My Lords, I, too, express my appreciation for the manner in which my noble and learned friend Lord Mackay so skilfully led our very lengthy consideration of this highly difficult issue. His Scottish canniness in retaining his neutrality as chairman was quite remarkable, while his diplomacy and sensitivity have helped to produce a report which should ensure that the quality of debate, both inside and outside your Lordships' House, is greatly improved.
Death is not a pretty affair, and it was a most humbling experience, and a great privilege, to have been appointed to this Select Committee. I would like to say how impressed I was by the dignity and the compassion of the witnesses who came before us, both here and abroad.
My consideration of the Bill benefited greatly from travelling to Switzerland, the Netherlands and the state of Oregon in the USA. All those jurisdictions permit some form of assisted dying, and these visits enabled me to consider the concerns and proposed benefits of changing the law in the context of what happens in practice. While the models used in the first two countries seem to be working satisfactorily, the system used in Oregon impressed me the most, and I intend to concentrate on their experience.
The law emerged as a result of a people's initiative in 1994, and is similar to that set out in the Bill of the noble Lord, Lord Joffe, with the exception of not allowing voluntary euthanasia for those unable to ingest the medication. The legislation has been in force for seven years and the take-up is very low. Only 208 terminally ill adults have taken the medication, which equates to 0.13 per cent of all deaths in the state. But a significant number of patients who were provided with the medication did not take it, and died of natural causes. However, as the noble Baroness, Lady Jay, said, the fact that they had it available and accordingly remained in control removed an enormous load. It gave them comfort and allowed them to come to terms with their impending death. As the committee noted, if the Oregon experience were replicated in the UK, on a pro rata calculation it would result in around 650 deaths per year.
Perhaps the most interesting information that we gained in Oregon was from Ann Jackson, the director of the Oregon Hospice Association, who was the primary spokesperson for the hospice movement there. She confirmed that the Oregon legislation had not adversely affected the hospice movement. In fact, since legislation, the number of Oregonians dying under hospice care had continued to increase. In 2003, all patients who were assisted to die were offered hospice care. Of those, 89 per cent were actually in hospice care and the rest had left or refused it.
Many of the negative predictions about what would happen when the legislation was passed, such as that patients who used it would be more likely to be the poor, the uneducated, the uninsured or depressed, had turned out to be unjustified. Furthermore, there was no abuse of the system. The committee held 10 sessions in Oregon at which evidence was given. In nine out of the 10 sessions, it was agreed that the system was working effectively and that there was no evidence of abuse or a slippery slope. This was the view, among others, of the Oregon Medical Association, the Oregon Board of Examiners—which is responsible for controlling the conduct of doctors—the Oregon Nursing Association and Oregon's equivalent of the Department of Health, as well as a number of researchers.
In only one session, comprising three doctors, a politician and a nurse, was evidence given against the legislation. However, when challenged, these witnesses were unable to explain why they had not taken up their concerns with the relevant authorities. Since our visit, one of these witnesses, Dr Kenneth Stevens, has made a presentation to Members of your Lordships' House. Unfortunately, he made a number of statements which are totally inconsistent with the evidence we heard from all of the reputable organisations to which I have just referred.
I also asked the chief operating officer of the Oregon Medical Association whether there were any common characteristics among the doctors who opposed the Oregon Act. He replied, "Yes. Dr Toffler"—who was one of the witnesses—
"is perhaps the most devoted religious Catholic I have ever known and I think it is fair to say that his abhorrence of not only physician-assisted suicide but abortion is based on that".
This was not uncommon. Opposition to the Bill was often based on strongly held religious beliefs, but these were not always explicitly stated. Your Lordships may be asking why, if assisted suicide has existed in Oregon for seven years, other states have not adopted it. Here it is interesting to note that Oregon has one of the lowest levels of church attendance in the USA. This would appear to be a key determinant of why this type of legislation has yet to be introduced in other states.
I would like to make one suggestion. A majority of the committee members who travelled to Oregon, as well as a majority of committee members more generally, thought that the Oregon model was working well. As a result, should the noble Lord, Lord Joffe, decide to reintroduce his Bill, he may like to consider amending it to reflect the Oregon Act even more closely by dropping his voluntary euthanasia provision.
It is my belief that society will, in its own time, eventually push such a Bill forward until the clamour for action becomes too great for Parliament to resist. Thus it was with homosexual reform and abortion, both of which at that time became unstoppable. When and if this happens with assisted suicide, it is essential that this House gets the Bill right and, above all, that we ensure that the safeguards are sensible, secure and workable.
In closing, I quote, very briefly, from one letter among so many from a gentleman with motor neurone disease. It states:
"It would be a great comfort to me . . . to know that if I reach a point where, having lost my dignity and control of my physical faculties and I cannot endure my illness any longer, I would be able to ask my doctor for help to die. Society appears to agree that patients like me should be given this fundamental choice and our laws should reflect this".
I suggest that that time is now approaching.