Assisted Dying for the Terminally Ill Bill [HL]

– in the House of Lords at 7:57 pm on 10th March 2004.

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Photo of Lord Joffe Lord Joffe Crossbench 7:57 pm, 10th March 2004

My Lords, I beg to move that this Bill be now read a second time.

The Bill enables a competent adult, who is suffering unbearably as a result of a terminal illness, to receive medical help to die, at his own considered and persistent request.

The purpose of the Bill is to provide an option for terminal patients who are suffering unbearably to bring an end to their suffering at a time of their choosing, in a way which will not place vulnerable members of society at risk, nor compel doctors or other members of medical teams to participate in processes to which they have conscientious objections.

Although more limited in its scope, the Bill is substantially the same as the Patient (Assisted Dying) Bill which had its Second Reading on 6 June last year. There are, however, three significant changes to that Bill, made in response to concerns which had been expressed on Second Reading.

First, the Bill is now limited in its application to terminally ill patients. Secondly, in assisting the patient to die, the attending physician may only provide the patient with the means to end the patient's life unless the patient is physically unable to do so, in which event he can actively end the patient's life. Thirdly, an additional safeguard has been included, requiring a specialist in palliative care to attend the patient to discuss the option of palliative care.

As the House has authorised the setting up of a Select Committee to consider the Bill, the noble Lord, Lord Alton of Liverpool, and the noble Baroness, Lady Finlay of Llandaff, who led the opposition to the Patient (Assisted Dying) Bill last year, have consulted others who spoke against the Bill and have agreed that there is no purpose in taking up the time of the House on a lengthy Second Reading that would largely be a repetition of the lengthy debate of 6 June last year. They have accordingly decided not to oppose the Second Reading, on the clear understanding that the decision is made solely for the convenience of the House and is in no way to be considered as an endorsement of the Bill. I have further been given an undertaking by the Voluntary Euthanasia Society that it will not seek to present that decision in any way as a victory for the Bill, and, naturally, I have given a similar undertaking myself.

In view of those facts, I shall not detain the House any longer, and I commend the Bill to the House.

Moved, That the Bill be now read a second time.—(Lord Joffe.)

Photo of Lord Alton of Liverpool Lord Alton of Liverpool Crossbench 8:00 pm, 10th March 2004

My Lords, on a Friday last June, as the noble Lord, Lord Joffe, has just mentioned, many of us gathered in your Lordships' House for what must rank as one of the longest Second Reading debates in recent years, starting as it did at 11 a.m. and not finishing until just before 7 p.m. It was a memorable debate with many distinguished contributions. By a small margin, a majority of Peers spoke against the Patient (Assisted Dying) Bill, as it was then known, proposed by the noble Lord, Lord Joffe.

Although there are some modifications in the Bill before your Lordships' House tonight, the objections that I and others raised to the earlier Bill remain valid in relation to the Assisted Dying for the Terminally Ill Bill. My noble friends Lady Masham and Lady Knight of Collingtree have particularly asked me to associate them with the continuing objections to the proposals. The medical and ethical objections raised by the Select Committee on Medical Ethics, chaired by the noble Lord, Lord Walton of Detchant, who is present tonight, also remain valid, as does the opposition of those involved in palliative care, along with the British Medical Association and the Royal Colleges. Yesterday the BMA issued a powerful and cogent new statement, reiterating its strong opposition to this Bill.

However, I also recognise that on 14 January this year, your Lordships' House voted to approve the report of the Liaison Committee and, in particular, its recommendation that an ad hoc Select Committee upon my noble friend's Bill be appointed. Therefore, whether as a draft Bill or as one with a Second Reading, the Assisted Dying for the Terminally Ill Bill will in due course be the subject of a Select Committee of this House. Distasteful as my colleagues and I might find that, it is the reality that we face. Little would therefore be gained by reiterating the points made in the Second Reading debate last June. There may well come a time when we shall have to divide on this question, but that should obviously happen after the Select Committee has deliberated, not before.

The Select Committee at least gives us the opportunity to deal with this issue once and for all. I hope that its deliberations will clearly demonstrate that there is no consensus in support of legislative change and that, without such consensus, legalised euthanasia will not be sanctioned by the British Parliament.

In common with many Members of your Lordships' House, I remain resolutely opposed to euthanasia and physician assisted suicide and believe that the consequences of the Bill proposed by the noble Lord, Lord Joffe, would be disastrous for the terminally ill, for the elderly, for disabled people, for the medical profession and for wider society. I am confident that when your Lordships have received evidence from patients, from disability rights campaigners, from palliative care specialists and from those who have witnessed the disastrous effects of legalised euthanasia in the Netherlands and elsewhere, the House will vote resoundingly to reject the Bill.

