My Lords, there were of course, as we have heard, very strongly held views on both sides of the argument in our committee, on which I was privileged to sit. Yet the report which was produced sets out the issues far more clearly than I ever expected, or even hoped for. That, of course, is largely due to the masterly work of our chairman, the noble and learned Lord, Lord Mackay of Clashfern—a remarkable achievement.
I start by expressing enormous sympathy for the view that patients suffering unbearably from a terminal illness who ask to be relieved of their misery should be helped in whatever way is possible. I imagine that very few doctors are unmoved by the patient who says "Help me out of my misery".
My anxieties reside elsewhere, however: in how it might be possible to avoid the unintended consequences of a Bill which allowed us to help patients to commit suicide. Even in a largely secular society, where the views of the main orthodox faiths on the essential sanctity of life above all else may not hold sway, there remain major practical problems.
Much was made in the evidence before us of the need to preserve the patient's autonomy; that is, every patient's wishes should be acceded to wherever that is possible. Where a patient insists on being helped to die, they should be so assisted. However, a patient's autonomy cannot be absolute. We have to consider the downside of our acceding to that patient's autonomy where others may suffer. It cannot be absolute autonomy where others are involved. The benefits to the individual are rather clearer than the risks to others.
It is here that I worry about patients who may feel a sense of obligation or coercion to go along the route to assisted suicide. They may feel that they are an increasing burden upon their families and carers, or a drain on their resources, or a continuing cost to the National Health Service. As they sense they are going to die anyway, why not have themselves removed from this life? It is a sense of burden to others, rather than unbearable suffering, which encourages them along this route. That this is a realistic burden was emphasised to our committee by a group of disabled people who felt very vulnerable indeed. So a Bill designed to help one group of patients might open a door to harm others.
Then there is the whole set of problems about definition of words, such as "unbearable" suffering—incidentally, I am much more attracted to the alternatives of "intractable" or "unrelievable" suffering, which suggest that at least an effort has been made to relieve it—or the word "terminal". Can we say with any degree of certainty that someone will be dead within six months, as has been suggested in the Bill? Predictions of that type are very insecure. Why, indeed, do we not refer to three or 12 months? Why do we need to have any time limit at all if someone is suffering unbearably? The illogicality of restricting assisted suicide to the terminally ill will, I fear, soon send us down that route.
I ought to say a brief word about the position of doctors in all of this. It seems clear from surveys that many—probably most—doctors would be unwilling to take part in assisted suicide. This means that only a subset would be involved in prescribing the fatal doses. Patients would have to be referred to such doctors, who may find themselves specialising in this type of practice. It is quite unclear what elderly or vulnerable patients might feel about doctors who have in their therapeutic repertoire the possibility of helping them to die. Who knows what might happen to the doctor-patient relationship?
Finally, I want to say a word or two about experience that was gained abroad, in Holland, Oregon and Switzerland. Some members of the committee gained confidence from what we heard there. I, on the other hand, was not reassured at all. In Holland, as we have heard, about one in 40 of all deaths is apparently due to euthanasia or assisted suicide, while in Oregon it is only one in 700. I think Holland goes too far, as many have suggested. In Oregon there are a number of complicating factors, not least the medical insurance payment business; that is, payment for palliative or hospice care that is limited to six months, when a renewal of cover has to be negotiated. What sort of pressure might that exert on vulnerable patients and their families?
I have every sympathy with the need to alleviate suffering, and we should do everything we can. I fully understand the reasons for assisted suicide in principle, but my fear is that in framing a law that allows it to happen, we will be placing some patients in a difficult dilemma, and they could be harmed in a singularly irrevocable way.