sacrifices. 12 May 2006 : Column 1196 The first major practical point I wish to make concerns abuse. The deadly sin of our time is not sexual promiscuity, which the Church goes on about the whole time?too much, in my opinion?and provides a mirror image of the ills of society; the evil of our time is greed, which exists throughout society and at every level. The trouble is that the Bill would open the way to abuse by the greedy and the acquisitive and bring pressure on those who are at their most vulnerable. My second point is that the end of life, the last period of life, is not a wasteland necessarily. It can be a wonderful period of renewal, reconciliation and acceptance. I have never spoken about this personal experience in public, but I do so now because I feel the issue before us is so important. My dear mother died in a convent here in London. I was summoned from a Shadow Cabinet meeting to her bedside. She said to me, "I do not want to die, but I feel that I am a burden to you". I said, "Dearest, you could never be a burden; you are an inspiration to me". I said, "If you do not want to die, let us say so out loud the Lord's Prayer, the Hail Mary and the Prayer of the Trinity"?because vocal prayer is sometimes so powerful. "Our prayer is that, if it is the will of God, you will rise through this crisis". We prayed and she fell into a deep sleep?and from that moment the fear of death lifted. As it lifted from her, I felt what it was like. It was like being up against a brick wall, but you could not get over the wall and you could not move backwards from it. It was one of the most dreadful experiences I have ever had. A year later she died. The marvellous reverend mother in charge, Mother Serrano, said to her, "Offer up everything you feel with the Lord". She said "Yes", bowed her head and died. Deo gratias for all those who substituted for a snuffing-out tender, loving, practical care and reached such a splendid result. 10.56 am ��Column1196-1200 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-04.htm The Archbishop of Canterbury: My Lords, opposition to the principle of this Bill is not confined to people of religious conviction?as we have been reminded by the noble, monotheistic and utilitarian Lord, Lord Carlile?and it would be a lazy counter-argument to suggest that such opposition can be written off because it comes only from those committed to a world view not universally shared. It is worth remembering that the secular or "enlightened" view of human autonomy assumed by many of the Bill's defenders is no less a particular world view rather than a self-evident and universal truth. It is, of course, the case that the opposition of many of us is rooted in religious conviction?a conviction not about an abstract principle of the sanctity of life but a conviction, rather, about the possibilities of life. All religious believers hold that there is no stage of human life, and no level of human experience, that is intrinsically incapable of being lived through in some kind of trust and hope. They would say that to suggest otherwise is to limit the possibility of faithful and hopeful lives to those who are in charge of their circumstances or who enjoy a measure of control and success. Believers hold that even experiences of pain 12 May 2006 : Column 1197 and helplessness can be passed through in a way that is meaningful and that communicates dignity and assurance. Of course this is not universally held in our society but, if it is true, we should expect that to ignore it would bring disastrous risks. Whether or not your Lordships agree with the fundamental principle from which those of us on these Benches?and, indeed, elsewhere?begin, it is not too difficult to spell out the nature of these risks and perhaps to find agreement there?as, indeed, we have found agreement in the powerful statements from the Royal College of Physicians and, even more, in the extraordinarily detailed submission of the Royal College of Psychiatrists in recent days. Many others will want to elaborate on these risks and, as time is limited, I shall confine myself to what I think are the most evident. The first is this: whether or not you believe that God enters into consideration, it remains true that to specify, even in the fairly broad terms of the Bill, conditions under which it would be both reasonable and legal to end your life, is to say that certain kinds of human life are not worth living. As soon as this is publicly granted, we put at risk the security of all who experience such conditions. That this is not an abstract matter or a matter concocted for scaremongering purposes by sinister Prelates ought to be evident from what has been said by the Disability Rights Commission and, indeed, by the association of sufferers from motor neurone disease. Secondly, we jeopardise the security of the vulnerable in another way by radically changing the relationship between patient and physician. The physician is not obliged to raise the possibility of assisted dying with the patient according to the Bill, yet every patient will know that this is a statutory possibility and there are many ways of exerting pressure on people even without intent. Furthermore, if a patient wishing for assistance in dying is confronted with a physician who has conscientious scruples, provision is made that he or she will be entitled to look around for an alternative. But how are we to guarantee that any such alternate could possibly give the advice and informed support that can be provided only by a doctor who has been involved long term with a sufferer? Does not the possibility of an alternate actually deprive even the patient who wishes to end their life of the best in medical care? Thirdly, we cannot conduct this debate in the abstract. In spite of the assurances helpfully given by the noble Lord, Lord Joffe, and the noble Baroness, Lady Jay, we know all too well that our health service is under severe financial pressure. We know, too, that while the standard of palliative care in the United Kingdom is second to none, it is distributed with great unevenness. What incentive is there to broaden and improve that standard if there is a simpler and, I have to say, more cost-effective solution to these pressures? I recognise fully that this is far from the authentically compassionate intentions of the Bill's proposers, but in our present circumstances, can we say with confidence that this is a climate in which we can secure 12 May 2006 : Column 1198 the kind of debate and consideration that is needed? The evidence from Oregon is, at best, ambiguous; that from the Netherlands, as we have been reminded, offers no comfort at all. Finally, having mentioned palliative care, I shall touch upon one more related matter. It is professionally acknowledged that the number of situations in which physical discomfort or agony is consistently and unavoidably extreme is very small, given our steady advances in pain control. Often what supporters of a change in the law are really arguing about is the mental and spiritual agony of the terminally sick. Those of us who have spent long hours with such people, witnessing and absorbing such agonies, would be the last to dismiss the seriousness of this. Yet to legislate on the basis of states of mind is again to open a door into a general change of attitude about the legitimacy of ending one's life, which has implications for everyone?for the suicidal teenager as well as the dying 80 year-old. We return to my opening point: what will we be heard to be saying about the worthwhileness of life under certain conditions? Do we, by legally accommodating the mental suffering of some, debase the currency for all? These are not trivial considerations; nor are they parochially religious ones. I believe that they are pertinent for anyone who wishes to see our society remain committed to human dignity and liberty and to the finest possible medical care for all our citizens. 11.02 am Lord Ashley of Stoke: My Lords, the most reverend Primate the Archbishop of Canterbury mentioned vulnerable people. The effect of the Bill on disabled people has been mentioned in various debates; some opponents claim that the public cannot distinguish between disabled people and those who are terminally ill and that, consequently, disabled people will be at risk. The public often misunderstand disability, largely because they are not basically interested in it, but they surely cannot be so stupid as to believe that Britain's 11 million disabled people are terminally ill. I completely reject that argument. The Disability Rights Commission says that it cannot support the Bill at this point in history. It suggests that a much higher priority is to legislate for the right to independent living and other matters. But these two things are not mutually exclusive. In fact, I have been working for some months on a major Bill on independent living for disabled people and hope to present it to the House shortly. The organisation that has been of enormous help to me on the Bill has been the Disability Rights Commission. So there is no point in saying that we must choose between one and the other. The most reverend Primate also mentioned the will of God, slippery slopes and society at large. I believe that these are very convenient arguments which can be transferred to any legislation. The basic question is this: how would those who oppose the Bill respond to a husband, a wife, a son or a daughter who is 12 May 2006 : Column 1199 agonisingly and terminally ill and says that he or she has had enough? That person has had all the love, affection and palliative care possible but still finds life unendurable and wants help to die. Would opponents of the Bill say, "Of course I love you and will do what I can to help but you may change your mind so I'm afraid the answer is no"? Would they say, "I would love to help and your personal autonomy is important, but it is only one small element in the complex equation of the broad interests of society. I am sorry that I can't help you, but the answer must be no"? Would they say, "I would do anything to help if I could, but if I help you to die, then I may encourage unscrupulous doctors to kill off disabled people like dogs. I couldn't do that, so the answer is no"? Or would they say, "Of course I want to help but please stick it out until God calls you. He knows what's best and is infallible. I'll pray for you, but I cannot say yes, and the answer is no"? With their nearest and dearest begging for help, who is to give these excuses and refuse to help? To say yes to a loved one is very hard but to say no is impossible. It is quite wrong to patronise or ignore disabled people; it is even more so to patronise and ignore terminally ill people. This admirable Bill, presented very ably by the noble Lord, Lord Joffe, offers a way forward which is compassionate, sensible and pragmatic. It can relieve human suffering by people who are begging for release. I hope the House will support it. 11.06 am Lord Patten: My Lords, I will not repeat the expression of my feelings raised on the issues in the Bill any more than I did when we last debated it on 10 October, save to add that, unlike the noble Lord, Lord Ashley of Stoke, whom I greatly respect, I do not agree that there is no slippery slope. Far from opening up a slippery slope, I think we will be going over the edge of a precipice and into a chasm, should the Bill proceed. That said, I have three points to make. First, grant the right to die and the right to live is lost. I am particularly concerned for child protection in the future. Today we see children being given abortions without the knowledge of their parents or guardians, despite the assurances to the contrary given when the Abortion Act passed into law. Despite all those assurances and safeguards, presumably some people will inevitably argue, coming from a human rights point of view, should the Bill pass into law, for a similar so-called human right allowing children to seek assisted dying in due course. That will happen, my Lords. Secondly, I believe in killing the pain, not the patient. I do not believe this is some trite phrase. Whatever my other strong feelings about the Bill are, it has served one good purpose in crystallising the urgent need for a very substantial and geographically just increase in NHS expenditure on palliative care and getting rid of the postcode lottery. I am very grateful to the noble Lord, Lord Joffe, for having brought that so much to the forefront of political debate. There, at least, he and I can agree wholeheartedly. 