In conclusion, this is an issue to be resolved not by parliamentary tactics but by rigorous argument and honest debate. Therefore, the brevity of tonight's proceedings should not be mistaken for a lack of determination to scrutinise thoroughly and to oppose this Bill.

Photo of The Bishop of Oxford The Bishop of Oxford Bishop 8:04 pm, 10th March 2004

My Lords, in the Second Reading of the Bill proposed by the noble Lord, Lord Joffe, on 6 June last year, I set out a range of reasons why I opposed the Bill. I believe that the reasons that I set out then are as valid for the revised Bill that comes before your Lordships now, but I shall not repeat those arguments because of the agreement made between the noble Lord, Lord Joffe, and the usual channels that we should be very brief indeed.

I understand that there is to be a Select Committee, and I am very glad to understand from the usual channels that they are very sympathetic to the idea of a bishop being a member of that Select Committee. When the matter comes before your Lordships' House, I hope that it will meet with your sympathy and agreement.

It is in some ways rather surprising that there should be a new Select Committee, given that there was a very thorough one in 1994. The noble Lord, Lord Joffe, set forth his reasons in a background note that appeared in Hansard in January. One reason that he set out there for changes that have happened since 1994 was that some of the noble Lords and noble Baronesses who were members of the original committee have in fact changed their minds. Those noble Baronesses included Lady Jay, Lady Warnock and Lady Flather. However, I hope that, when the Select Committee begins to meet, it will realise that there are members of that original committee who have not changed their minds. I see the noble Lord, Lord Walton, shaking his head in agreement. I have particularly in mind the noble and right reverend Lord, Lord Habgood, the then Archbishop of York, who made a very decisive contribution to that earlier Select Committee, who has not changed his mind. I hope that the Select Committee will not only ask for written evidence from people like that but will also call them for oral hearings.

Like the noble Lord, Lord Alton, I very much hope that groups that it is very easy to overlook, such as the Disability Rights Commission, will be called to give evidence. The commission believes that the Bill, however finely tuned—and respect must be paid to the noble Lord, Lord Joffe, for trying to get the Bill very precisely and finely tuned—seriously disadvantages disabled people. I hope, too, that the Select Committee will gather what evidence it can about the extent and quality of palliative care, which is clearly crucial to the whole issue. It is fortuitous that there is a House of Commons Health Committee inquiry into palliative care happening at the moment, to which the Church of England has contributed. That committee's findings should prove very useful to the Select Committee; it might want to make some recommendations about palliative care.

In the submission given by the noble Lord, Lord Joffe, in January, he rightly suggested that the medical profession needed to be consulted. So, too, do the Churches—and, I suggest, the other faith communities. When I had the privilege of chairing a committee of your Lordships' House on stem cell research, it was very good to get views from Muslims and Jews. In a way, I should have liked to hear from more Muslims and Jews, as we live in a multi-faith society. Their views will be very crucial indeed.

As far as concerns the Roman Catholic and Anglican Churches, the small group of Anglican and Roman Catholic bishops that put in a joint contribution to the original committee said:

"Neither of our churches insists that a dying or seriously ill person should be kept alive by all possible means for as long as possible. On the other hand, we do not believe the right to personal autonomy is absolute".

That is the final point that I would like the Select Committee to address. It includes some fundamental questions about what it is to be a human being. It might be suggested that human beings cannot simply be defined by their autonomy, by their capacity to make free, unfettered choices. We are born dependent on others and we die dependent on others. Our dependence is just as much a characteristic of what it is to be a person as our capacity to make free choices. I very much hope that the Select Committee will not just consider the evidence of what is happening in Oregon or the Netherlands, but will address fundamental questions of what it is to be a person.

Finally, the Orkney poet, Edwin Muir, wrote a very moving poem called One Foot in Eden, contrasting life in paradise with life in the world as we know it. He ended that poem by saying:

"Blossoms of grief and charity

Bloom in these darkened fields alone. . . . Strange blessings never in paradise Fall from these beclouded skies". For me, that poem has always hinted at and pointed to some fundamental truths about what it is to be a human being, particularly when the clouds are particularly dark or beclouded.

Photo of Lord Maginnis of Drumglass Lord Maginnis of Drumglass Crossbench 8:10 pm, 10th March 2004

My Lords, when the predecessor of this Bill, the Patient (Assisted Dying) Bill, was debated in your Lordships House on 6 June last year, I had the opportunity to set out clearly what was my attitude. In my considered judgment it reflected the attitude of a large majority of my community. I refer your Lordships to cols. 1644 to 1646 of the Official Report. Hence, it is not my intention to reiterate each of those arguments but simply to indicate that I am equally opposed to this new Assisted Dying for the Terminally Ill Bill.

