My Lords, like many noble Lords I took part in the last debate we had on this subject in June 2003. I strongly supported the establishment of the Select Committee although I did not support the Bill. Despite personal experience as a carer, I have tried as dispassionately as I can to test the arguments that I used in that debate against the Bill against the evidence which has been given to the committee.
In our last debate one of my key arguments was that assisted suicide or voluntary euthanasia would crucially alter the duties of and trust in the medical profession. The overseas evidence from Oregon and the Netherlands taken by the committee is therefore I believe absolutely crucial in this debate.
As regards the Netherlands, Dr Johan Legemaate, legal counsel of the Royal Dutch Medical Association, KNMG stated that,
"without a sufficient level of trust, we would never have had the development we have had over the past 30 years."
Yet other Dutch health professionals claimed quite the opposite. Dr van den Muijsenbergh, a Dutch GP, told the committee:
"At the level of the patient doctor relationship I see a growing anxiety among terminally ill patients, as well as, other patients, that they think it is not decent not to ask for euthanasia sometimes, because they feel that they are such a burden to their families or to their carers".
She also talked of the pressures faced by her GP colleagues. Evidence from Oregon from Doctors Hamilton and Toffler was similar in content.
I therefore still have strong concerns that the traditional role of and necessary trust in doctors would be eroded by the Bill. Then, as many of your Lordships said, we come to the relationship with the availability of palliative care. The crucial argument made by overseas witnesses is that there is a case for assisting dying even where excellent and widespread palliative care is available. But it is far from clear that in the Netherlands or Oregon there is actually good palliative care.
In the Netherlands, Dr van Coevorden, a GP and part-time consultant in palliative care, does, I grant, describe an enormous boom in palliative care training and in hospice care. He considers that that has been stimulated by the law on euthanasia and that such provision is now at a high level. But the fact is that other witnesses had a completely contrary view. It appears that the boom in training courses in palliative care was the result not of the legislation but of the prior debate about voluntary euthanasia. The funding for research and training is now in fact diminishing. As we heard from the noble Baroness, Lady Finlay, there are no full-time palliative care posts in the Netherlands at all. Dr van Coevorden himself admitted that if you give proper care, you will see requests for euthanasia fall. Some of those giving evidence alleged that Oregon also has extensive palliative and hospice care and that it has grown substantially, but other evidence, such as that from Professor Katherine Foley of the Sloane-Kettering in New York, completely contradicts that.
So the suspicion remains that palliative care has not been fully developed in either Oregon or the Netherlands. However, as we have heard in the debate today, massive strides in palliative care have been made in this country during the past five years. Even the past year has seen major advances. Surveys show that palliative care doctors themselves are overwhelmingly opposed to the proposals. Should we not, as many noble Lords have said tonight, be concentrating on ensuring that patients have the best palliative care and developing adequate resources in the NHS and in our hospices? As palliative care doctors can testify, all patients have moments of despair, even the most positive, as I can testify from experience.
However, in the words of one US doctor who gave evidence to the committee:
"Patients can be given a sense of control without being handed a deadly weapon".
The burden of proof is on the supporters of the Bill and, after consideration of the evidence taken by the Select Committee, I do not believe that the right to get professional assistance in handling one's own death has been made out. I do not support going forward with the Bill.