January 16th 2015 Further Debate on the Falconer Bill. Is this “assisted dying” or “assisted suicide”?
Lord Alton of Liverpool (CB):
My Lords, I will be brief because I did hear what the right reverend Prelate the Bishop of Chester has just said. I understand that the House will want to move to a conclusion but I was very struck by the remarks made a few moments ago by the noble Lord, Lord Dobbs, about suicide. I would like to return to that point in a moment. However, I support my noble friend Lady O’Neill for three reasons: the first is because of language, the second because of law and the third because of practice.
On the question of language, the noble Lord, Lord Dobbs, being a well known and very accomplished writer, will be familiar with the influential dystopian novel 1984 by George Orwell, who said in it that,
“if thought corrupts language, language can also corrupt thought … It’s a beautiful thing, the destruction of words”.
The words that we use to describe our actions are crucial. There are so many other examples in law of euphemism, referred to earlier by the noble Lord, Lord Brennan, where we have distorted language to disguise the realities of what we are doing. I do not accuse the noble and learned Lord, Lord Falconer, of doing that in his Bill but it is quite clear on page 4, line 11, where Clause 6(2) states:
“In the Suicide Act 1961, after section 2B (course of conduct), insert—”.
So the law will be changed. It is not the Dying Act but the Suicide Act that we are seeking to change.
There is language and law, but there is practice as well. The noble Lord, Lord Dobbs, talked about suicide. At an earlier stage, I mentioned that my father was one of five brothers who served in the Second World War. His eldest brother lost his hearing and became deeply depressed. He was very ill at the end of the war and took his own life. I agree with what the noble Lord said about the stigmatisation, particularly of mental health, and the suicides which can follow from it. We must be acutely aware of that.
In 2000, the World Health Organization issued new guidelines about suicide. It said:
“Suicide is perhaps the most tragic way of ending one’s life … Every effort should be made to avoid overstatement”.
Interestingly, given the media coverage of these events, it also said:
“Front page headlines are never the ideal location for suicide reports … Suicide should not be depicted as a method of coping with personal problems … Instead, the emphasis should be on mourning the person’s death”.
This House wisely published a Select Committee report on these questions. It stated:
“Dying is not only a personal or individual affair. The death of a person affects the lives of others, often in ways and to an extent which cannot be foreseen”.
The ending or taking of a life is not a trivial question. We must say what we mean. The language must be clear and we must be aware of what the practice will involve. As I have said in this House before, I wish that we placed as much emphasis on helping those who wish to live by providing assisted living as opposed to assisted dying, especially for those who are vulnerable and feel at risk as a result of this legislation.
Also see – we cannot have “zero suicides” if we allow euthanasia:
Lord Alton of Liverpool:
Before my noble friend, Baroness Campbell, completes her remarks, has she had a chance to read the briefing that was sent to Members of your Lordships’ House only yesterday by the disabled people’s charity Scope, which says—this reinforces the point she has just made—that in the US state of Washington, where assisted dying is legal,
“61% of those requesting to end their lives did so because they felt a burden on friends, family or care-givers”?
Scope says in its briefing to your Lordships in support of the amendments we are considering:
“The definition in the Bill of ‘reasonably expected to die within six months’ would capture many disabled people”.:
Lord Alton of Liverpool:
My Lords, I support what the noble Lord, Lord McColl, said. He is one of the foremost medical authorities in your Lordships’ House. We know that many of the royal colleges and the British Medical Association, speaking for 153,000 doctors, say that it is not possible to legislate safely—which is the point that the noble Lord, Lord Cormack, made.
However, I recall that when my late father was dying and I went to spend time with him during the last part of his life, the doctor told me that I should make provision for long-term care. After he left the room it was the nurse, who was the wife of one of the policemen who worked in the Houses of Parliament at that time, when I was in another place, who said to me, “David, you don’t need to make long-term provision. In my view, your father will be dead before the end of this weekend”. Needless to say, it was the nurse rather than the doctor who got it right.
Many noble Lords will have read the briefing from the Royal College of Nursing, which arrived only today. It says:
“Terminal illnesses are often extremely unpredictable with periods of improvement and deterioration. This can make it extremely difficult to pinpoint when someone might die … we remain concerned that diagnosing that a patient is expected to die within six months could result in inaccurate judgements through no fault of the medical practitioner”.
That is the point that that noble Lord, Lord Warner, has just made and it could lead to litigation against doctors and nurses if we do not put in far better safeguards than the Bill provides at present.
