Committee (5th Day)
Coroners and Justice Bill
Baroness Finlay of Llandaff (Crossbench)
Last week, the BMA rejected the amendment's proposal, and also rejected supporting physician-assisted suicide generally. Why? Because it saw that this does not serve true choice in patient care. There are no safeguards of substance here. The two doctors have only to be registered—in other words, a year out of medical school. They need no training in the patient's condition, in assessing mental capacity or in detecting coercion. Each doctor has to do only a single assessment, which will inevitably miss some impairments in capacity and distorted thinking that may be fluctuant. The requirements would not have safeguarded the patients in the five cases highlighted by the noble and learned Lord, Lord Falconer, in his opening remarks.
This is a rubber-stamping exercise. The criteria are far less rigorous than those required for other serious assessments such as brain-stem death. What about the witness? Will they be a lawyer, or trained to detect coercion? How will the witness check the veracity of the doctors' statements? The declarations do not have to be formally registered with the Ministry of Justice; nor do they have a shelf life. There is no monitoring here, and the requirement that the patient has read or been informed of the contents of the doctors' certificates affords less protection than the informed consent required for major surgery.
Where will the registered medical practitioners come from? In Oregon, there is a culture of doctor-shopping. The pro-assisted-suicide organisations link patients to a compliant doctor. The Oregon health department's report showed that a tiny number of doctors provide all the lethal prescriptions. Such doctors from pro-assisted-suicide organisations are hardly going to be unbiased in their "in good faith" assessments. Let us not be fooled into thinking that a second, independent doctor is a rigorous check. I remind the Committee that Dr Shipman's cremation forms were all signed by doctors independent of him. That safeguard failed in several hundred cases. More than 90 per cent of doctors in palliative medicine in this country want nothing to do with this, as we work day in and day out with those with end-of-life diseases, on their management and care.
The amendment certainly does not define terminal illness. Indeed, as stated, many of the Britons who have had assisted suicide at Dignitas were far from terminally ill. The definition which I used in my Palliative Care Bill related to an entitlement to care. If more than those who fitted the definition came within its ambit, they certainly would get more enhanced care than they were already receiving but that would not endanger the safety of anyone. They would simply receive that care and, subsequently, be discharged back to ordinary care.
Even when patients are thought by their doctors to be terminally ill, trying to predict time of death is notoriously inaccurate. In one in 20 post-mortems, misdiagnosis of a terminal illness has been shown to result in inappropriate treatment. I am afraid that I see enough patients every year who are thought to be terminally ill and dying to know that it is not easy to establish. Even, four years ago, when my mother was in a hospice, I and the doctors looking after her thought that she was within days of her death, but we were proved wrong. She lived to see her two great-grandsons born and now says that she has a great quality of life. I never believed that I would have my mother now.
Assisted suicide does not guarantee a peaceful death. There are well documented cases from Oregon, Switzerland and Holland of patients waking up again, some in overwhelming distress, hours or days after taking their lethal prescription. Once immunity from prosecution is granted, there is no check whatever. As care becomes more burdensome and family funds dwindle, why not encourage a patient to travel? Such pressure could be brought to bear by a family free from any worry that they might face a severe penalty. The amendment is an invitation to those whose wish for their relative to be put out of their misery may be dubious. Indeed, relatives often feel that a patient should be dead before a patient is ready to die, yet this amendment naively assumes that relatives never stand to gain anything by a foreshortened life.
Remember the Court of Appeal's judgment last November in the Purdy case which stated:
"Cases of assisted suicide ... vary hugely in their criminality ... not all cases of assisted suicide represent the final act or acts of love or the culmination of a lifelong loving relationship".
Only too often, patients feel that they cannot or should not go on. Improved care and dealing with their concerns results in them subsequently saying that they are glad that they are alive and that they never believed that they could have such good quality of life.
Some months ago, a man referred to me was adamant that he would travel to Dignitas but he wanted better pain control for the journey. His wife fully supported his decision and I felt that it was inevitable that he would go. Tentatively, I asked whether he had any unrealised dreams. He said that he had always wanted to go on a cruise but that that was now clearly out of the question. I suggested that we controlled his pain and got him on the QE2, where he had the time of his life. Eventually, months later, he died at home after a winter trip to the beach and an overly large helping of fish and chips. He never went to Switzerland and his wife is clear that neither of them would have missed the last months for the world. How hard his care was for us all. It was not easy but it would have been easy to have simply processed his request.
People change their minds. The law as it stands dissuades relatives from readily taking people to commit suicide. It dissuades clinicians from going for the easy option which would be to acquiesce to such requests. Make no mistake, coercion is very subtle. This amendment is no simple tidying up of the law; it would provide immunity from prosecution, irrespective of the subsequent events around the death.
Finally, which "country or territory" is referred to in the amendment? It actually means Dignitas in Switzerland because it provides suicide for non-Swiss nationals. Oregon and the Netherlands certainly do not take non-nationals for suicide and Belgium and Luxembourg are extremely reluctant to because they do not want the label of "death tourism" which has applied to Switzerland. Despite the media hype, the Swiss suicides referred to represent fewer than one out of every 50,000 British deaths.
However, the articles in the British press, as well as highlighting those who have gone to Dignitas, have also importantly exposed just what has been going on at Dignitas. Ludwig Minelli, its founder manager, wrote to me and the letter is in the Library. He said that he felt that he should make sure that suicides were complete because of the healthcare costs of failed suicides. His nurse, Soraya Wernli, who was working for him when the Select Committee visited, has blown the whistle and gone to the Swiss authorities, having become so disturbed by what she has witnessed. The attorney-general of the canton of Zürich warned the Select Committee that there is no surveillance and no state control, yet this amendment encourages more British people to place their relatives in the hands of Mr Minelli.
The noble and learned Lord, Lord Falconer, said that at present there is nothing to stop people going off to Switzerland without any check on their mental or physical state. Therein he recognises that there are no adequate controls at Dignitas, yet he proposes that we facilitate people going there. In the past 10 years we have had 37,000 suicides in this country and 27,000 open verdicts. Suicides are tragic. Those were all people who felt that they would be better off dead. The amendment invites us to endorse the view that for some, the terminally ill, there should be assistance. Should we really be setting less value on the lives of those who are seriously ill than on those who feel that their lives, for whatever reason, hold for them no value and no future? The law sends a signal. This amendment will preferentially attract those whose motives are dubious in assisting the foreshortening of a relative's life through suicide because its so-called safeguards are illusory. I understand that this would be the only time someone would have immunity from potential prosecution in advance of an event.
No matter what you feel about assisted suicide or euthanasia, we have a duty to look very carefully at the words before us. The amendment provides far fewer safeguards than earlier assisted suicide Bills put forward by the noble Lord, Lord Joffe, and the House rejected those as unsafe. It should give the same response here.