12 May 2006 : Column 1200 Thirdly, as someone who has more than one lawyer and more than one philosopher as a close personal friend, I do not care for many of the arguments advanced for the Bill by some human rights lawyers, aided and abetted by the usual philosophical suspects of a utilitarian or relativist cast of mind. But one does not have to be a human rights lawyer to recognise new human rights. We all have the human right to recognise new human rights, and I feel a new one coming over me: the absolute right to know the intentions in this matter of not just doctors but of nurses and other carers and, should the Bill pass into law, the need to have publicly available registers of those who wish to promote assisted dying. I think the sick, the elderly, the disabled and others concerned have the human right to have that information. Should the Bill proceed into Committee, which I profoundly hope it does not, I shall be arguing very strongly for that right. In registering with a new doctor, I would certainly wish to know his or her views. Lastly, it is a great pleasure to see the terraces of Bishops in the House. I look forward to seeing the most reverend Primate and his nine colleagues leave those terraces later on during the Division, and to going through the Lobby with them and earlier holders of the Archbishoprics of York and Canterbury on this very important issue. 11.10 am ��Column 1200-1204 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-05.htm Baroness Williams of Crosby: My Lords, in the past three days I have received 124 letters, of which 123 have been against this Bill and one in favour. They have not been in any sense propagandistic. They have been written by the individual person concerned and have clearly expressed a deep sense on the part of that person. I want to make three points. The first is that, particularly in a society that has a National Health Service, intrinsic to the success of that service is the profound trust between a physician and his or her patients. Many of the letters I have received raise the issue of whether that trust would be maintained in a situation where it might be thought that the intrinsic and profound value of human life was in any way questioned by the physician. My second point is that there is indeed a very powerful "slippery slope" argument. It does not only link to Holland, where, as my noble friend Lord Carlile said, there is already discussion about the possibility of legally ending the lives of children with learning difficulties or other handicaps such as Down's syndrome. Like noble Lords elsewhere in this House, I have close friends who have had a great deal of joy from their Down's syndrome child and would never wish to see that child in any way sacrificed. In addition to that, I have a letter from a distinguished nurse?who points out, incidentally, that today is the international day in celebration of nursing?saying that already under the terms of the Mental Capacity Act there has been a notable slip towards bringing the lives of some patients to an end. She writes from the hospital where she has worked for many years: 12 May 2006 : Column 1201 "All of a sudden we nurses aren't allowed to pass NG tubes unless the Consultant has approved it. This is just a new protocol since the Mental Capacity Act". She goes on to say that she has been forbidden by consultants from sustaining life on the part of patients who have not asked to die. This is the slippery slope in practice, and is something we have to consider extremely seriously. My final point is about palliative care. I believe that the most reverend Primate the Archbishop of Canterbury is right in suggesting that if this alternative is open to us, the pressures on the Administration to bring more palliative care to bear will be much less than they ought to be. Palliative care has been one of the huge and celebrated achievements of this country and it has been extended to the world. Dame Cicely Saunders, the distinguished founder of the palliative care movement, made the powerful point that it is not just medicine that people in the last stages of life need but also, to be put it bluntly, love and respect. They are to be found in the marvellous hospices that now exist in this country, in a way that cannot be found anywhere else. 11.13 am Baroness Finlay of Llandaff: My Lords, why does this Bill ignore the majority of the essential changes recommended by the Select Committee report when we as a Select Committee looked at the previous Bill? Several so-called safeguards have been weakened, despite the committee recommending that they needed to be tightened up. The Bill is not called "Assisted Suicide" for good reason, because it takes us to the very brink of euthanasia in one fell swoop. Doctors could supply a lethal overdose, which is assisted suicide in the Oregon law. But what are the alternate means, undefined in this Bill, by which those drugs could be taken? The doctor is not required to be present, so who knows whether the patient actually took the drugs themselves or was euphemistically "helped" by someone else? How could malpractice be proven if the principal witnesses were dead or would not come forward? The Bill ignores the recommendation that the doctor's actions be clearly set out. As I listen today, there is still no clarity about precisely what "assisting to die" is. Even the proposed amendment does not clarify what alternative means to ingest can be provided, nor the circumstances in which an intravenous dose could be used. The Bill flies in the face of the committee's recommendation that, "a clear distinction should be drawn in any future bill between assisted suicide and voluntary euthanasia". The test for mental competence is weakened. The applicant should not "lack capacity", yet the Mental Capacity Act was designed for different purposes and errs towards preserving life, not committing suicide. The Bill has dropped protecting those whose judgment is impaired through fear, misinformation or depression, despite the committee's recommendation 12 May 2006 : Column 1202 that all applicants should have a psychiatric assessment. Dutch research shows that undiagnosed depression is eightfold more common in those seeking assisted dying than in those who do not. No clinician can accurately predict prognosis beyond eight to 12 weeks at most. The committee recommended that a definition of terminal illness should "reflect the realities of clinical practice", but it has been slackened to cover anyone considered to have six months to live. Now any progressive disease that cannot be reversed by treatment is included, rather than just those whose effects cannot be reversed. How does the doctor judge that you are or are not suffering enough, if you refuse attempts for your "unbearable suffering" to be relieved? I am Professor of Palliative Medicine at Cardiff University and Groningen University in the Netherlands. There are failures and complications, even when doctors assist suicide or inject a lethal overdose. The public need to know that 94 per cent of palliative medicine specialists in the UK oppose this Bill. It is we who work day in, day out to give dignity to the dying; know the pressures and fears behind the statement, "I wish I were dead"; and know how often time and care that enhances dignity prove everyone wrong. Across all hospital doctors, over 71 per cent oppose this Bill, a figure proven by validation using the very question put to the profession by the noble Lord, Lord Joffe. Palliative care in Oregon does not fulfil the quality specialist criteria of the UK. It is domiciliary primary care or in-patient care at the end of life. I was not impressed by what I saw when I went to Oregon as a member of the Select Committee. Our palliative care has led the world, and the world is watching this debate. In letting this Bill proceed, we would be giving a message to the rest of the world that we will abandon the vulnerable and treat suffering by ending the sufferer's life. Let us get on with working for patients to live as well as possible until a natural dignified death and teaching others how to do it, not be taken up in becoming complicit in suicide. 11.17 am Lord Beaumont of Whitley: My Lords, I thank the noble Lord, Lord Joffe, for introducing this important and long overdue Bill and I salute his bravery in doing so. I was chairman of an organisation called Exit, a possibly politically incorrect name these days. I took over the post when the doctors who were then running it, although in favour of the principles of this Bill, were not prepared to publish a pamphlet of advice on the subject and thereby risk prosecution. I became chairman and, with the support of my committee, published the pamphlet and was not prosecuted, although I did spend a night in the cells?one of the only two occasions on which I have made the front page of the Evening Standard. I salute the noble Lord, Lord Joffe, for the fact that he has been prepared to endure. 