My Lords, I am grateful to the noble and learned Lord, Lord Mackay of Clashfern, for introducing this debate. It has provided a chance for this House to continue the important debate on how people should be treated as they reach the end of their lives. I join other noble Lords in saying that the noble and learned Lord and the members of the Select Committee have done an excellent job in assimilating an impressive range of evidence in such a challenging area, and I will comment further on their report a little later.
In the available time, I cannot respond to all the individual points made. First of all, I want to acknowledge the strong and sometimes opposing views that we have heard today. These reflect the strength of feeling held on this issue within society and the Government are well aware of the differences of opinion and belief and the reasons behind them. I also want to acknowledge Parliament's role in considering issues of this nature. In our response to the Select Committee, the Government stated:
"It is appropriate that Parliament should lead on debates of this nature and provide the forum where all shades of opinion can be heard".
The wisdom of your Lordships has been, and will continue to be, particularly valuable in this respect.
As many noble Lords have said, we are not alone in having this debate. Other countries are considering similar issues. For example there were debates in California about a Death with Dignity Act earlier this year; a Private Member's Bill to legalise assisted suicide in Canada has been introduced recently; and, as has been mentioned, the Council of Europe has considered issues about assistance at the end of life in detail, although I understand that it rejected the idea of active euthanasia. I am aware that in Scotland there has been a consultation on a draft proposal for a Private Member's Bill to allow capable adults with a terminal illness to access the means to die with dignity.
As several noble Lords said, it is more than 10 years since the House of Lords Select Committee on Medical Ethics reported on euthanasia. It is pertinent to have the debate again and on a more specific aspect and in the light of experience elsewhere—for example in Oregon and the Netherlands, from which noble Lords draw differing conclusions. In 2003, this House debated the Patients' Protection Bill introduced by the noble Baroness, Lady Knight, and the earlier Bill of the noble Lord, Lord Joffe.
Last year, the House decided that a Select Committee should be established to consider the revised draft of the noble Lord's Bill and I feel that those who served on the Select Committee have demonstrated the wisdom of that decision. I want to commend the Select Committee on such comprehensive evidence gathering; on handling such a difficult issue with sensitivity and balance and on producing such a comprehensive report. Like other noble Lords, I congratulate the noble and learned Lord, Lord Mackay, on steering that process with such fairness and skill.
I well understand the persistence of the noble Lord, Lord Joffe, on this issue. There is no doubting his compassion and integrity, but it is clear that others are equally committed to opposing views. This Private Member's Bill raises profound and complex ethical questions and it is right that the Government take a neutral stance while we listen to the debate on the Select Committee's report. Neutrality continues to be our position.
I was especially interested to hear of the reality in places where this sort of legislation has been introduced—for example, on the differences between Oregon and the Netherlands. The report makes clear that there seems to be general agreement that there are a number of people,
"who might be regarded as serious about ending their lives, who are not psychiatrically ill and who are unlikely to be deflected from their purpose", and that that number is very small. Equally importantly, the report details the concerns of groups who fear that any legislation in this area could result in pressure on people who do not fall into this group to seek to end their lives. It also highlights the need for stringent safeguards in any future Bill. Many noble Lords have emphasised that point today.
I was also interested in the picture presented of public opinion—a very interesting contribution was made by the noble Lord, Lord Moser—and that of healthcare professionals. The report quotes a number of polls that show public support for the principle of assistance to die—for example, the various British Social Attitudes surveys showing rates of between 75 per cent and 82 per cent in favour. But it also gives a valuable health warning that such figures cannot be taken conclusively as the considered view of the UK public. Healthcare professionals' views are, of course, important, as many noble Lords have indicated, because they will have much more direct knowledge of the realities involved. It is interesting to note the report's point that,
"It seems likely that medical professionals view the issue of the legalisation of euthanasia as less straightforward than the lay public".
All of those aspects must be weighed carefully as we consider the way forward.
A feature of the debate has been the number of times that noble Lords have raised issues around palliative care and have paid tribute to the advances made in this country. Patients need good symptom control. The Government recognise the importance of providing effective and efficient palliative and specialist palliative care services. Thanks to people such as the noble Baroness, Lady Finlay, and I should add, the Government's support, we have made much progress in this field over recent years. I certainly pay tribute on this occasion to those working in this area and I accept that we need to do more. That is why we are investing an extra £50 million per annum in specialist palliative care services. This substantial increase in NHS funding for specialist palliative care—about 40 per cent more than 2000 levels—provides direct benefit to patients.
In 2003-04, more than half this extra money went to the voluntary sector, mainly to hospices to support their valuable existing work and to expand that work. Nationally, the additional £50 million has so far funded 38 new palliative medicine consultants, 143 new clinical nurse specialists and 38 new specialist palliative care beds, which is a pretty good start. Between 2001 and 2004, we invested in training about 10,000 nurses and other health professionals who were not specialist in the principles and practice of palliative care.
The relief of pain has been mentioned in this debate on many occasions. A recent National Audit Office survey showed that in 2004 five out of six cancer patients thought that hospital staff had done all they could at all times to relieve pain, while more than nine out of 10 felt they were given enough medication or other help to deal with pain after leaving hospital. In both cases, patients' experiences were a real improvement on the position reported in 2000. Clearly we would like those figures to be better, but I would suggest that great improvements are being made in that area as a result of hard work by NHS and voluntary sector staff.
