My Lords, I too pay tribute to the skill of the noble and learned Lord, Lord Mackay of Clashfern, whose wisdom and good humour have proved to be essential. In summing up from these Benches, I should say that the leader of our party, Michael Howard, is strongly opposed to the Bill, but of course there will be a free vote.
I have enjoyed the debate. As usual, I have learnt a great deal from your Lordships, and, as always, I appreciated the noble Lord, Lord Maginnis, putting things in perspective, especially at the very beginning and at the end of life. We doctors can be carried away with enthusiasm, like the paediatrician who said in a lecture, "The first few minutes of life are the most dangerous". An old man from the back shouted out, "The last few minutes are pretty dangerous, too".
My noble friend Lady Flather has invited me to mention my experiences in Holland to reinforce what the noble and right reverend Lord, Lord Habgood, said. I asked a Dutch doctor what it was like doing his first case of euthanasia. "Oh," he said, "we agonised all day. It was terrible". However, he said the second case was much easier, and the third—I quote—"was a piece of cake". That left us feeling cold.
When the noble Lord, Lord Joffe, introduced his Bill, he said that he recognised that it should not place vulnerable members of society at risk, nor compel doctors or other members of medical teams to participate in processes to which they have a conscientious objection. My fear is that the Bill will fail in both those respects. A Bill legalising euthanasia or assisted suicide would be a radical change in our law. The so-called safeguards are anything but safe. They are rather like banisters along the side of a high staircase that look fairly sturdy from a distance but give way when they are leant upon for support. As my noble friend Lady O'Cathain said, the risk of undiagnosed depression is very real and depression is common among the terminally ill. The risk of misdiagnosing terminal illness is also real. The Royal College of Pathologists told the committee that that sort of misdiagnosis occurred in about 5 per cent of cases. Yet, if a depressive illness goes untreated or a non-terminal illness is wrongly diagnosed, no one will ever know or be able to do anything about it, for the simple reason that the patient will be dead.
The Bill does not even require the physician who certifies that the patient complies with the safeguards to have any previous knowledge of the patient, nor does the Bill allow or require the physician to consult others who know the patient, such as his or her family. Then there is the danger that what appears to be a voluntary request to die is no such thing. If the Bill is passed, it will start a process over which we have no control and from which there will be no turning back. It is likely to cause a subtle change whereby it is expected of the elderly and vulnerable that they should opt for assisted death. The elderly and vulnerable should never have to justify their continued existence to others, nor should they have to justify their continued existence to themselves. How voluntary is a request that is made against a background of expectation created by the Bill, an expectation that the vulnerable will chose death over life?
The present law is not perfect, but it makes a clear distinction between the removal of treatment allowing nature to take its course on the one hand and the active commission of death on the other. The Bill removes the clear line and in its place introduces fuzzy lines that are arbitrary. As the noble Lord, Lord Phillips of Sudbury, asked, how does one objectively assess unbearable suffering? If it is a reason to end the life of people who are expected to die shortly, how long will it be before it is argued that it should be applied to others whose suffering can be expected to last longer? The new lines drawn by the Bill are liable to shift, as the noble Lord, Lord Turnberg, said.
The law as it stands does not allow the patient to demand medical treatment that his doctor does not regard as medically indicated, but the Bill creates two exceptions to that rule. Assistance with suicide and the lethal injection will become treatment options that the patient can demand and the doctor cannot refuse, provided that the checklist of so-called safeguards can be ticked.
It is no comfort to point to the conscience clause. At best, it will be divisive and, at worst, it will be ineffective in protecting would-be physicians who will probably opt out of geriatric care, just as those who rely on a similar clause in the Abortion Act have opted out of gynaecology. The noble Lord, Lord Neill of Bladen, speculated about the questions that would be asked of somebody applying for a job. How right he is; that is exactly what happened over the Abortion Act. The question that was asked of would-be obstetricians and gynaecologists by interviewing committees was whether the candidates would be prepared to take their share of abortions. If they said "Yes", they were considered for the appointment; but if they said, "Yes, I will act within the law", they would be excluded. Hundreds of midwives and obstetricians had to emigrate because they were discriminated against in that way.
Engineers are trained to design potentially lethal machines to fail to safety. For example, a thermostat that monitors the temperature on a heated oil tanker will be designed so that should it fail the heating element turns off, thus avoiding the possibility of overheating and explosion. The law as it stands now fails to safety. It errs on the side of prolonging life and protecting the vulnerable. For all its intended safeguards, the Bill will not fail to safety. The present law errs on the side of life; this Bill will err on the side of death.
Today the noble Lord, Lord Joffe, indicated that he proposed a new Bill that will relate to assisted suicide but not euthanasia. I fear that that revision is mere expediency. Imagine the reality. If I, as a doctor, place a lethal pill in a patient's hand and he swallows it, that would be legal; but if I place the pill on the patient's tongue a few inches away, that would be murder. One cannot make laws on that basis. The two acts are morally equivalent.
There have been several mentions of the double effect. It is important to stress that that is generally misunderstood. The medical profession has been accused of hypocrisy, and it is alleged that we give patients, say, heroin to relieve their symptoms but really what we are doing is killing them. People who make such criticisms are ignorant of the elements of pharmacology. The dose required to relieve a symptom is a fraction of the dose required to kill, which, after all, is the definition of a good drug. It is called the therapeutic index. What Cecily Saunders did so brilliantly was that she realized that the answer to relieving symptoms was to keep a constant level of drugs in the blood so that the patient was kept free of pain but was able to enjoy life; whereas in the old days we waited until patients got pain and then gave them a slug of heroin, which put them out for a while. When they surfaced and got the pain again, they would have another injection. That intermittent regime had its problems. So there is no hypocrisy at all.
When a patient comes into a hospice, it takes about 24 hours to settle the various doses of drugs to deal with the anxiety, to deal with the pain, and to deal with the breathlessness. Once the dose, say, of heroin has been fixed, it stays at that dose largely until the patient dies. So the idea that doctors are killing patients in this way is certainly not true.
Finally, I am glad that the noble and right reverend Lord, Lord Carey, stressed that religious views should not be excluded from the euthanasia debate. I have never tried to impose my Christian views, but what I have done on debates on euthanasia and in articles that I have written is to quote a TV programme shown on the much maligned BBC. It was called "Five Steps to Tyranny", and it brought together all the scientific and historical evidence that led to the conclusion that,
"we are all capable of doing the most appalling things to other people".
That was not a religious programme; it was a secular programme. The law is a great dam holding back the wildest excesses of the wild men, but it also holds back the potential for evil inherent in mankind. However careful and thoughtful the noble Lord, Lord Joffe, has been, many regard his Bill as a crack in the dam that could put in danger the elderly, the vulnerable and the dying: the very people most in need of protection.