12 May 2006 : Column 1203 The reason for my support for this Bill is simple. The country slowly becomes more sensible, and the sheer lunacy of having a law that made suicide a crime has, thank God, vanished. I hope I never have even to contemplate suicide myself, but if I do, I wish to be able to rely on my nearest and dearest to help me to perform this legal but disagreeable action without fear of prosecution. And what I desire for myself?I hope that this is a principle which your Lordships accept for all your legislative actions?I would not deny to others. As a keen reader?like most clergymen?of crime fiction, I am aware of the dangers and temptations involved. I therefore welcome the safeguards, even though some of them go further than I would personally want. Finally, I am, as most of your Lordships know, a priest of the Church of England, currently licensed to a regular ministry in the parish in which I live. In addition to my crime fiction, I keep up my theological reading and I have found no theological or ethical objection to the Bill which I consider holds water. I will therefore vote for it and I urge your Lordships to do likewise. 11.20 am Baroness David: My Lords, I speak to support the Bill of the noble Lord, Lord Joffe, and to speak against the, in my view, ill-judged amendment of the noble Lord, Lord Carlile. I still hope that he may withdraw it. All the Bill provides for is an option. The safeguards are very strong. In a review of the safeguards and qualifying conditions, Professor MacLean says that the Bill offers far more protection that the current situation, both for those who want this option and those who do not. I have one reservation about Clause 3 on determination of lack of capacity. Here, if, in the opinion of either the attending or consulting physician, a patient who wishes to make a declaration may lack capacity, the attending physician shall refer the patient to a consultant psychiatrist or psychologist, who shall be independent of the attending physician, for an opinion on the patient's capacity. I think I should resent that, and I wish it were not in the Bill. I strongly believe in personal autonomy and the right of individuals to decide when and how they die. As a 92 year-old, and I think probably the oldest person speaking in this debate today, I think it is patronising for opponents of the Bill to suggest that elderly people are unable to make informed decisions about their lives. If I were terminally ill, I believe that I would be the only person with the right to decide how I died and whether I preferred palliative care to assisted dying. It would provide me with an additional option on how to end my life, which I would find tremendously reassuring, whichever choice I made. With all the hurdles to get over before it is possible to decide on the assisted dying option, I hope I would have the courage and determination to make that choice. I think I should. 12 May 2006 : Column 1204 11.22 am ��Column 1204-1207 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-06.htm Lord Gilmour of Craigmillar: My Lords, like most of your Lordships I have received many letters about this Bill. Like my noble friend Lord St John, I soon gave up reading them very carefully. Then I learnt from the Catholic Herald that a very expensive campaign had been undertaken by the Catholic bishops, which cost several million pounds, which, of course, they are fully entitled to undertake. However, I could not help thinking that it might have been better to give the money to charities for the poor and that the bishops' lobbying efforts might have been better directed towards Rome to support African efforts to rescind the Vatican's ban on the use of condoms, even among partners with AIDS. The Archbishop of Cardiff has said that this Bill would "kill off" people. However, it will kill off very few people and the people who will be killed will be killed voluntarily, whereas in Africa many people are being killed and there is nothing voluntary about it at all. In the previous debate the noble Baroness, Lady Hayman, said that she did not think the Bill crossed a Rubicon. I entirely agree that it does not. Up to 1961 there would have been a good deal of logic in the case made by the opponents of the Bill because suicide was illegal. They could have argued that there was no reason why the terminally ill should be allowed to do something that the rest of us were not allowed to do. Today, of course, the case is very different. Suicide is legal and now the Bill's opponents have to explain why those who want to kill themselves because they are terminally ill and in agony, but are unable to do so because of their illness, should not be put in a position to do so, like all the rest of us. No amount of talk about palliative care will alter that position. The trouble with the Bill's opponents is that they ignore the reality of what happens today. After all, terminally ill patients are allowed to stop taking life preserving drugs and thus probably face many days of pain before they die, and doctors are allowed to give pain killing drugs even though they know that that will speed up the death of the patient. We also know from surveys that doctors commit euthanasia anyway, normally probably in a very good cause. So, the Bill does not constitute the crossing of a Rubicon. Therefore, I cannot help thinking that the Bill's opponents are in the position?I quoted the following words in the previous debate?satirised by Arthur Hugh Clough, who said: "Thou shalt not kill but need not strive officiously to keep alive". Both because I think that the position of the opponents of the Bill is illogical and because public opinion is overwhelmingly in favour of it, I strongly support the Bill. 11.25 am Baroness Chapman: My Lords, this Bill has caused me to look at my own life and how other people perceive my life. I do not often discuss my condition because it is obvious and I do not want to be defined by it. Today I feel that I must talk about it?osteogenesis 12 May 2006 : Column 1205 imperfecta. In plain English, this means that my bones were imperfect from the beginning. The consequence is that I have very brittle bones. I believe that the count of my fractures is now well over 600, with residual bone pain as an added bonus. About four years ago, before I came to your Lordships' House, I had a neck injury that was incredibly painful. For several months I struggled trying various means of pain control. Because I am small and do not weigh very much, this can make pain control even more problematic. It was a difficult time for me. I am fortunate to have a fantastically supportive GP who worked incredibly hard to find the right medication for me. Too little and I could not function because of the pain, too much and I could not function because I was sedated. I live alone so I need to function to live. After trying several types of medication with no success, my GP phoned the local hospice and asked a palliative care doctor for advice. Within 24 hours my pain was under control and I was physically and mentally able to function. Indeed, I still need to take that medication. Thinking about those months of pain, I dread to think what decisions I might have made if a Bill like this had been passed previously. I have lost count of the number of times that I have been told by the medical profession, "This could be the beginning of the end". On all of those occasions it is feasible that I would have been classed as terminal under the structure of the Bill. To describe my condition many people would assume unbearable suffering. I would hate to be in a situation where I could be offered physician assisted suicide as a treatment option. I meet a lot of disabled people. Some are born with conditions, some develop conditions, others are injured in accidents. When a group of disabled people come together the subjects around disability and pain control always include an element of fear about how undervalued the lives of disabled people are and how vulnerable they feel if they need to go into hospital. We fear "Do not resuscitate" instructions being written into files without any discussion or consultation. Often we are not offered the most positive options. We are afraid of the consequences of this Bill. People who are injured or develop a condition often speak of how they assumed they would not, or could not, enjoy life anymore. This is when they are at their most vulnerable and death can seem the only solution for all concerned. It can take a long time for them to adapt to their new situation but, in my experience, the human spirit usually wins. People begin to value life and eventually enjoy the rest of their life. 11.28 am Lord Goodhart: My Lords, in the very few minutes available I want to concentrate on the safeguards in the Bill?safeguards both for those seeking assistance to die and for those whose assistance is sought. I recognise that for those who have religious or philosophical objections to the whole concept of assisted dying, safeguards are irrelevant. But I believe 12 May 2006 : Column 1206 that I speak for very many people in this country when I say to opponents on grounds of principle, we respect your views. I particularly respect the views of the noble Baroness, Lady Chapman, who has a personal knowledge of the problems of people with disabilities which I believe goes far beyond that of any other Member of your Lordships' House. We do not wish to use this Bill to force you to do anything that you do not wish to do; but we ask you also to respect our views and not to deny us access to an option that we would like to have at hand, even though we hope that we will never need to use it. Others argue against this Bill not from an absolutely position of principle but on more pragmatic grounds. They fear that we will end up by killing disabled people, or elderly people under pressure from their families, or damaged babies, or people with severe depression. If those are the issues that concern you, then I ask you to consider the safeguards in the Bill. Let me start by discussing the safeguards for the medical profession. Under Clause 7, no person, whether doctor or other, can be required to take any part in assisting death. No hospital, hospice or other care establishment can be required to permit assisted death on the premises. No doctor can be required to raise the option of assisted death with a patient, or refer the patient to someone who will do so. Then there is the even more important question of the safeguards for patients. Under Clauses 2 to 6, the decision to assist death must start with a written request from the patient. The decision must be made by two doctors; one the patient's own doctor and the other a consultant diagnostician. Both must be satisfied that the patient has the mental capacity to take the decision. Both must be satisfied that the patient suffers from a terminal illness, defined as progressive, irreversible and likely to lead to death within six months. Both must be satisfied that the patient is suffering unbearably as a result of that illness. The consultant must have informed the patient of the alternatives, including palliative care, and the patient's own doctor must ensure that a specialist in palliative care has seen the patient and explained the benefits of it. Both must be satisfied that the patient's request is made voluntarily and is an informed decision. If either doctor has doubts about capacity, the patient must be referred to a consultant