I will, however, make a few brief points at this stage. It has become the accepted reality in the United Kingdom that state executions of murderers, rather than deterring them, brutalise society. For that reason, and also for religious reasons, I voted for the abolition of the death penalty, as did a large majority of our legislators. I do not think that I need to ask your Lordships how can we, as a society, reconcile that position with one where, only yesterday, the British Medical Association posed the case that:

"If assisted suicide were to be an available option, there would inevitably be pressure for all seriously ill people to consider it even if they would not otherwise entertain such an idea;

"Health professionals explaining all options for the management of terminal illness would have to include mention of assisted suicide. Patients might choose it for the wrong reasons. They might feel obliged to choose that option if they feel themselves to be burdensome to others or concerned, for example, about financial implications for their families of a long terminal illness".

My second point, also based on the British Medical Association opinion, is to ask whether the state has the right to legislate to alter the fundamental ethos of the medical profession. The BMA says:

"Legalised assisted suicide would affect patients' ability to trust their doctors and to trust medical advice;

"In particular, it could undermine the trust that vulnerable, elderly, disabled or very ill patients have in the health care system".

I wonder which doctor would be more trusted, one who had opted in to facilitating assisted dying or one who had opted out?

The BMA recognises what it calls the matter of enabling individuals,

"to achieve their personal goals", but concludes:

"We believe that in the case of euthanasia and assisted suicide, benefit for an individual in terms of having their wishes respected, is only achievable at too high a cost in terms of potential harm to society at large".

Finally, I draw attention to the BMA's scepticism regarding the proposition in this Bill that there needs to be legal provision for pain relief. The BMA states that that assumption is inaccurate and,

"plays on unjustified public fears about the possibility of intolerable or unrelieved pain at the end of life. In fact the law and ethical position is already clear on the rights of patients to receive the most effective pain relief available".

I believe that that aspect of the Bill is cynical and tilts at windmills. It seeks unnecessarily and unjustifiably to play on the emotion of the most vulnerable—the elderly and the sick and dying. That must be resisted. That is both my experience and my conviction. That is why I oppose the Bill and why I hope the Select Committee will concur not only with my opinion but with that of the British Medical Association and the Royal Colleges.

Photo of Baroness Finlay of Llandaff Baroness Finlay of Llandaff Crossbench 8:15 pm, 10th March 2004

My Lords, I do not wish to detain the House any longer than is necessary to confirm that there is little to be gained by reiterating the points made in the Second Reading debate, on 6 June 2003, on the Patient (Assisted Dying) Bill which was promoted by the noble Lord, Lord Joffe.

The Bill before us is changed in detail from that previously debated, but the principles remain unchanged. However, in the light of the House's decision to establish a Select Committee of inquiry after this Bill's Second Reading, that process of in-depth inquiry is to be supported. I am grateful to the noble Lord, Lord Joffe, for his letter stating, as he has reiterated today, that the action of the opponents of the Bill in agreeing to no debate and no vote must not in any way be interpreted as representing a victory or endorsement of the Bill.

The points of objection made in the debate on 6 June 2003 remain, in my view, valid in relation to the Bill before us. The Select Committee will, I hope, be adequately resourced to undertake this very serious and very important inquiry.

Photo of The Duke of Montrose The Duke of Montrose Conservative 8:16 pm, 10th March 2004

My Lords, I apologise for speaking in the gap, but something was brought to my attention this afternoon that I should like to bring before your Lordships' House. I must also apologise for not having paid attention to the earlier Patient (Assisted Dying) Bill, to which the same question might have applied.

The Scotland Act 1998 devolves all powers to the Scottish Parliament other than those that were reserved under Schedule 5. Schedule 5, Part II contains specific reservations under Head J, which deals with "Health and Medicines". Dying is not mentioned. Therefore, I presume that legislation concerning dying is devolved to the Scottish Parliament.

There is a convention, as I understand it, that this Parliament does not consider devolved matters unless it has received notice that the Scottish Parliament has considered the matter and passed a Sewel Motion. May I ask the noble Lord, Lord Joffe, what steps he has taken to secure a Sewel Motion? If it has not been possible, what steps does he plan to take—or is this convention such that the consideration of this Bill should be held up until such a Motion is forthcoming?

Photo of Lord Roper Lord Roper Chief Whip 8:18 pm, 10th March 2004

My Lords, on these Benches, as I believe in most other parts of the House, there are a variety of views on the substance of the Bill. I am fortunate, therefore, that I do not have to try to go through all of them this evening. However, having had personal experience in the past 12 months of the remarkable quality of palliative care provided in this country and particularly within hospices, I should say that I recognise what is being done and I think that the contributions made by those involved are particularly important.

