My Lords, we must all be brief today. I want to do no more than indicate my support for the introduction of a very limited Bill to enable those with terminal illness to request help to die.
I have changed my mind over the past 20 years from being actively against such a measure to being a strong supporter. Indeed, my first letter to the British Medical Journal in 1984, on taking up my chair at Guys, was on this very topic. It would have done credit to the noble Baroness, Lady Finlay; she would have been proud of me. But over the past 20 years, I am afraid, my patients and their families have changed my mind and it has now become a moral issue for me that we should respect the diversity of patients' wishes in the last days of life, just as, as doctors, we are beholden professionally to respect their wishes at other times.
We have said with some force that we do not always respect an individual's autonomy of action where a decision may impact adversely on others. Certainly we all know that a patient's suicide during a depressive illness can have a profound and widespread distressing impact on other family members, even to the next generation. In practice, however, patients with terminal illness are in a very different position and relatives are almost always sympathetic to the wishes of their suffering loved one, even when they do not agree with the course of action they wish.
How do I know this? I worked as a gerontologist and psychiatrist in hospital and community services for most of my working life. In hospital practice we have a category called "no psychiatric disorder". This includes those referred by another hospital consultant with a request to "query depressed suicidal thoughts"; patients near the end of long and wearying illnesses who think the time has come to go and feel trapped inside the business of being and yet no longer have the physical means to end it. Of course, if they do, they make their own decision.
As has already been said, these people are quite distinctive personalities and often not very easy patients. They hate above all the prospect of total dependence on others, detest losing control and are unwilling to sacrifice their individuality to institutional norms. They want to be in charge of their fate and it is the uncertainty about the end that is distressing to an unbearable degree. It is scarcely ever a matter of pain control, although, as we know, there is insufficient expertise in the palliation of pain and the expansion of palliative care services to the very old and those with longer term terminal conditions is long overdue. No, it is not that. What causes their unbearable suffering is remediable not by medicine or psychological supports but by respecting their wishes and supporting them to choose their own time of death. I can think of no greater privilege, as a doctor, than being trusted to help make happen a person's final wish.
I remind noble Lords that this limited Bill proposes that a prescription be given and that the person concerned makes the final decision. Most people will be sufficiently helped to feel in control if they just have it available and can think about it. From what we have heard, only a third or so of such people would ever take it. Of course, there are many others. As a psycho-geriatrician, the majority of people I see have treatable, reversible depressions during terminal illness. Others go through periods of hopelessness after diagnosis or after a particularly gruelling course of treatment and come out of it again. You have to sort out one from the other. That requires strict safeguards, but I believe it is possible to make these distinctions, which I hope to address at greater length in some future debate.
For the moment, I should like to praise the quality of the committee's work, which I found enormously helpful in setting the international scene. Of course those who take the religious view that only God can decide when life begins and ends must always reject the notion of assisted dying. I understand that. But for me and for many others, particularly in those parts of the medical profession that are changing their mind, human suffering demands a human response.