Lord McColl of Dulwich:
I thank the noble Lord for that intervention. I have been in practice for very many years and I still am. One of the things that always struck me was how wrong I was about trying to predict when a patient would die. I well remember a typical case of a lady who was only 28. She had inoperable cancer of her throat. She was in great distress, with pain and distressed breathing. I saw my job as a doctor to relieve all her symptoms, whatever the cost. I said to her, “If you like, I can put a needle into your vein and titrate you with heroin”. Heroin is a marvellous drug. You have to dilute it in a large volume and not use the small volumes in the ampoule, because if a gun goes off you might suddenly give them too much too quickly. I titrated her and asked her to tell me when all the symptoms had gone. Eventually she said, “Yes, that’s fine”. It was a huge dose of heroin. I had no problem about giving it. The strange thing was, not only did it not kill her, it gave her a new lease of life. It is unrelieved pain that is the killer.
J.R.R. Tolkien, The Lord of the Rings
PIPPIN: I didn’t think it would end this way.
GANDALF: End? No, the journey doesn’t end here. Death is just another path, one that we all must take. The grey rain-curtain of this world rolls back, and all turns to silver glass, and then you see it.
PIPPIN: What? Gandalf? See what?
GANDALF: White shores, and beyond, a far green country under a swift sunrise.
PIPPIN: Well, that isn’t so bad.
GANDALF: No. No, it isn’t.”
― J.R.R. Tolkien, The Lord of the Rings
When Denethor is going to kill himself and Faramir in ’Return of the King’, (The Pyre of Denethor), he is not allowed. “Authority is not given to you, Steward of Gondor, to order the hour of your death,’ answered Gandalf, ’and only the heathen kings, under the dominion of the Dark Power, did thus, slaying themselves in pride and despair, murdering their own kin to ease their own death.”
December 2014: Welsh Assembly Votes Against Assisted Suicide Bill
BARONESS ILORA FINLAY
Last Wednesday the National Assembly for Wales debated a matter that affects everyone: whether doctors should be licensed to supply lethal drugs to terminally ill people who ask for them.
Campaigners prefer the gentle-sounding term ‘assisted dying’, but in reality they are proposing physician-assisted suicide.
Lord Falconer’s Private Member’s Bill before the Westminster Parliament, if it were to pass, would apply to both England and Wales.
Assembly Members (AMs) were asked to vote on whether they supported the principles of the Assisted Dying Bill.
The answer was a clear and refreshing “No”, it does not support it. Only 12 Assembly Members voted to support it, 21 voted against doing so; 20 abstained.
It was heartening to watch the quality of this debate from the public gallery.
I was particularly impressed by the understanding which many Members showed of a Bill that goes to considerable lengths to dress up what it is proposing in reassuring language (for example, by describing the lethal drugs it would supply to terminally ill people as ‘medicines’) yet makes no effort, beyond stating a handful of vague eligibility conditions, to provide for any serious safeguards to protect vulnerable people from harm.
Lord Falconer’s Bill ‘is not fit for purpose’ says Tanni Grey-Thompson, as the so-called ‘right-to-die’ debate was reignited
The Assembly was having none of this. Speaker after speaker, including some who were not averse to the principle of such a law, drew attention to the gaping holes in Lord Falconer’s Bill.
All spoke with sensitivity and compassion – about for example the impossibility of predicting life expectancy, the ways people in despair can change their views when they get the care they need and the way they can easily come to feel they are a burden.
There were a few misconceptions. For example, one Member perhaps misunderstood House of Lords’ procedures, by implying it had unanimous support at Second Reading. This is completely wrong; opinion on the Bill is sharply divided.
The Bill was allowed to proceed to Committee stage so that the Lords could consider it line by line. Over sixty Peers spoke against the Bill last July, highlighting as AMs did, that it would put many patients at risk.
My own views on this controversial issue are well known. As a doctor who has specialised in caring for dying people for over 25 years, I have seen at first-hand how thousands of people have faced their own dying.
Dying people have spoken to me about wanting to end it all. The vast majority of such conversations are a response to fear or depression, or to unseen pressures or feelings of being a burden. When they are listened to and get the care they need, the wish to die vanishes.
Licensing doctors to supply lethal drugs for suicide is highly dangerous.
Doctors can diagnose terminal illness, although predicting how long people have to live is fraught with error. But doctors rarely know whether there is family pressure on a patient or just how settled a wish to die is.