psychiatrist, and assistance cannot be given unless the psychiatrist decides that the patient has capacity. The patient must then sign a witnessed document, one of the witnesses being a solicitor. That document is revocable at any time without formality. No one involved in the process as a medic or a witness can be a person who has any expectation of benefit from the death of the patient. That seems to me to be a strong list of safeguards. In particular, the requirement for unbearable pain caused by terminal illness and the need for capacity completely rule out assistance to anyone under age, depressed, or just fed up with living, or even suffering unbearable pain from an illness that is chronic but not terminal. If you believe that assisted dying is wrong in any circumstances, the safeguards are meaningless. All 12 May 2006 : Column 1207 I can do is ask you not to force your own convictions on others who do not share them. If your opposition is not absolute, but you are not satisfied with the safeguards or with other aspects of the Bill, I ask you to vote for a Second Reading. We all recognise that this Bill will not become law. There is plainly not enough time to get this Bill through the House of Commons before the end of the Session, even in the unlikely event of the Government being willing to give it time. But giving it a Second Reading would give us a chance to examine and improve the text of the Bill and meet those objections which fall short of absolute objection. Voting to deny this Bill a Second Reading is to imply that it is so wrong and so wicked that we cannot even debate it in a Committee of your Lordships' House. I do not share that view and I believe that most of my fellow citizens of this country do not share that view either. 11.33 am ��Column 1207-1210 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-07.htm Baroness Murphy: My Lords, I support this Bill, and I express my admiration for the courageous persistence of my noble friend Lord Joffe in this matter. As a psychiatrist and geriatrician, I know how diverse and sometimes contrary patients can be. I recognise the differences in how people approach death, and I respect those very few who would want to take advantage of this Bill's provisions. It should be their choice, not ours, and a matter of human rights. I have three brief points to make. First, I want to talk about palliative care. According to the recent figures from the National Council for Palliative Care, at present about 70 per cent of all cancer sufferers are referred to palliative care services, and under the age of 50 almost everyone is referred. That is not bad coverage, although I entirely accept that we need a massive expansion of palliative care skills, and I heartily agree that we must campaign for that, but it would make very little difference to this very small group of people. It would be brave and right if palliative care specialists championed the rights of their patients to have their wishes respected. Secondly, there is the issue of undue influence. One of the burdens that older people and those with disabilities face?the noble Lord, Lord Ashley, made this comment?is the often unwanted protective paternalism of those who run their services. Unless they have mental frailty?many older people do have undiagnosed dementia?older people are no more likely to suffer from undue influence from their relatives or carers than younger people. It is a fallacy to think that older people will be persuaded to take their own lives against their better judgment. The paternalistic denial of older people's right to be treated as others are is an ageist idea. Thirdly, I want to comment on the safeguards in the Bill to prevent hasty decisions being taken by those who have a treatable, reversible depression, which is very common indeed when someone discovers they have a terminal illness, as my noble friend Lady Finlay of Llandaff said, and is usually responsive to timely medication. I was concerned by the earlier drafting of 12 May 2006 : Column 1208 the Bill, and I suggested that there should be clearer wording to ensure that any mental disorder that impacts on capacity should be sought, and those individuals excluded. While legally capacity can readily be impaired by emotional disorder, unfortunately many doctors interpret capacity wrongly to include only intellectual capacity. I wanted to ensure that people with disturbed emotional states were clearly excluded from the Bill. I am now satisfied that the current wording in Clause 2(4) would ensure that. This legislation will strengthen patients' confidence that at the end their wishes will be respected. I commend this compassionate Bill to the House. 11.36 am Lord Turnberg: My Lords, I have thought long and hard since our previous debates on the Bill, but I am sorry to have to say to the noble Lord, Lord Joffe, for whom I have enormous respect and whose motives I admire enormously, that I cannot support the Bill. I say that not because I am against the principle that we should do all we can as a society in general, and as doctors in particular, to relieve a patient's suffering, especially the type of heart-rending cases that we have heard about today. Where they are terminally ill, I am not against easing their passage from this life as best we can by palliative care; how could I, as an ex-practising physician, not support that principle? All my feelings and emotions are in favour of those who speak for the Bill. I am not against the Bill because of the religious convictions that I may have, because I do not wish to inflict those convictions on others who do not hold them. I am against the Bill for entirely practical reasons?the unintended consequences of acceding to one patient's desire for assisted suicide when the risks entailed for others seem, to my mind, too great. The probability of a risk to the aged, the disabled and the depressed, who will feel a burden to others despite the safeguards in the Bill, seem to me too high. The finality of that risk, the termination of a person's life, is too severe. When mistakes are made they will be fatal, and mistakes seem inevitable. Some mistakes, such as a wrong diagnosis or a misdiagnosis of depression, will go undetected. I have tried hard to see whether it would be possible to amend the Bill to the extent that my anxieties could be allayed. Perhaps we could better define terminal illness, or change "unbearable" suffering to "unrelievable" or "intractable" suffering. Perhaps we could relieve doctors of this responsibility, as the majority of doctors seem to wish to be relieved, and give it to some other professionals to pursue. But I am afraid that none of those types of amendment would get around my concerns, and for those reasons I cannot support the Bill. Having said that, I would be sorry if the noble Lord, Lord Carlile, were to press his amendment. Such a controversial Bill, which raises such high feelings, does deserve to be debated in Committee. 12 May 2006 : Column 1209 11.39 am Lord Prior: My Lords, I am a very diffident speaker, and I am very rarely able to attend your Lordships' House, but on this issue one should stand up and be counted, and I wish to be counted as a supporter of the noble Lord, Lord Joffe. I admire enormously the courage that he has shown in introducing this highly controversial and difficult Bill. For me, it is not a moral issue, because already we know that a number of people are helped to die by one means or another, and that issue is irrelevant. I am surprised that so many people turn a blind eye to that, yet make such a fuss about a comparatively small number of people who could be helped by the Bill. The Bill deals essentially with a small number of people who are highly intelligent, but are struck down by a physical illness that leaves their mental capacity intact but destroys their physical ability to lead a dignified and normal life. Surely any Christian doctrine has to accept that there are people who suffer deeply, for whom the Lord would take the view that they should be helped, and that there is no point in causing people to suffer the indignities that go with such diseases and which have nothing to do with the sanctity of life. For me, these are the issues that really count. It would be a great shame if your Lordships did not give this Bill a Second Reading. That would enable some of the other issues to be brought out and we could, perhaps, get the Bill into an acceptable form. If it comes in an acceptable form, there is a chance that it could get through the Commons, perhaps next Session. To kill the Bill at this stage would be a tragedy for all those who think that there should be some change, but would also deny your Lordships a chance to put right anything that needs to be put right. 11.41 am Lord Clement-Jones: My Lords, the more we debate it, the more ethical difficulties I see in the Bill, because my objections to it are only partly borne from personal experience as the carer of a terminally ill spouse, from problems I have with the language of the Bill?words such as, "the benefits of various forms of palliative care", and "unbearable suffering"?and from the failure to implement all the Select Committee's recommendations. Principally, my objections are founded on similar grounds to views expressed by the Royal College of Physicians, which recently produced an impressive and definitive briefing. It considers that assisted suicide is incompatible with the doctor's role of trying to prevent death by effective treatment. It would lead to erosion of trust in the medical profession and adversely affect people's willingness to accept treatment for relief. The RCP also outlines the huge issues surrounding the assessment of capacity in making a decision on assisted suicide and the impact of conditions such as depression, which can require specialist diagnosis and are treatable. The RCP correctly states that: 12 May 2006 : Column 1210 "Requests for physician-assisted suicide should trigger effective treatment of depression and its causes?not actual physician-assisted suicide". I am still convinced that the way forward is through the development of high-quality palliative care, pioneered by the hospice movement in this country, in which we are now world leaders. We should not extend patient autonomy for a few by a dramatic change in medical ethics and practice, which could be detrimental to the many. We are told by those who want the law changed that doctors in the UK are already illegally helping people to die and that it would be better to recognise that and regulate it by law. But the report by Professor Clive Seale shows that illegal actions by doctors to end the lives of patients were estimated to occur in about 0.5 per cent of all deaths. The argument that in Britain there is widespread euthanasia or assisted suicide that needs to be regulated cannot be sustained. Annual reports from the Oregon Department of Human Services give figures for assisted suicides. Every report states also that the numbers given, "are based on a reporting system for terminally ill patients who legally receive prescriptions for lethal medications and do not include patients and physicians who may act outside the law". The operation of Oregon law on assisted suicide is based entirely on a voluntary reporting system. We have a paradox?we are not being warned about illegal assisted dying in Oregon, where the responsible government department clearly thinks that it might be happening, but we are being warned that illegal assisted dying is widespread in Britain when there is a report that says the practice is extremely rare. That demonstrates the dangers of new legislation and the lack of necessity and desirability for it here in Britain. I support the amendment of the noble Lord, Lord Carlile. 