Assisted Dying for the Terminally Ill Bill: Select Committee Report

Part of the debate – in the House of Lords at 9:41 pm on 10th October 2005.

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Photo of Lord Guthrie of Craigiebank Lord Guthrie of Craigiebank Crossbench 9:41 pm, 10th October 2005

My Lords, I belonged for 44 years to one of the professions that see death at first hand more often than others. Like doctors, soldiers cannot afford to marginalise death as something that does not impinge on their life. I make that point because I know that that attitude exists in a large part of our society and because I am afraid that, if we are not careful, we might be tempted to focus on the more comfortable philosophical side of the subject and to neglect the hard realities.

Let us start with one of those hard realities: many people in this country die in pain or with other distressing symptoms of terminal illness. That is one argument advanced to legalise voluntary euthanasia, but we need, first, to ask why it is that, in this day and age when medicine has made such great strides, people are still dying in pain. The Select Committee answered the question. Its report records that Britain is a world leader in the science of effective palliative care. So why are people dying in pain? The answer has nothing to do with medical science. It is because too few doctors and nurses in the National Health Service have been given core training in the techniques of alleviating pain and other symptoms of terminal illness; because there is a large shortfall in the number of palliative care consultants; because hospitals other than those that are specialist do not have the resources to treat the dying effectively and sympathetically away from the bustle of mainstream general wards; and—last but by no means least—because we do not make supporting hospices and providing proper care for people to die at home enough of a national priority.

I do not envy the task of the resource allocators in the Department of Health. The essential problem that they face is that patients have ever-increasing expectations of curative treatments while the cost of such treatments rises rapidly. National health—like national defence, with which I have been closely associated—is an area where we could spend almost limitless sums of money to good effect. But the budgetary line must be drawn somewhere, and available resources must be allocated according to a system of priorities. Surely, therefore, with demographic changes taking place, that is an area of medicine that deserves a much higher priority. It is the failure of successive governments of all parties to do that that has fuelled the demands of the pro-euthanasia lobby and which, if we are not careful, will lead us into the error of killing the patient instead of the pain. Moreover, unlike expensive new treatments, such as cardiac surgery, palliative care is relatively low-cost. A substantial injection of funds into that branch of medicine would therefore benefit far more people than some of the projects that hit the headlines but actually benefit relatively small numbers of patients—what we used to call, when I was concerned with resource allocation in the Ministry of Defence, getting more bang for your buck. We should remember that we may all need palliative care at some point.

I now turn to another hard reality. We are told that the demand is for assisted suicide or voluntary euthanasia, so why should not those who want to do that be able to do it while those who do not want it can stay as they are? That notion—that all that you have to do is to draft a law and that is what will happen on the ground—is naive in the extreme. All laws are evaded or broken, and it is simply irresponsible to ignore the potential for abuse or elastic interpretation of what the law says. The Select Committee on Medical Ethics concluded unanimously 10 years ago that it was not possible to set secure limits on voluntary euthanasia and that,

"It would be next to impossible to ensure that all acts of euthanasia were truly voluntary, and that any liberalisation of the law was not abused".

The latest Select Committee's report is full of warnings about that: about the silent, and often internal, pressures on dying people to avoid being a burden on their children; about incremental creep in the law; about the margins of error in terminal prognosis; about the near impossibility of defining unbearable suffering or mental competence; and about what has happened in other countries that have legalised such acts.

In Holland, the Select Committee tells us, one in every 38 deaths is the result of either legal or illegal euthanasia. The Dutch sister of our Voluntary Euthanasia Society, known as the NVVE, has secured the legalisation of euthanasia. The chairman of the NVVE's medical committee told the committee that his organisation's next goal was legalising euthanasia for people with dementia. After achieving that, he said, the ultimate goal was legalisation of what is known in Holland as the "end-of-life pill". Today, we have heard people say that there is no such slippery slope, but how else could it be described? I understand that now the Dutch Parliament is about to have euthanasia of children—the so-called Gröningen protocol—laid before it.

Another Dutch pro-euthanasia witness put it another way:

"Euthanasia is not a medical problem at all"— he said—

"I personally feel that it is a normal medical procedure".

He continued:

"However, the patients need the doctors because we have to access the medication . . . Eventually maybe they can decide for themselves and have the possibility to do so without consulting a doctor".

Those are chilling words.

Although we are talking here of euthanasia to relieve the suffering of terminal illness, the Dutch experience seems to be moving towards death on demand. If we once embark on that road, the pressures to go further will grow. Although I respect the compassionate motives of those who advocate a change in the law, I look at the way that the campaigning organisations behave once they have a foot in the door. Did not the noble Lord, Lord Joffe, himself tell the committee that his recent Bill might be just "the first stage"?

My advice to your Lordships, therefore, is to think carefully before taking the leap in the dark that some Members of the House suggest. Remember that we know how to deal with the pain and distress of terminal illness. It is tragic that it is not available to all, through the misallocation of National Health Service resources. Be warned of what has happened elsewhere.