I have been fooled by patients’ families who were apparently loving but turned out to be otherwise. That is why the majority of doctors, and more than nine out of 10 of those who care for the dying, are strongly opposed to legalising physician-assisted suicide.
I have lived and practised medicine in Wales for 30 years. On Wednesday I felt proud watching how the Assembly handled this difficult and controversial subject
House of Lords
November 8th 2014:
Committee Stage of the Assisted Dying Bill Day One – Full Debate at:
Lord Alton of Liverpool (CB): My Lords, I support very strongly what the noble Baroness, Lady Cumberlege, has just said about the effect of the Bill on medics. I was struck by a recent conversation that I had with one of my sons, who is a fifth-year medic. He very much welcomes the stand that the BMA and the royal colleges have taken in saying that they would not wish to see a change in the law because of the position that it would place doctors in. He argues, as I would argue, that you do not need a doctor to kill you to die with
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dignity. I was very struck by what the noble Lord, Lord Howard, said about the roles that the hospice movement and palliative care can play.
However, I see the point of these amendments and I understand what my noble friend Lord Pannick and the noble Lord, Lord Carlile, are trying to do in improving the Bill. It is right that we should, at a Committee stage of the House, take the amendments extremely seriously, as we are required to do. Therefore, I honestly believe that today we should not be pressurised by either time or the thought that we are going to be railroaded into taking votes at this stage. I hope that those who have been calling for greater reflection on the amendments will be listening, too.
My noble friend Lady Murphy said that this is a decision for patients. However, implicit in the amendments is the fact that it is not just a decision for patients. This will require an assessment process. It is not an “on demand” situation, and therefore there is the possibility that from time to time such proposals will be rejected as well by the courts.
My noble and gallant friend Lord Stirrup rightly made the point that there will be people who are unable to take these decisions for themselves. That returns to one of the cases raised during the opening remarks of my noble friend Lord Pannick. He mentioned the case of Tony Bland, who went into a persistent vegetative state as a result of the football game that took place at Hillsborough. On Monday, I went to Warrington. I was incredibly impressed by the extraordinary resources and time that have been put into the new inquest process and by the work being done by the Independent Police Complaints Commission in reinvestigating the events. I made my own deposition there.
I was thinking not about the Tony Bland case—although I am well aware of it and well aware of those of my then constituents who died at Hillsborough—but about the case of Andrew Devine, who was a constituent of mine and who also went into a persistent vegetative state. It was predicted at that time that he, too, would die. Of course, Tony Bland was never on a life support machine; he had food and fluid withdrawn—a decision made through the court process. I just reflect that Andrew is still alive and is loved and cherished by his family. Having been in a persistent vegetative state and been told that he would never be in a position to take solid foods again, within a couple of years he was able to do so. Therefore, we have to be careful about prognosis. We have to be very careful in assuming that we will always get these things right.
Every single case matters, and that is what I would say to the noble Baroness, Lady Wheatcroft, following the intervention made by the noble Lord, Lord Deben. Every single case matters; it is not just about the one or two people who will not be able to take decisions for themselves. Public safety goes to the very heart of the concerns raised by my noble friend Lady Finlay and in the amendment put before us by the noble Lord, Lord Carlile.
I was struck by what Lord Sumption said in the Supreme Court judgment. He said:
“It is right to add that there is a tendency for those who would like to see the existing law changed, to overstate its difficulties”,
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by suggesting that,
“the current law and practice is less humane and flexible than it really is”.
So we are not at a settled point as far as this legislation is concerned.
I have been genuinely surprised that another place has not been given the opportunity to reflect on the extraordinary moral and ethical issues in this legislation, which are also contained in the questions raised by this amendment. One should recall that the Guardian said about the Bill:
“It would create a new moral landscape. It is also, potentially, open to abuse”.
That is what I think the amendment of the noble Lord, Lord Carlile, seeks to address. The newspaper went on to say:
“Reshaping the moral landscape is no alternative to cherishing life and the living”.
The Daily Telegraph said:
“The more assisted dying is discussed, the more its risks will become apparent”.