11.45 am ��Column 1120-1124 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-08.htm The Lord Bishop of St Albans: My Lords, I read Alice in Wonderland when I was far too young. I remember even now how much I disliked it?all those things suddenly changing shape, flamingos becoming croquet mallets and the irrational tyranny of the Queen of Hearts. It was the stuff of nightmares. Ever since, I have been wary when Lewis Carroll's methods are used by other people to try to achieve their ends. I remind noble Lords of Humpty Dumpty in Through the Looking-Glass, who said: "When I use a word . . . it means just what I choose it to mean". The Bill is a classic example of that. For example, it is said that this Bill is of the same nature as previous Bills. It is not at all. I served on the Select Committee?which was a huge privilege?and we spent far more time looking at euthanasia than we did at assisted suicide. I am sure that, had we thought that this would be a different Bill that was just about suicide, we would have called in evidence from experts in that kind of field. We did not. This Bill is not of the same nature. This Bill seeks to legalise assisted dying, which of course sounds enormously compassionate; but in reality it is about assisted suicide for the terminally ill. 12 May 2006 : Column 1211 We should be clear what it is but, more importantly, we should ask why euphemisms always surround this Bill. Why are we not being absolutely straight with each other about what the Bill entails? The organisation that is one of the driving forces behind the Bill used to call itself the Voluntary Euthanasia Society, but now, of course, it has changed its name to Dignity in Dying, which seems to imply that there is only one dignified way to die?by euthanasia or assisted suicide. The organisation has taken a phrase that is used in palliative care and by the hospice movement and has turned it around to mean the exact opposite of what it originally meant: "'When I use a word,' Humpty Dumpty said . . . 'it means just what I choose it to mean'". The noble Lord, Lord Joffe, has made it abundantly clear today that he has changed his mind about this being a first stage. Naturally, I welcome his change of heart and recognise with others his honesty and courage in doing so, but presumably it has come about because of the dangers that he and some of us have seen in other countries. I look forward to further discussions about some of the dangers in this Bill. The Bill's proponents, again by a Lewis Carroll-ish sleight of hand, argue that it is all about personal autonomy. But personal autonomy is fundamentally anarchic. It places the individual in a solipsistic universe and fails to recognise that we human beings flourish only in our relationships with one another. But this Bill would give me the legal right to require and demand of a doctor that he or she provides me with a means to kill myself. There are those who talk about this as a therapeutic option?what kind of twist in language is that? It is like saying: "This is not a flamingo, this is a croquet mallet". It is not at all difficult to see how the apparent surface meaning given to human rights could be shifted. It is not impossible to imagine in the future a harrowing case whereby an individual choosing to try to commit suicide was then unable to do so. Then there would be arguments that that person's human rights had been infringed and a more humane way should be found. Lo and behold, euthanasia would then be back on the agenda. We are told that this is about one group imposing beliefs on another. I suppose that if that is said often enough and loudly enough people will believe it. It is simply not the case. This is about debate and I relish debate, but I think that this is a Lewis Carroll-ish Bill, because it is morally confused yet so chillingly plausible?and as a result, I shall vote against it. 11.49 am Lord Tombs: My Lords, terminally ill people are vulnerable people?afraid and apprehensive of approaching death and the manner of its arrival. They are very sensitive to suggestion and there is no shortage of potential coercive influences, some apparent, some less so. Most insidious is the atmosphere created by the environment in which the sick patient finds him or herself. Acceptance by the law of the deliberate termination of life, albeit at the patient's request, could create an ambience in which the patient felt pressured 12 May 2006 : Column 1212 to comply. The feeling of being a burden on others is familiar to many elderly and disabled people, and it would be all too easy for a right to opt for a deliberate death to become a duty to do so for the sake of others. The exception would then become normal, irrespective of the real wishes and welfare of the patient. I do not doubt the sincerity of the sponsors of this Bill but I deplore what I see as their naivety. In seeking to change the law in order to help a small number of people to end their lives voluntarily within the law, they will imperil many others by creating a presumption that life has become worthless, or inconvenient to others, as a means of inducement to end their lives. That seems to me quite indefensible. Coercive pressures could change measures intended to be caring into aggressive ones against the terminally ill, the aged and the handicapped, who would rightly feel threatened in a way that no civilised society should accept. I believe that that argument alone is sufficient reason to reject the Bill. I support the amendment. 11.51 am Baroness Hayman: My Lords, the noble Lord, Lord Carlile, opened his speech by objecting, quite rightly, to the misrepresentation of his position in The Times recently. Perhaps I could open mine by objecting to what I felt was a misrepresentation of my position when the noble Lord said that those who supported the Bill and were proponents of it were intent on extending it to euthanasia in the future. I went on to the Select Committee as someone who did not have clear views on this subject and was not committed to the Bill that had been brought forward formally. It was only following my experience on the committee and having listened to the evidence that I felt that I could, with good conscience, support a Bill that was constrained to physician-assisted suicide but would not be able to support a Bill that allowed physician-administered euthanasia. I made that position clear in your Lordships' House and when I spoke in the Select Committee, and I certainly made it clear to my noble friend Lord Joffe. I feel that it is unfair to punish my noble friend Lord Joffe for having constrained the Bill. He listened to some, like me, who felt that it should be more limited and then brought forward a more limited Bill. So it is unfair then to argue in procedural terms that, because the Bill is more limited, we are not bound by the recommendation in the Select Committee report that this should go on to further and full discussion in your Lordships' House. It would be a matter of enormous sadness to me if we could not deal with these issues in some detail. I wish to say something to two fellow members of the committee. First, I say to my noble friend Lord Turnberg that his register against which to assess this Bill is exactly the same as mine but he comes to a different conclusion on whether you can meet the needs of a minority without endangering a majority. We differ not on our absolutes but on our interpretation of the Bill. Secondly, I say to the right reverend Prelate the Bishop of St Albans, whose 12 May 2006 : Column 1213 company I enjoyed enormously?we swapped a lot of books during our time on the Select Committee?that I, too, felt as though I was living in the world of Alice in Wonderland when I read the letters that I received recently about the Bill, because they described a Bill quite different from the one before the House today. So it is possible for us to have the same feelings but to disagree about the way forward. Finally, I absolutely agree with the noble Baroness, Lady Williams, that at the end of life we need to show people love and respect as well as giving them physical and medical care. For some people?I say this having received testimony both as part of the committee and personally from individuals?that love and respect would be given and devoted by the implementation of the Bill introduced by my noble friend Lord Joffe. The question whether we can afford that quality of love and respect for a minority without causing anxiety and detriment to many others is a matter of the gravest concern to us as legislators. It is not a question to which we can answer "yes" or "no" today; it deserves the most detailed attention and I hope that, for that reason, the House will not support the amendment of the noble Lord, Lord Carlile. 