Choice in palliative care and end-of-life care are key areas that we are working on. In our general election manifesto we said that we would increase the choice for patients with cancer and double the investment going into palliative care services, giving more people the choice to be treated at home. I have to say that I do not recall any other parties giving such a commitment. The details of delivering our commitment are being worked through in consultation with a wide range of opinion. I am sure that in this process we will look at the points concerning rural services made by the noble Lord, Lord Cavendish, and the kind of health inequality issues that my noble friend Lady Howells made. Our commitment will help us to improve end-of-life care for children as well as adults.
The views of the public, service users and staff on end-of-life care issues will be an essential element of the important consultation exercise we are currently engaged in: Your health, your care, your say. We want to hear what people have to say and we will take account of what they tell us in the way that we discharge our manifesto commitment on palliative care.
It is always worth bearing in mind that there is little point in consulting the public on end-of-life issues and then being unwilling to listen to what is said. We know that the public want more personalised healthcare and that this is likely to extend to end-of-life issues: how people can die with dignity and in their own way. The importance of patient choice and personal autonomy is a central theme throughout the work of the Department of Health and will continue to be such a theme, despite some of the considerations raised today. It is right that we, both individually and as a society, should ask ourselves how we feel about and respond to the issue of helping someone to end their life. The sad cases raised by a number of noble Lords where people request help with dying challenge deeply held moral beliefs about the value of life and the qualities themselves which make it valuable. As some have argued today, it challenges the very idea of the sanctity of human life. But in a diverse, multicultural and often secular society, which is the one we live in today and which rightly recognises the dignity of all citizens and their right to make autonomous choices, we have to consider those aspects as well.
However, patients increasingly have access to information about their healthcare and exercise their right to make decisions about the treatment choices available to them, including declining interventions where to them this seems appropriate. We know that the rights to individual liberty must be balanced in part against the freedoms and interests of other members of society, an aspect raised by a number of noble Lords. Thus perhaps the ultimate decision that a person can make, to control the time and manner of death, is not a purely personal one. This debate forces upon us the contested question about whether patients, by exercising that very autonomy, should have a right to ask for and receive help to die from doctors whose prime task, as has rightly been said, is to heal. Thus, it could be said that such requests could damage the fundamental trust between doctor and patient, although I would suggest that acting to relieve unbearable suffering for terminally ill patients could also represent a final act of care and respect. On the other hand, experience in other countries shows that some members of the medical profession are willing, on a voluntary basis, to assist people who have made a well informed and personally determined choice about dying with dignity at a time of their own choosing instead of continuing with a painful existence that they consider unbearable or intractable.
These are complex arguments that the Government feel they need to listen to and consider carefully from a position of neutrality. Our role as parliamentarians, among other things, is to gauge and reflect society's views in all their diversity. We are here to develop sound policies and laws that may need to move with the times if that is required for a particular issue, but we must not be afraid to maintain the status quo if, despite different viewpoints, that is what we judge to be fundamentally in the best interests of society as a whole. Above all, we have a duty to protect the vulnerable and to ensure that any measures for change we do promulgate bring benefit and not harm.
It was helpful that in introducing his revised Bill the noble Lord, Lord Joffe, set some clear parameters for the debate. For example, his Bill concerned itself with competent people only and those who are terminally ill. This helps to focus the debate more clearly. As the Select Committee report highlights, a number of issues arise around the use of terms and how they are defined. It is clear that robust safeguards will be vital in any Bill that is reintroduced. The committee has also made a useful distinction between assisted suicide, when a doctor provides the means to allow a patient to end his own life, and voluntary euthanasia, when the patient needs the physical help of a doctor to do so. For the purposes of legislative clarity, the two should be addressed separately. It also highlights the difficulty of dealing with the qualifying terms in legislation.
I imagine that those drafting any future Bill would want to reflect on the detailed consideration that the Select Committee has given these points and the points that have been raised in the debate.
I conclude by repeating my thanks to the Select Committee for the valuable piece of work it has carried out in producing this balanced and comprehensive report and to all noble Lords for the important and considered points made today. This is a profound issue that deserves careful scrutiny. The quality of argument and the intensity of the views expressed have done full justice today to the subject. I have little doubt that we will return to this subject as many in an ageing society think more about end-of-life issues and how they can leave this world in a manner that is dignified and reflects their personal values. The noble Lord, Lord Joffe, seems likely to ensure that we will do just that.
However, in response to the question about government time for a Bill, posed to me by my noble friend Lord Carter and others, I remind him and them that we have a busy Session in both Houses. Let me reassure the noble Lord, Lord Patten, that the Government have not signalled that time will be given for a future Bill and I am not doing so today. In this House allocation of time is a matter for the usual channels, thankfully, and not for me. I hope that I have achieved a suitable degree of inscrutability in my remarks, consistent with the Government's position of neutrality on this issue. On that note I conclude my remarks, despite attempts by several noble Lords opposite to get me to go further.