That was the point made in the eloquent remarks of the noble Lord, Lord Tebbit, who reminded us today of the pressure that can be placed on vulnerable people. We should recall the speech made at Second Reading by my noble friend Lady Campbell of Surbiton: it is not just the BMA and future medics; it is not just the hospice movement; it is also the disability rights organisation, whose representatives are standing outside this House today. I spoke to them this morning on my way in. They hope that, if we proceed with the Bill, we will do everything we possibly can to put in greater and stronger safeguards. Therefore, I hope that we will have a chance between now and Report to reflect on the different approaches contained in these two amendments and that the noble and learned Lord, Lord Falconer, will also go away and reflect on them following today’s debate.
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Lord Alton of Liverpool: My Lords, I echo very strongly the remarks made by the noble Lord, Lord Empey, about the special and sacred relationship between doctor and patient. It is worth reminding the House of what the General Medical Council said unambiguously and robustly: “A change in the law to allow physician-assisted dying would have profound implications for the role and responsibilities of doctors and their relationships with patients. Acting with the
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primary intention to hasten a patient’s death would be difficult to reconcile with the medical ethical principals of beneficence and non-maleficence”.
I agree with what the noble Lord said about relationships, but I also agree in particular with the importance of Amendment 68, in the name of the noble Lord, Lord Carlile, which is about the importance of independent safeguards. I will speak to it in a moment. I come from a region where Dr Shipman was a general practitioner. He was referred to by the noble Lord, Lord Carlile, in his opening remarks on this group of amendments. Hundreds of cremation forms were signed by doctors who were not Dr Shipman; they were signed and those patients went to their deaths. That is why we are right to talk in detail about the safeguards that I know the noble and learned Lord, Lord Falconer, wants to see incorporated in the Bill, should it proceed.
I am particularly enthusiastic about what the noble Lord, Lord Carlile, said about providing an independent element in this process. I think back to an exchange in a constituency surgery. The noble Lords, Lord Deben and Lord Empey, are right to remind the House that sometimes the exchanges one has on the ground as a local politician can inform the way we think about these moral and ethical issues, on the basis of human behaviour and human nature. Just after the Toxteth riots in Liverpool a man came to see me in my surgery about the death of his father. His father had divorced from his mother. They had lived in Germany and at the end of the war they went to Holland. After their divorce the mother and son came to live in England. After his mother died, the son wanted to be reunited with his father, whom he had not known since childhood. He went to Holland, only to find that, under the Dutch laws, his father, in a state of deep depression, had taken his own life.
What really distressed this young man was that he had a half-brother who had inherited all his father’s wealth and had given permission for his father’s life to be ended.
That reminded me of something that the noble Baroness, Lady Cumberlege, said to us on an earlier occasion. I thought it a wry but very accurate remark. She said that where there is a will, there is a relative. There are profound implications. People can gain from these circumstances. That is why an independent element is so important.
One thing that has united the House is the sense we all have about public protection. For me it is the key question for whether we support the Bill or not. Public safety is the issue. Polling data have been referred to, but those data reduce massively to only 43% approval for a change in the law if people believe that public safety will be compromised. That is the issue that your Lordships have to deal with if the Bill is to go on the statute book.
Amendment 68 takes us to the point where we can have an independent overview of any decisions that are to be made. It builds on what the noble Lord, Lord Deben, said on how we assess the effects of any individual act in the context of society as a whole: how we look at the aftermath of these decisions.
We heard from the noble Lord, Lord Howard, about the role of the hospice movement in palliative care. I am a patron of a couple of hospices, I suspect like many of your Lordships. I know the wonderful work that they do, particularly on Merseyside, which I have been involved with throughout my political life. Every year at one of those hospices there is a walk of witness through the local community, where they raise significant sums of money. It costs a lot of money to keep those hospices going. However, for me, what is really wonderful about those walks of witness is the therapeutic effect that they have on all those who participate. It is a healing process in grief.
I accompanied my father in the last moments of his life. He had a healing moment, believing that he had seen his brother who, as a member of the RAF, had died in the Second World War. I do not know whether this was a near-death experience or whether it was accurate, but it certainly helped him. If he had been given a lethal injection earlier, he would have been denied that moment. I believe that the concept of a good death—the one that historically we have always treasured in this country—could be lost if we proceeded into the mechanistic view that authorised assisted dying would probably introduce. Therefore, for me, safeguards are important.
People have been talking of their own experiences during these debates. My father was one of five brothers who were in the Armed Forces. He was a Desert Rat. One of his brothers lost his hearing and took his own life after the war was over. I remember it even though I was very young at the time. It had a profound effect—a point made by the noble Lord, Lord Deben—on everyone in our family and it still has to this day.