11.56 am Lord Elton: My Lords, I hope that it is clear already that there is compassion on both sides in this debate. Those who think that Christians are constrained by theology to vote in one direction to the exclusion of any other consideration have been shown to be wrong both by the noble Lord, Lord Beaumont, and by the right reverend Prelate the Bishop of St Albans?a schism between them which the most reverend Primate, to give him his correct title, will notice with concern. The noble Lord, Lord Ashley of Stoke, put forward very hard but hypothetical cases. One has to remember that hard cases make bad law. At the moment we are engaged in something which is directed not at individual cases but at the colour of society and the way that it is moving and at how pain?moral, physical or intellectual?can be minimised and individual autonomy maintained in a society which is still ordered. That means that we have to have a clear structure of law dealing with how people are treated at the end of their lives, which is often their most vulnerable stage. The vulnerability is very real. It is not ageist to say that old people are vulnerable. Most of us fall above the line where, we are told, palliative care is most freely available, so we have a direct interest in this. The effect of the Bill, if enacted, would be to change not only the legal but also the general perception of the sanctity of human life, and it would have many unintended consequences, of which I shall mention only one in order to shave a minute off my share and get us home earlier. I was a Minister in the Department of Health and Social Security, as well is in four other departments over a period of years in government, and it is an 12 May 2006 : Column 1214 inescapable fact that ultimately policy is driven by money. That is why the Treasury always controls policy?which makes the present juncture in politics so interesting. The stark fact is that palliative care is expensive and a lethal pill is cheap, and the generators of policy?I do not just mean people sitting in the Cabinet Office or the Secretary of State's office but the many hundreds involved in generating policy in the Civil Service and putting the choices between them?will be steered in a critical part by that financial consideration. That is a direction that we should not follow. For other equally or more powerful reasons which have been stated, and which will be stated again, I shall be supporting the amendment today but I put one case to your Lordships: I ask noble Lords to go into that Lobby and I do so not from Christian principle but from ministerial experience. Noon ��Column 1214-1217 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-09.htm Lord Phillips of Sudbury: My Lords, although I still, with misgivings, oppose the Bill, I congratulate the noble Lord, Lord Joffe, on improving it and bringing it back to the House. I should also say that if my noble friend Lord Carlile seeks to kill the Bill at this stage, I will decline to support him. I favour the House having the chance to consider the Bill in detail in view of the widespread public interest in it. The Bill could then be voted down at Third Reading if the House so decided In earlier debates, I concentrated on two broad issues. The first, which was largely overlooked then, is the pressure that the Bill would, unintentionally though inescapably, exert on many vulnerable people to avail themselves of assisted suicide to avoid being a burden on their families or dissipating scarce resources. That is now recognised as a foremost objection to the Bill and I need not say more. My second point?odd for a lawyer, you may think?is to observe that there are some matters that are so infinitely sensitive and complex that to try to regulate them by law is self-defeating. In effect, legislation is too blunt an instrument. Perhaps my early role as a coroner's assistant helped to inculcate that belief. I think that it is better to rely on and trust the professional integrity, practical wisdom and ethical common sense of the medical profession?nurses as well as doctors. "But", proponents may ask, "hasn't that led to abuse?". Occasionally, of course, but no outcome can or will avoid that. Indeed, abuse is more likely if we pass the Bill because it will tend to drive out, or at least override, individual doctors' professional and ethical judgment, replacing it by law. That will lead to doctors in cities specialising in assisted suicide law, often working in informal partnership with other doctors giving second opinions under the Bill, and with solicitors specialising in finding ways through the legislative maze. Look what happened with the abortion law. Why not avoid all that with a Bill that is more broad brush? If the law is drafted widely enough to cover the infinite variety of human predicaments, it will necessarily be vulnerable to legally strained interpretations, some of which will go well beyond the 12 May 2006 : Column 1215 intentions of the noble Lord, Lord Joffe. Yet, if we throw out the Bill, I have to concede that a few people may be forced to suffer unbearably. That is a harsh reality, but it must be juxtaposed against my earlier harsh reality that the Bill will exert pressure on some people and encourage them to seek assisted suicide. Then there is the text of the Bill. It has many defects and I wish that there was time to debate with my noble friend Lord Goodhart the list of so-called protections he enunciated, including the definition of unbearable suffering" in Clause 13. As drafted, that extends to, "distress . . . which the patient finds . . . unacceptable". Such unacceptable distress could be emotional upset, sheer frustration or a pervading sense of the pointlessness of life. That opens up vistas for the Bill that I believe to be highly dangerous. Finally, the Bill will inadvertently but inevitably change the culture of both medicine and society, which is partly why the disability fraternity is almost united against it. That change could well lead down a dark slope. I do not believe, for example, that it will be long before the definition in the Bill of "terminal illness" as one that is, "likely to result in the patient's death within six months", will be lengthened. The need for the Bill should be proven beyond reasonable doubt. It has not been. 12.04 pm Lord Pearson of Rannoch: My Lords, I support the Bill and salute the courage of the noble Lord, Lord Joffe, in introducing it. I do so with some trepidation, as an ambassador in bonds, because nearly all my Christian friends oppose it. I pray that they will forgive me. I say what I am about to say not to offend them but to contribute some perhaps fairly original thought to the debate. I should add, too, that I speak from a personal religious experience, which some of your Lordships may have noticed was unfortunately sensationalised in the national press just after we rose for last summer's Recess. It is that experience which leads me to query two threads that run through all the many letters against the Bill that I have received from the Christian community?threads which can also be detected in the heartfelt speeches of the many noble Lords who oppose the Bill. The first thread is what seems to me to be an exaggerated fear of death. I find it perplexing that our humanists, who presumably do not believe much in an afterlife, should support this Bill, whereas my Christian friends, who trust that death leads to the salvation of the soul and eternal bliss, should oppose the death proposed by the Bill. I should have thought that the humanists would be more likely to hang on to life like grim death rather than the Christians, but it appears to be the other way round. I am aware of the commandment: "Thou shalt not kill", but it is generally accepted by Christians to mean: "Thou shalt not murder". Murder will not result from the Bill. 12 May 2006 : Column 1216 The second thread which seems to run through the Christian position is an assumption that suicide is a religious crime. I may be wrong but I am not aware of anything in the Gospels validating that assumption. It is true that the Church has made suicide into a crime, supported often by the state. But there are several areas where the Church appears to have distorted the burning purity of our Lord's teaching, and I suggest that this may be one of them. Be that as it may, are we really saying that all the thoroughly decent Christian doctors over the years who knew and loved their patients well, and who relieved them from the hopelessness of a painful terminal illness, will have been punished by our just and loving God? Do any of us really believe that? Not many I would suggest. Why should they continue to be punished by our terrestrial law? Perhaps even more irritatingly for my Christian friends, I suggest that our Lord does not appear to have gone out of his way to preserve his own earthly life?quite the reverse. All four gospels show that he did not need to go to Gethsemane or to surrender his humanity upon the cross. Let us not forget that in his great agony, he cried out those terrible, fearful words: "My God, my God, why hast thou forsaken me?". It would seem that for a few moments at least, even the Son of Man may have lost confidence in where he was going. Then came his glorious resurrection which gives so many people their certainty in the life to come. I can but recommend that certainty to my Christian friends, and ask them to ponder these matters in their hearts before they vote against the Second Reading of this compassionate and reasonable Bill. 12.08 pm Lord Ballyedmond: My Lords, to speak on this Bill is to undertake the position of being heard as yet another voice with yet another amalgam of personal opinions on this multifaceted issue. I do not seek to preach morals and ethics, nor do I seek to persuade others to adopt my opinion on these issues. Instead I wish to establish facts. There has been some debate among doctors regarding the appropriate stance that they should take as a profession in the spotlight. Their position of neutrality in the past was borne out of a desire to remain as the providers of medicine rather than to become the keepers of society's ethics and morals. Nor do they wish to become law makers. There is now a definite opinion in the medical profession after a Royal College of Physicians survey showed that three-quarters of the profession oppose a change in law. These doctors believe that a change in legislation is not necessary for the small number of patients whose needs are not met by current levels of palliative care, where that palliative care is not sufficient or is believed to be insufficient. It is our duty to pay due attention to the body of professionals to which this Bill is directed. 12 May 2006 : Column 1217 Regardless of one's personal views on this matter, it must be noted that, before the Bill of the noble Lord, Lord Joffe, could ever be implemented, a wealth of research and development in the field of palliative care would be required. That has not yet occurred to a satisfactory level. We are elevating ourselves to a very high platform today. We are adjudicating on a Bill to legalise the taking of life. My view is that to legalise assisted suicide is an attempt to regulate death and to remove the very aspects that in life we fight to protect. Rightfully, there can be no such legislation. We must exercise caution and treat voluntary death with the respect that it commands. This is not an issue that can be resolved on the basis of who is right and who is wrong. We must be very careful not to give any further credence to the Bill, which may ultimately be abused to the point where the sick, dying and disabled in our society will be placed in an unacceptable position. This Bill contains unsatisfactory safeguards. We do not have the benefit of sufficient proven scientific evidence at our disposal today to make the decision to support the Bill or accurately to assess its consequences. To proceed where experts do not wish to go would, in my view, be the utmost folly. I ask your Lordships to reject the Bill in its totality. To do otherwise would mean that we were crossing the Rubicon. The die must not be cast. 12.12 pm ��Column 1217-1220 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-10.htm Lord Archer of Sandwell: My Lords, like the most reverend Primate the Archbishop of Canterbury, I regret that this debate has been presented in some quarters as representing a difference between those who hold a