Thank you for giving me the opportunity to raise this important and sensitive issue in the House this evening, Mr. Deputy Speaker.
When I served as Health Secretary a few years ago, I became increasingly concerned about the plight of individuals who were seeking an assisted death and who desperately wanted the support of their families, friends and medical practitioners, but who could not-and cannot-get that help legally, here in their own country. I was also clear, however, that the issue was not one on which Ministers in general, or the Health Secretary in particular, should seek to initiate a change in the law. As the House will remember, I already had quite enough controversies to deal with when I was at the Department of Health. I decided instead to pursue the issue once I had returned to the Back Benches, which I am now doing as a patron of Dignity in Dying, an admirable organisation dedicated to ensuring that patients can make well-informed choices about the care and treatment that they receive at the end of their lives. If I am ever faced with the diagnosis of a terminal illness, I do not know what choice I would make for myself, but I do know that I want that choice.
I want to begin by warmly welcoming the publication of the Government's "End of life" strategy. In my constituency I have seen the wonderful work done over many years by staff and volunteers at our local hospice run by LOROS-the Leicestershire and Rutland Organisation for the Relief of Suffering-and, similarly, the work of the Leicestershire-based children's hospice, Rainbow. We all want palliative care of that quality to be available in every part of the country, not just within the NHS but funded by the NHS. The Government's strategy, if and when it is fully implemented, will do much to achieve that goal.
But palliative care, however good, is not the answer for everyone. Professor Baroness Finlay, to whose work in palliative care I readily pay tribute, is a staunch opponent of any change in the law on assisted dying, yet even she has testified that palliative care is not a blanket panacea. For patients who are terminally ill, whose distress cannot be alleviated by palliative care, and who want to end their lives, what is the choice? Given the present state of our law, there is no good answer.
For some people-more than 100 Britons since 2002-the answer lies in a visit to the Dignitas clinic in Switzerland. Some 700 of our fellow citizens are members of that organisation. For others, help might come from their doctor-sometimes, but not always, acting within the present law. Professor Clive Seale, who has researched this issue in great detail, found that around one in 500 deaths in the United Kingdom-more than 1,000 a year-were the result of voluntary euthanasia, involving a criminal act. Even more-over 1,500 deaths a year-involved non-voluntary euthanasia. Other desperate people find that they have to refuse food and water-a wretched process-in order to exercise some control over when and how they die. And each year, a number of terminally ill people-it is impossible to say how many-resort in desperation to violent, lonely and often botched suicides.
Dr. Harris-on this issue, I shall call him my hon. Friend-made the point in his excellent speech in the Westminster Hall debate last November that on the one hand, our society and the law recognise and fully respect the right of a mentally competent person to refuse life-saving treatment, and thus to die. He pointed out that that applies even in the case of a 13-year-old girl. On the other hand, however, we refuse to recognise the right of a mentally competent adult who is terminally ill to seek help to die when they want to. That debate in Westminster Hall was the first on this subject in the House in the past 10 years-and an excellent debate it as, too.
The House has a long and honourable tradition of debating and then changing the law on controversial issues that, very properly, belong to free votes rather than to party manifestos. The other place, to its credit, has held a number of serious and thoughtful debates in recent years, as well as conducting its own review of this issue. When the great majority of people say that they want a law to permit assisted dying, and when there is such an urgent need to re-establish the reputation of this House, we should have the courage to tackle controversial issues rather than run away from them. In the absence of parliamentary action, however, it has been left to individuals and the courts to force the pace of change.
Last year I was approached by a constituent-a woman with a severe progressive condition, from which she will never recover, who had already suffered years of distress. She wants to go to Switzerland to die, but she does not want to go alone. She asked whether I could help her by giving her, and above all her family, the reassurance that they would not be prosecuted if they accompanied her to Dignitas. At that point, I could not. I told her that no one had been prosecuted for many years, but that several people had been interviewed by the police, and not known for months whether they would be prosecuted or not.
That situation at least has now changed, because of one courageous and determined woman, Debbie Purdy, who wanted to know whether her husband would be prosecuted if he went with her to Dignitas. After years of legal battles, Miss Purdy finally won her case. In his judgment, Lord Brown said:
"What to my mind is needed is a custom-built policy statement indicating the various factors for and against prosecution...factors designed to distinguish between those situations in which, however tempted to assist, the prospective aider and abettor should refrain from doing so, and those situations in which he or she may fairly hope to be, if not commended, at the very least forgiven, rather than condemned, for giving assistance."
As a result of that decision, the Director of Public Prosecutions, Keir Starmer, issued new prosecuting guidelines last month. This final policy, unlike the interim guidelines, was broadly welcomed by supporters and opponents of a change in the law, which I believe is testament to a difficult job very well done.
At their heart, the new prosecuting guidelines distinguish between compassionate assistance given to someone who has reached
"a voluntary, clear, settled and informed decision to commit suicide", and malicious, irresponsible or organised help. But the new guidelines, although very welcome, are not the end of the matter. Indeed, the DPP, in his entirely proper determination to avoid usurping the role of Parliament by creating a new regulatory regime for assisted suicide, might well have created a fresh set of problems. For instance, the new guidelines make no reference at all to the victim having
"a terminal illness or a severe degenerative physical condition from which there was no possibility of recovery".
Those words appeared in the consultation draft, but they have been dropped from the final guidelines. I am not sure how widely it is appreciated that the guidelines go much further than the cases of terminal illness that Miss Purdy and Dignity in Dying, in particular, were seeking to deal with.
Furthermore, the new guidelines, unlike the consultation draft, make no reference to residency requirements, so we may find that some people living in jurisdictions that are significantly more hostile to assisted dying will in future travel to the UK to commit suicide with the help of friends or relatives, just as some Britons now travel to Switzerland to seek a legal, medically assisted death.
Most worryingly of all, the new guidelines create a greater risk of prosecution for members of the medical and other caring professions. Unlike the initial draft, they specifically state that prosecution is more likely if
"the suspect was acting in his or her capacity as a medical doctor, nurse, other healthcare professional or carer".
In the words of Professor Penney Lewis of the centre of medical law and ethics at King's College, London, the guidelines
"are designed to ensure that assistance in suicide remains an amateur activity carried out by inexperienced individuals without the assistance of professionals", thus increasing the risk, of course, of more desperate but botched suicide attempts.
The Medical Protection Society, which provides professional and legal support to around half of all UK doctors, tells me that in the last few years it has received a growing number of queries from doctors concerned about how to care for a dying patient. It has no policy position on the issue of assisted suicide, but it does want legal certainty for its members, and it fears that, under the new guidelines, a doctor might be risking prosecution-for instance, by providing the medical records and certificate of fitness to travel required for a visit to Dignitas.
No prosecuting guidelines, however sensitively and carefully drafted, can be a substitute for clarity in the law. Above all, they can deal with the situation only after someone has received help to die. They cannot provide any safeguards in advance-the safeguards that I, Dignity in Dying and most of the public believe are needed to protect vulnerable people from exploitation or unscrupulous pressure.
This issue is not going to go away. I am one of the baby boomer generation that has been responsible for initiating and creating so much social change. As this generation faces the end of our parents' lives and then begins to confront the end of our own lives, I believe that we will insist on change in this area, too.