Therefore, the idea that these decisions are purely acts of autonomy and matters of private choice that have no effect on others is simply wrong. Indeed, it was your Lordships who said precisely that in 1994, when my noble friend Lord Walton of Detchant, who cannot be here today but who, in his 90s, still plays a very active part in the House, chaired the Select Committee in question.
I know that the noble Baroness, Lady Warnock, has changed her mind since then but she has played a significant part in the debates around these issues over the years, and she, too, was a member of that Select Committee. The committee said:
“Individual cases cannot reasonably establish the foundation of a policy which would have such serious and widespread repercussions … Dying is not only a personal or individual affair. The death of a person affects the lives of others, often in ways and to an extent which cannot be foreseen. We believe that the issue of euthanasia is one in which the interest of the individual cannot be separated from the interest of society as a whole”.
“We believe that … the interest of the individual cannot be separated from the interest of society as a whole”.
I profoundly believe that. There is great wisdom in what the Select Committee said at that time. We have to weigh up that issue as we consider this and all the other amendments that will follow. Are we able to provide the necessary public safeguards? Are we sufficiently concerned about what will happen in the aftermath? And are we sure that we can proceed without safeguards such as the independent element that the noble Lord, Lord Carlile, is suggesting to your Lordships in this amendment today?
7 Nov 2014 : Column 1901 Baroness Warnock (CB): My Lords, why is it thought wrong for someone to ask to die out of a sense of duty or a wish not to continue in a condition that is intolerable—the condition of being disruptive, indeed often destructive, to the well-being of their own family? All the way through their life until this point, putting their family first will have been counted a virtue, and then suddenly, when they most want to avoid the trouble, bother, sorrow and misery of disruption to their family, they are told they are not allowed to follow that motive. I simply find this extraordinary puzzling and I would like the noble Lord to explain it to me.
Lord Carlile of Berriew: People with much less strength of character than the noble Baroness, who is known for her views and her enormous strength of character, are at risk of those feelings being adopted, condoned and co-opted by their family. Those of us who have practised law for many years have come across such cases. Indeed, there will be people who have observed it in the lives of friends and family. It is our view that a sense of obligation—“It would be better for my children if I were carried away”—is not a sufficient basis for allowing an individual to do what is anticipated by the Bill, which is deliberately to end the life of another person.
Lord Alton of Liverpool: My Lords, I am grateful to the noble Lord for giving way.
Lord Ashton of Hyde (Con): My Lords, I think it is usual not to intervene before the noble Lord has moved the amendment.
Lord Carlile of Berriew: I believe that I moved the amendment right at the beginning of my speech, so I am very happy to give way to the noble Lord, Lord Alton.
Lord Alton of Liverpool: I am grateful to the noble Lord. I was aware that he had moved the amendment. On the point about the pressure that can be placed on people to take decisions that they might involuntarily be asked to take, does he agree that the “right to die”, as it is sometimes described, can easily morph into a duty to die? I understand the point made by my noble friend Lady Warnock. However, I recall that in 2008 she also said that you can become a burden to the National Health Service if you have something such as dementia and then you can become a burden to society. I am personally disturbed by the idea that we place on people’s shoulders the idea that somehow they are a burden not just to their families but to the rest of us as well.
Lord Carlile of Berriew: I agree with the noble Lord. Indeed, there is a very slippery slope from saying, “I feel an obligation to my family or the NHS” to it being said, “Well, we have to deal with people
who are an obligation to their family or the NHS”. The safety that this provision would introduce into the system is, in my view, very important.
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Lord Alton of Liverpool: My Lords, I support Amendment 65 and Amendment 71 in the name of my noble friend Lady Hollins. I also support what the noble Lord, Lord Swinfen, has just said. I thought that he made some incredibly important points. We are dealing with capacity, depression, burdensomeness and the ability to communicate. The last point made by my noble friend Lady Masham during her intervention is one that the movers of the Bill need to take very seriously.
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I draw the attention of noble Lords to an Early Day Motion tabled in another place earlier this year. It deals with some of the points in these amendments and states:
“That this House notes the results of the Washington State Death With Dignity Act Report 2013, published on 10 June 2014, which concludes that the number of deaths through physician-assisted suicide has tripled since the first year of implementation and increased by 43% between 2012 and 2013; expresses grave concern that 61% of those who received lethal drugs in Washington in 2013 gave as a reason for seeking assisted suicide being a burden on family, friends or caregivers; recalls that those who introduced the law in Washington assured the public that it would only apply to terminally ill, mentally competent patients; and reiterates its belief that a corresponding change in UK law would endanger the lives of the most vulnerable in society”.