religious faith and those who are devoid of faith. As he rightly pointed out, some opponents of the Bill hold no religious faith. I am sure that he would accept that the converse is equally true, as has just emerged from what we heard from the noble Lord, Lord Pearson. Those who oppose the Bill are not necessarily speaking on behalf of all believers or all faiths. We respect one another's views, but we do not speak on this issue with one voice. Nor is this a debate between those who respect human life and those who are indifferent to it. I fully respect the sanctity of life of someone who wishes to live. That is why I support the peace movement and why I campaigned for human rights before they became fashionable. I have received, like many of your Lordships, an avalanche of letters of varying quality, influenced no doubt by the somewhat dramatic warnings that their authors seem to have been given. They tell me that I should be pressing for medical and palliative care instead. There is no "instead", as the noble Lord, Lord Joffe, and my noble friend Lady Hayman made clear. The proponents of the Bill strongly support the provision of medical treatment and palliative care for all who wish to avail themselves of them. I believe that 12 May 2006 : Column 1218 everything should be done to preserve the life and the best possible quality of life of someone who wishes to live. Some of your Lordships seem very perturbed at what was called the "slippery slope". I do not believe that anyone who is familiar with your Lordships' House can believe in the possibility of some unnoticed slippery slope in the future; scrutiny in this House would preclude any such possibility. Perhaps we would be wiser to debate the Bill that is before us and not some speculative nightmare that has not been proposed. I was puzzled to be told by one correspondent that he was precluded by his faith from accepting my argument that human beings have a right to choose. I do not doubt his sincerity and I defend his right to practise his faith and to abstain from any act that it precluded. My difficulty with his argument?pace the right reverend Prelate the Bishop of St Albans?is whether he should be entitled to impose his faith on those who do not share it. That is not exercising his right; it is denying the right of someone else. It is inevitable that much of this debate will be anecdotal. My mother had been a byword all her life for stoical indifference to pain. She never allowed it to interfere with what needed to be done, but in her 80th year she contracted cancer. She did not complain, but as the pain became worse she knew that she could not hide it. She was excluded from what was going on in the house because she was confined to bed. There came a time when she said to me, "I wish I were dead". That was not a momentary aberration; her mind was perfectly clear. But that option was not open to her. For three months, she was compelled to drag out a life that she would have wished to end. I believe that it would have been compassionate to give her that choice. It would not have been my choice for her; I would have tried to dissuade her. Indeed, if she had known that the choice would have been available to her had she felt driven to it, I believe that she might have taken a different view. However, I believe that to withhold that choice from her was indefensible. That is why I support the Bill. 12.16 pm Viscount Craigavon: My Lords, on the last two occasions when this subject was debated, I fully supported the noble Lord, Lord Joffe, and I continue to do so. Even more so now do I believe in the desirability of further examination at Committee stage of what is proposed. As the noble Lord, Lord St. John of Fawsley, said, your Lordships' House is an ideal forum for such examination. Owing to the time pressures of this debate, the noble Baroness, Lady Finlay of Llandaff, came up with a string of assertions of what she believed were the defects of this Bill. It would be ideal if all her points could be examined and debated in Committee. If we come to that point at the end of today by passing the Motion of the noble Lord, Lord Joffe, to commit the Bill to a Committee of the Whole House, I sincerely hope that any opposition will be entirely constructive. 12 May 2006 : Column 1219 I believe that, as many noble Lords have said, we should be taking more account of public opinion. However much some inconvenient opinion polls are discounted, it seems to me to be clear that a convincing majority of the public are in favour of some change in the law. My justification for that view are the figures that I used in our previous debate and those that the noble Lord, Lord Joffe, quoted today. I have wanted to ask many speakers who have opposed the Bill today this question: are you content that we should have a continuing procession of cases to Zurich in Switzerland involving people who do not accept the present orthodoxy offered by the Churches and by the noble Baroness, Lady Finlay? I recommend that anyone who is trying in future to understand this stage of our debate should listen to a recording of what some of your Lordships may have heard on Radio 4 just after eight o'clock this morning. It was a perfect vignette of our arguments. A distressing case was articulately presented by a woman called Sally McIntosh, who would have liked to have been able to avail herself of what the Bill would allow. However, she said that she had only a few weeks to live and could not get the paperwork required by Swiss rules ready in time. That was followed by the two Archbishops, who had absolutely nothing to offer that individual. They went on, in the expected form of words, to question the concept of autonomy and to argue that, because it is impossible to get the law into a perfect state, everything should remain unchanged. That woman had consciously and with rational consideration rejected palliative care, but that strategy is not allowed by the Churches or by the noble Baroness, Lady Finlay. Because of what I call their absolute position, whatever distressing circumstances you might describe, you are told that you have not thought it through properly. My noble friend Lady Finlay told us in her speech that when she hears the words, "I wish I were dead", she needs to interpret them for you?on the grounds that you do not really mean what you say. And I imagine that if you are not convinced by her first interpretation, she will explain again, and so on. I am not just personalising this on her: that is now the attitude of the Churches, and I would personally call it "Kafka-esque". That is the intractable difficulty of the position where no exceptions are allowed in the debate. In my view, the discussions around autonomy have become a self-induced fog, to obfuscate the debate and to cause apparent uncertainty. It sometimes seems like a medieval disputation that, almost by definition, has no solution hence no conclusion can be arrived at. Similarly, it sometimes appears that because perfection cannot be reached in framing a law in this apparently very difficult area, nothing should ever be done. In my opinion, those have become largely excuses. We get the phenomenon of "society" being defined in such a way that it can never, by definition, allow enough autonomy ever to permit a decision for people to be allowed to avail themselves of the option under this Bill. I believe that those amount to excuses for perpetual inaction. We should be more practical. 12 May 2006 : Column 1220 12.21 pm Lord Laing of Dunphail: My Lords, in supporting the Bill, I acknowledge the risks. But let us not overstate them to the extent that the benefits are submerged. We must keep our eyes firmly on the intention behind the Bill, which is to achieve the legal framework for competent, terminally ill adults to die with dignity at a time of their own choosing and in the controlled manner that they desperately seek. In our heart of hearts, is that not what we would all pray for and hope for? While containment of pain is obviously important, I base my arguments on quality of life. The briefest examination of the evidence from Oregon reveals that this particular group of patients are not motivated by pain, but by their own judgments and the quality of their lives. Why on earth should we refuse to grant a competent adult their request to receive assistance in dying when suffering unbearably from an illness such as motor neurone disease? Is it not a form of arrogance to deny someone such as I have described the right to take their onward journey with dignity and in their own time? Which of us has the right to say, "No, you can't"? If someone who is near the end of their life feels that their life is without value, why should we force them to live against their will? As a Christian, I believe in life after death. Remember the words of Christ uttered on the Cross to the two thieves: "Today, you will be with me in Paradise". If the words of Christ are as meaningful as they are to me, the next life will be a happier place. I see no contradiction between my faith and my support for the Bill. A person contemplating assisted suicide will no doubt bear in mind the views of the Church. But I believe that one has a personal relationship with God through Jesus Christ. If after prayer one chooses assisted suicide, that is a personal decision between oneself and one's maker. We should bear in mind that God gave us free will. It is a strange coincidence that we are debating this issue almost four years to the day that brave Dianne Pretty died. I, like the majority of the population at the time, did not believe that she should have had to suffer the indignity of dying in the manner she feared; a manner contrary to all her values. Since then, many others have been forced to go on living against their will and I hope that this House will have the compassion to spare others the same fate. ��Column 1220-1223 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-11.htm Lord Livsey of Talgarth: My Lords, I come to this debate objectively? Noble Lords: Order! 