My Lords, I, too, add my congratulations to the noble and learned Lord, Lord Mackay, for his balanced report. I intend to place on record why I am deeply unhappy with the Bill that the noble Lord, Lord Joffe, intends to present. Those reasons are such that I am unlikely to support any future Bill on this subject, because I envisage the negative fallout on the poor and on the black community in particular. Will this Bill be used later as a form of ethnic cleansing?
There is one certainty in life and that is death. It is final. There is no turning back. I urge the House to support the old-fashioned notion to let nature take its course. One of the most striking features of any assisted dying Bill is its lack of contact with the real world. It depicts people who are wholly rational, who have thought long and hard about ending their lives and who have access to good palliative care. But that is not the real world. Most people who receive a terminal prognosis are at a very irrational stage of their lives. Most have not thought about ending them at all. Why should they have done so? Many of them do not have access to the best palliative care and, above all, they are frightened and confused. It is all very well for any Bill to talk about referring people for psychiatric assessment if there appears to be a psychiatric disorder or offering them a palliative care assessment. But anyone who knows anything about the matter will tell you that in a multiracial society doctors often cannot spot depression and internalised pressures and that hearing about good palliative care is a world away from experiencing it.
There is another way in which the Bill falls short of reality. My attention was caught by a statement made to the committee by one of its witnesses—Professor Irene Higginson of King's College, London. Professor Higginson, who specialises in palliative care, told the committee:
"There are certain under-privileged communities which have lower access to palliative care services".
"Work that we have done in the south London area has shown a mixed experience in advanced cancer, for example, among the local black Caribbean community".
And reports showed, said Professor Higginson,
"a trend towards a greater number of unmet needs and also reports of less satisfactory care . . . compared to a local white UK-born population".
Is assisted dying the answer?
Noble Lords may ask what this has to do with euthanasia. The answer is simply this: the more disadvantaged that people are in accessing palliative care services, the greater the push for them to access assistance with suicide or euthanasia. Let us look at what the Select Committee was told when it visited Oregon to inquire into the working of the so-called Death with Dignity Act. The Oregon health department, which collected data on the numbers and characteristics of people who opt for medical assistance with suicide, told the committee:
"Asians are about three times more likely than whites", to take lethal drugs supplied by a doctor to help them out of their confusion.
I want to look at another aspect of this matter, and I am glad to see that the committee flagged this up clearly in its report. Society does everything possible—and rightly so—to prevent or frustrate suicides, yet here we are considering whether one group of people—the terminally ill—should be aided and abetted in killing themselves.
I have long been concerned about suicides among prisoners—especially among black prisoners—and about the watch that is kept on them to prevent tragic and ill considered actions. What kind of signal will it send to prisoners who are suffering—and many of them are, in the words of the Bill of the noble Lord, Lord Joffe, "suffering unbearably"—if we decide that such suffering is a key criterion for being helped to end one's life rather than being discouraged from doing so? Not only is there a complete inconsistency here, with society facing in opposite directions, but in my view there is a risk that over time this will translate, however subtly, into less rigorous oversight of suffering prisoners. It is no good to say that we are talking here only about the terminally ill; a Rubicon will have been crossed, and it would be less than realistic to expect there to be no impact on other situations of unbearable suffering.
Finally, what about nurses, of whom mention has already been made? The report says much about the problems of doctors but precious little about the effect on nurses. Community nurses see dying people all the time. They could not withdraw from participating in this law without withdrawing from the nursing profession. It is all very well to say that there will be a conscience clause but, in reality, many nurses will fear for their jobs if they are seen to be unco-operative, and the likelihood is that they will either find jobs other than nursing or take their skills abroad. The Royal College of Nursing pointed to the high proportion of trained nurses in the UK who come from cultures which are hostile to euthanasia, and predicted a haemorrhage of trained staff if a Bill like this were to become law. I ask the House: is this really what we want in the UK?