I agree with the sentiments expressed in that Early Day Motion. As the debate continues in the country at large, I hope that we shall have the chance to hear more voices from those who have been elected and who have had direct contact with their constituents.
It is not just in the state of Washington where we have seen things change from often good intentions—I pay tribute to the noble and learned Lord, Lord Falconer, whose motives in this I have never doubted—so that what comes out at the end is not always so. I draw the attention of the House to the comments of Professor Theo Boer in Holland, who said:
“I used to be a supporter of the Dutch law. But now, with 12 years of experience, I take a very different view … Pressure on doctors to conform to patients’ (or in some cases relatives’) wishes can be intense”.
He admitted that he was,
“wrong—terribly wrong, in fact”.
He had changed his mind. Since 2008, the number of assisted deaths in Holland has increased by about 15% every year, maybe reaching a record of 6,000 a year. It is worth pointing out that the law there changed at first simply by turning a blind eye—then voluntary euthanasia was introduced and then involuntary euthanasia. About a quarter of the deaths in Holland every year now are involuntary—that is, without the consent of the patient. These are the facts that we must consider as we consider whether or not we are putting sufficient safeguards in the Bill to safeguard the most vulnerable.
The noble Lord, Lord Deben, was right to point to the often fragile existence that many elderly people have. I saw figures recently that suggested that around 1 million elderly people do not see a friend, relative or neighbour during an average week: toxic loneliness. It is assisted living that we need in this country, not assisted dying. We need people who can help people in that kind of situation.
We have all experienced depression. Winston Churchill experienced the black dog. Depression is prevalent in many of our large urban communities. Certainly, in the areas that I represented, it was not heroin—although you saw heroin on the streets—it was antidepressants on every shelf of every home that you went into in the high-rise blocks, cluster blocks and spine blocks, where people were forced to live in depressing situations. That is why I was not surprised by the remarks of the noble Baroness, Lady Hollins, with all her experience as a former president of the Royal College of Psychiatry.
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I was not surprised to hear what she had to say, but I was particularly struck by a report published in April of this year by Price, McCormack, Wiseman and Hotopf. They said:
“Before mental capacity can be placed so centrally as a safeguard in the process, discussion needs to take place about what exactly is meant by the term ‘mental capacity’ in the new Assisted Dying Bill”.
The Bill does not require any treatment for depression, although it proposes in Clause 8(1)(a)(ii) that there should be a recognition of its effects on a person’s decision-making. It is not clear what that would mean in practice. Would it mean that a patient would have to receive treatment or a psychiatric assessment, or be refused altogether? There simply is no clarity on that key point.
I also draw the House’s attention to the evidence given to the noble and learned Lord’s own commission when it considered the issue of capacity and judgment back in 2006. It said that,
“in the context of such a serious decision as requesting an assisted death, the Commission considers that a formal assessment would be needed to ensure that the person concerned had capacity. The evidence given to the Commission made it clear that there are a number of factors that might affect an individual’s mental capacity, including temporary factors caused by physical or mental illness, and more permanent impairments such as a learning disability. It would be important that such factors were identified and that an assessment was conducted to explore whether the subject’s decision-making capacity was significantly impaired … the Commission does not consider that a person with depression, whose judgement might be significantly impaired as a result of this depression, should be permitted to take such a momentous decision as ending their own life”.
I know that the noble and learned Lord still holds to that view. I commend it to the House.
Lord Avebury: Does the noble Lord prefer the situation that exists at present, in which several hundred unassisted suicides of terminally ill people take place every year?
Lord Alton of Liverpool: The noble Lord is right—and every one of those deaths is a tragedy. That is why I said that we have to intervene to assist in living, providing unconditional care, support and love. Simply to provide opportunities for people to take their own lives does not seem a wholesome or good way for this country to proceed. I have known the noble Lord for a very long time and I know that he would not support that either. Let us therefore be careful not to institutionalise what he rightly says already takes place. Just because something happens is not a good reason to make it legal or more easily available. That is why I support these amendments.
Debate on whether Clause 1, as amended, should stand part of the Bill.