12.24 pm Baroness Warnock: My Lords, I am sure that all Members in this House, whatever views they hold on the Bill, wish profoundly that palliative care for the 12 May 2006 : Column 1221 dying should be made better and more accessible. Assisted suicide is not and never will be a substitute. Having said that, I want to make two further points. First, like others, I remind your Lordships of the extremely narrow scope of the Bill. It is irrational, in my view, to reject the Bill on the grounds that its scope will inevitably be widened. The Bill excludes euthanasia, even if this may be what the patient would prefer. It excludes assisted suicide, except where a patient is facing imminent death with no hope of recovery. It excludes assisted suicide unless the patient is thought to be wholly determined and of sound mind. It presumes only that in certain circumstances suicide is a rational choice. There can be no evidence that this Bill poises us on the top of a slippery slope, let alone one that leads to the widespread euthanasia of the vulnerable?an argument that we hear over and over again. Of course, some of those who fall within the scope of the Bill may be disabled. Others will not, except that they will be disabled by their illness. There is no threat in the Bill to the disabled in general, still less to those who are mentally disabled. My second point is this. The whole purpose of my noble friend's Bill is to define a small category of person for whom the general law against assisted suicide should not apply. It is to be presumed that these people, who choose suicide when facing the suffering that will lead to their death, do not think it morally wrong to do so. It is not contrary to their moral principles, or, perhaps, those of their family. Is it just, then, that they should be governed by moral principles, whether of the clergy or the medical profession, in which they do not believe? I do not argue that they should disregard the law simply because they do not agree with it; only that the law should be changed in such a way that they, in their extreme circumstances, should be allowed to follow the morality in which they do believe, not another which would compel them to live against their wish. 12.27 pm Lord Livsey of Talgarth: My Lords, I apologise to the distinguished noble Baroness, Lady Warnock, for intervening wrongly in the pecking order of the debate. I come to the debate objectively not from any particular religious view?certainly not a fundamentalist one. But if, like me, your father died at 35, when you were three years old, you regard every day lived as a very precious one indeed. Philosophically, and from the progressive side of politics?because this is a difficult speech for me to make, I believe that my earlier intervention was as a result of anxiety?I can clearly see the humanitarian aims of the Bill. It contains passion and understanding of the plight of the individual whose life is becoming, and often is, intolerable and unbearable. Often, too, the lives of their nearest and dearest are pretty intolerable. This indeed may contain part of the problem associated with the Bill. 12 May 2006 : Column 1222 Mercy in such circumstances is a very natural and humane response. I totally understand and respect those who support the Bill. This frequently stems from their life experience, as we have heard today. Also, I understand that this carefully crafted Bill puts the onus of the decision to end the life of the person concerned on the current or stated wish of that individual. A person with the precious gift of life is blessed. Taking that life away is an unbearable responsibility, even if taken by that person, based on the decisions and advice of others, however highly qualified and merciful. The weakness of the Bill is not its humanitarianism, which I salute?my heart thus far is sympathetic?but its omission of the human frailties of others, whether members of the immediate family or others who may purport to support the individual but who, in reality, have agendas that may be linked to the money, property, the cost of long-term care or the plain settling of long-term scores unknown to others. They may not be genuinely concerned for the true well-being of the individual whose fate is under review. Albeit that it is to be the patient's own decision, it will be made under acute mental stress at their weakest possible moment in life. Persuasion, manoeuvring and denial of good palliative care could in those circumstances play a part. It is virtually impossible to legislate for such vagaries of human nature. That would break the trust between the doctor and patient. It is for those reasons that I am unable to support the Bill, however well intentioned it may be. 12.31 pm Lord Nickson: My Lords, when I was much younger, I remember being deeply influenced by the story of the father of an acquaintance who was terminally ill and in great distress in hospital. He asked that a briefcase be brought to him from his study desk?it was presumed, so that he could look at some papers. That briefcase contained not some papers but a loaded pistol, with which he shot himself. I remember feeling at the time there must be a better, more civilised way out for someone in such distress and pain. That feeling has stuck with me. In the October debate, I would have counted myself, if not as a "don't know" perhaps in the 70 to 87 per cent who might have thought that the Bill was a very good idea. Since then, I have thought a lot. I have talked to a lot of people whose views I respect. During the October debate, I swayed one way and another. I remember being very influenced by the speech of the noble Lord, Lord Puttnam, about his mother; just as I was influenced by the speech of the noble and learned Lord, Lord Archer of Sandwell, just now. I have now made up my mind. I think that the Bill is dangerous and I shall oppose it, for four reasons. First, I believe in the sanctity of human life?if you like, the Christian argument. The second reason is one of medical ethics and the trust between patient and doctor. I believe that that trust would be irrevocably damaged. Although I paraphrase, I believe that doctors, in the Hippocratic oath, sign something that 12 May 2006 : Column 1223 says, "I will not give poison to anyone else who asks for it, nor will I make a suggestion to that effect". I believe in that. Thirdly, I am very influenced by the subtle, insidious pressure that I believe would be placed on people as our population ages, expressed in the briefest speech yet by my noble friend Lord Tombs. Finally, I am of the view that whether we use the phrase slippery slope, a Rubicon, or the analogy of the little Dutch boy with his finger in the dyke or of the abortion law, as expressed by the noble Lord, Lord Phillips of Sudbury, we are in great danger of crossing the line. It is a line that we all know concerning inhibitions. As were so many things, it was expressed very concisely by Alexander Pope: "Vice is a monster of so frightful mien, As to be hated needs but to be seen; Yet seen too oft, familiar with her face, We first endure, then pity, then embrace". If we cross that line by approving the Bill, however much it may be limited, we shall be moving down a road that leads to something far less than we want. The Bill is very well intentioned and moved with great sympathy, but we all know that good intentions lead to a different road. 12.34 pm Baroness Symons of Vernham Dean: My Lords, just over 14 years ago, I sat every day and most nights at the bedside of a man in his 30s who had been diagnosed with a very advanced case of the most aggressive and virulent form of leukaemia. He fulfilled the criteria in the Bill of the noble Lord, Lord Joffe, to legislate for his assisted dying. He had been given a less than 20 per cent chance of survival and was likely to die within weeks?on some days, he was likely to die before the end of the afternoon. His physical pain was excruciating. Indeed, it was unbearable?so much so that administering any form of pain-killer was initially almost impossible. His mental anguish was constant and acute. As his treatment began?there were four rounds of huge doses of chemotherapy, each round lasting for 13 days?he was absolutely clear-minded, but his will to fight became blunted. He said repeatedly that he could not go on. But he had to, and I am glad. Fourteen years later, I am happy to say that he is thriving and I am so glad that the Bill of the noble Lord, Lord Joffe, was not on the statute book. I fervently hope that it never will be. 12.36 pm ��Column 1223-1227 http://www.parliament.the-stationery-office.co.uk/pa/ld199900/ldhansrd/pdvn/lds06/text/60512-12.htm Lord Mawhinney: My Lords, I pay tribute to the noble Baroness for her speech. My mailbag experience was the same as that of the noble Baroness, Lady Williams of Crosby. Overwhelmingly, it consisted of letters against the Bill. Knowledge from another place suggests that when those letters are being written off a factsheet, you can see the similarities between them. The letters that I received were personal experiences. Two views emerged. One was that the passage of the Bill would 12 May 2006 : Column 1224 alter the value of human life. The most reverend Primate made the point that not only would it alter the lives of those who might make a decision, it would alter the lives of a lot of others who might want to resist making such a decision. Secondly, it would alter the relationship between members of the medical profession and their patients. Over and over, doctors wrote to say: "We were trained to heal and save life, not to kill". Because of time pressure, I shall read only one paragraph from one letter. It is from a nurse in Cheshire. She wrote: "As a senior nurse working in Intensive Care, I care for the sickest patients often undergoing degrees of pain and suffering with a plethora of problems. Sometimes these problems seem insurmountable and I will admit I have thought that they may be better off dead. With care and support provided by skilled and caring staff they can be helped through their ordeal. I have realised how wrong I was when patients return to visit the unit, grateful to be alive". That is not a deeply theological argument; it is an intensely practical and pertinent day-by-day argument that applies to the Bill. I was grateful to the noble Lord, Lord Carlile, for pointing out the illusory difference between killing and simply writing the prescription that makes the killing appropriate. He was absolutely right to do so. I hope that the House will not think the less of me if I say that I was reminded of all the safeguards that were built into the abortion legislation to facilitate its passage on to the statute book. Of course, I imply no such motivation to the noble Lord, Lord Joffe, in this case, but I am persuaded by previous experience. In his speech, the noble Lord, Lord Joffe, said that he hoped that those of us whose views were shaped by faith would not press our faith because it is a minority view in a secular society. I can tell the House that I have spent 27 years in public service and I do not believe that I could ever have been accused of using my faith as a cudgel. I seek to have my faith integrated as part of who I am. I cannot?and I will not?seek to dissociate who I am and my views from my faith. My faith and my world view are just as legitimate as the faith, whether secular or theological, and world worth view of anyone else. Finally, I believe the noble Lord, Lord Joffe, was quoted over the weekend as saying that he had received hate mail. As a former Minister, I know what that is like. I deplore it, and he has my sympathy. It was also said that he had said that much of the mail he received lacked Christian compassion. I recognise his compassion and I dissociate myself from any letters he received that lacked Christian compassion. Equally, I hope that he will recognise my compassion. This is not a battle about compassion; it is a question