This evening we are faced with the decision that was, as has been said, taken in the House on 14 January. There is a clear view from these Benches that the decision of the House to set up a Select Committee to evaluate the issues underlying the Bill is the correct one. I hope that the Select Committee will also be able to consider the issue of whether the provisions of the Scotland Act require that the Scottish Parliament pass a Sewel Motion before the Bill can be considered at later stages.

It is, of course, inappropriate for anyone who participates in the activities of the usual channels to divulge on the Floor of the House anything that might occur. However, in view of the views stated by the right reverend Prelate the Bishop of Oxford, I think that there is a reasonable chance that, next Wednesday, when the Committee of Selection comes to consider the composition of the Select Committee, provision will be made for the inclusion of one of his right reverend colleagues.

For those reasons, we on these Benches this evening—unlike the situation on Monday evening—will be able to support a Motion for the reference of the Bill to a Select Committee after Second Reading.

Photo of Lord McColl of Dulwich Lord McColl of Dulwich Conservative 8:19 pm, 10th March 2004

My Lords, I should simply like to say that I entirely agree with the views set out by the noble Lords, Lord Alton of Liverpool and Lord Maginnis of Drumglass. As a practising doctor, I should like to emphasise that I do not need any new legislation to enable me to relieve the pain of my patients who are suffering. I have been doing it without that for many years, and I hope that I shall do so for many more years to come.

Photo of Lord Warner Lord Warner Parliamentary Under-Secretary, Department of Health, Parliamentary Under-Secretary (Department of Health) 8:20 pm, 10th March 2004

My Lords, I am grateful to the noble Lord, Lord Joffe, for his explanation of the Bill before us today. It contains some significant differences compared with the previous Bill, which was debated in this House on 6 June last year. That debate was of the highest standard and reflected differing and strongly held views. I am sure that noble Lords are grateful to the noble Lord, Lord Joffe, for reflecting on many of the concerns expressed earlier in his changes to the Bill.

The noble Lord, Lord Joffe, will understand, as I do, the strength of feeling held on this issue; the differences of opinion and belief, and where those differences derive from. The public debate on this, both here and in other countries, reveals the many strands of human belief about how we as human beings should handle the end of life. This House has made a distinguished contribution to these very human debates: in 1994 the House of Lords Select Committee on Medical Ethics reported and, more recently in 2003, the House of Lords debated the Patients' Protection Bill of the noble Baroness, Lady Knight, and the previous version of the Bill now before us.

As a Private Member's Bill that involves issues of conscience, the Government's stance is one of neutrality. We listen carefully to the debates and offer advice on what we see as key issues and implications in the context of our present laws. I refer your Lordships to the previous debate in June, when my noble friend Lady Andrews spoke for the Government. Of course, Members of the Government have personal views, but I stand by the comments made by my noble friend following that debate where all shades of opinion were expressed. The Government have no plans to change the current laws on euthanasia and assisted suicide, but welcome and listen closely to the debate.

The Government recognise the complexity of the issues involved and the polarity of views held. Decisions about the end of life are all about our personal values, views and circumstances and provoke strongly held and diverse opinions. I know that some noble Lords are disappointed that we shall not have a substantive debate tonight. However, the gravity of the issues have led to agreement that a Select Committee should be established to consider the Bill. A thorough and balanced consideration of the full range of issues in a Select Committee could therefore be a sensible way forward in informing policy in this area. It might be considered timely given that a decade has elapsed since the previous Select Committee.

The Government will, of course, co-operate fully with the Select Committee and will consider its findings carefully in due course. We look forward to revisiting the issues again, taking into account the position of our colleagues in the devolved administrations.

Photo of Lord Joffe Lord Joffe Crossbench 8:23 pm, 10th March 2004

My Lords, I express my appreciation to all noble Lords, and in particular to my noble friends Lord Alton and Lady Finlay, for so readily co-operating in order to ensure that this Second Reading should not unnecessarily use up the valuable time of the House.

A number of points have been made with which I profoundly disagree. However, in the spirit of the agreement to which I referred in my opening speech, I shall not respond to them but rather leave them to be considered by the Select Committee.

However, I refer to the specific question asked by the noble Duke, the Duke of Montrose. I must admit to some surprise at the point not having been raised at any time before with me or the House. I gave some consideration to it, and was advised that it would not be a bar. I should mention that, at the same time, a decision was taken that the Bill as it stands specifically excludes reference to Northern Ireland. I am sure that that would interest the noble Lord, Lord Maginnis.

I will, however, look further into the matter that the noble Duke raised, but the point will of course be considered by the Select Committee. If necessary, I am sure that that committee will form a view on it; certainly I do not at this stage see it being any bar to the decision of the House to set up a Select Committee.

On Question, Bill read a second time, and committed to a Select Committee.

House adjourned at twenty-five minutes past eight o'clock.