Lord Alton of Liverpool: My Lords, given the advice of the noble Lord, Lord Newby, I will take the Committee to the arguments that would have been contained in the group led by Amendment 11. I think that was the guidance that we were just given. Noble Lords will realise that later amendments, Amendments 90, 92, 93, 105 and 122 will be reached when they get there. I will try to keep my remarks fairly short, because I think that the Committee is growing weary.
This is an important question, as are many of those that have been laid before the Committee today. It deals with the title of the clause, which is “Assisted dying”. I would argue that that is incorrect; it is assisted suicide. Those who support the noble and learned Lord’s Bill are at pains to tell us that assisted dying is not physician-administered euthanasia, whereby a doctor administers a lethal dosage of drugs to a patient, but physician-assisted suicide, whereby a doctor supplies a lethal dosage of drugs and the patient swallows or otherwise ingests them. I invite the Committee to look at the procedures set out in the noble and learned Lord’s Bill against these claims.
Clause 4 is perhaps the principal clause in this respect. Its subsection (4)(a) allows a doctor or nurse to “prepare” lethal drugs for self-administration. Presumably this means putting them into a form, such as a liquid, that the person can swallow—in a way, so
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far so good—but subsection (4)(b) then provides for a “medical device” to be put in place to aid self-administration. Again, I suppose that this is fair enough, although rather more precision is needed as to the object of such a device. That is why I have tabled an amendment to that effect.
Then we come to subsection (4)(c), which allows a doctor or nurse to,
“assist that person to ingest or otherwise self-administer”.
Here we really are on the borderline between physician-assisted suicide and physician- administered euthanasia. Subsection (4)(c) raises some important questions. Precisely what assistance, apart from preparing the lethal drugs and perhaps inserting a feeding tube, does “assist … to ingest” include? Does it include, for instance, holding a beaker to the lips of the person? It is not difficult to foresee a situation in which a doctor or nurse supplying lethal drugs under the terms of the noble and learned Lord’s Bill could cross the line, however innocently, between giving the patient those drugs and administering them. Subsection (4)(c) introduces a significant and dangerous grey area into the process of assisting suicide.
The noble and learned Lord has, I can see, recognised this ambiguity in subsection (5), which states that neither the doctor nor the nurse may administer the drugs to the patient, but it seems that as long as subsection (4)(c) stands, the ambiguity will remain. Moreover, subsection (5) says nothing about others administering the drugs, which brings me to my next concern. It is not just a matter of the doctor or nurse refraining from administering lethal drugs. There are others who might be inclined to do so, possibly from altruistic motives. It is therefore important that there is oversight by the doctor or nurse of what happens when the lethal drugs are delivered.
At this point, the noble and learned Lord’s Bill becomes rather convoluted. It states, reasonably enough, that the doctor or nurse must remain with the person to whom the drugs have been delivered until either they have been ingested and the person has died or the person has decided not to take them, in which case they are withdrawn. Yet subsection (6) defines remaining with the person as being,
“in close proximity to, but not in the same room as, the person”.
I understand and respect the noble and learned Lord’s wish to allow a person who is self-administering lethal drugs to die without strangers in the room but we have to balance that against the scope for others to intervene in a way that is not permitted in his Bill if the drugs are ingested without supervision.
We all heard the intervention that the noble Lord, Lord Jopling, put to my noble friend Lady Finlay much earlier in our debates about the circumstances in which people might die. I would have thought that the doctor’s presence need not be obtrusive. Apart from anything else, we have to allow for the possibility—this sometimes happens, according to the evidence from Oregon—that complications, such as vomiting or distress, arise when the drugs are taken. The doctor needs to be in the room if that happens.
For me, this is an issue that helps to distinguish between assisted suicide and assisted dying. If it is not the wish of this Committee that we should legalise outright euthanasia—I do not believe that it is—then it is very important that those clarifications are made. While I am unable to move Amendment 11, which was originally on the Marshalled List, that would have been its purpose. I am grateful to the noble Lord, Lord Newby, for providing us with the opportunity while debating the amended Clause 1, which I will not be opposing, to debate some of these questions.
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August 21st: 2014
Oxford University has published a study which looked at trips to the assisted suicide clinic between 2008 to 2012, and found that Britons comprised the second highest number of foreigners going to Zurich for assisted suicide during that period. More dying patients travelling to the Dignitas clinic now have non-terminal conditions such as chronic pain or paralysis and 5% of individuals that had an assisted suicide did so because they suffered from a mental illness.