My Lords, perhaps I too may say what a pleasure it was to serve on the committee chaired by the noble and learned Lord, Lord Mackay of Clashfern, who presided over our proceedings with such skill, charm and fairness.
I accept the present inclination of the noble Lord, Lord Joffe, to promote assisted suicide only, but I want to put the case for euthanasia, based on the evidence we heard in the Netherlands. The Dutch experience is often referred to and often misrepresented. Indeed, I am not entirely satisfied that the summary of it in our report gives an altogether balanced picture, because, in trying to be as fair as possible in representing both sides, it perhaps gives undue weight to critical witnesses who are part of a small minority and did not reflect general opinion.
In the Netherlands, euthanasia has overwhelming support among the public and the medical profession. Dutch experience shows that there is no conflict with palliative care; it has in no way undermined trust in doctors; there are fewer cases of involuntary euthanasia than in other countries; it has not led to a slippery slope; and there is not a shred of evidence of danger to vulnerable groups.
More than 90 per cent of the public and doctors in the Netherlands support the law. The official government study shows that 85 per cent of doctors believe that helping their patients to die improved the quality of their dying considerably. The noble Baroness, Lady Finlay, gave the example of one doctor who was vehemently opposed to the Dutch law. Of course there are doctors who are vehemently opposed to it, but it would be quite wrong to suggest that they were part of a majority opinion. There is no doubt of the overwhelming support of the Dutch medical profession for the law there as it stands.
On palliative care, the Dutch Ministry of Health and the Dutch Medical Association told us that, since the law came into force, interest in palliative care has grown and has led to a boom in the training of GPs and others. I refer to the passage in questions 1304 and 1396. The respondents saw no conflict. A Dutch palliative care consultant at a Catholic hospice told us that they were happy with the possibility of providing euthanasia in the hospice and added—Catholics and reverend Prelates please note:
"It does not create a conflict with our religious background".
On trust in doctors, in 2002 a BMJ survey of 11 European countries, including Britain, showed that trust in doctors is highest in the Netherlands. There is much more open discussion there of end-of-life decisions with patients and families—far more than in any other European country. The actual experience of the law in the Netherlands in no way upholds the contention that a change in the law would undermine the relationship between patient and doctor.
It is often mentioned that there are 1,000 cases in the Netherlands of active ending of life without explicit request, amounting to 0.7 per cent of all deaths. However, the available evidence suggests that involuntary euthanasia occurs much more frequently in countries without legislation. Professor van der Wal, the person who led the official study into the practice of euthanasia, told us that in the Netherlands there is no association between enacting the law and the number of cases of involuntary euthanasia; see question 1683. Indeed, his research showed that these were examples of alleviation of symptoms rather than deliberate ending of life—all of them cases of people who were incompetent and suffering severely. Doctors estimate that in 33 per cent of those cases, life was shortened by less than 24 hours, in 58 per cent by less than a week and in 6 per cent by less than six months.
Lastly, it is often alleged that changing the law leads to a slippery slope and endangers vulnerable groups. The Dutch evidence explodes those myths. There has been no significant increase in the number of cases since the law was passed. One of the witnesses, a hospice director who opposes the law, agreed that there was no evidence of growing laxity in the use of the rules. Here, he said, there is no slippery slope; see question 1510. Of course, it is somehow alleged that the Netherlands does provide evidence of that, because there are now demands for a change in the law, but that is not what is normally meant by a slippery slope. There are always demands for a change in the law—some for making the law more restrictive and some for making it more relaxed. But that is not the same as the question about whether there is a laxity in the use of the rules. That is what is normally meant by a slippery slope. One witness, who conducted the official study, told us that there was no evidence that disabled groups were affected more than others. Indeed, most euthanasia cases in the Netherlands do not involve the very old but relatively younger people; see questions 1664 and 1666.
To sum up, the evidence shows that in the Netherlands the law works well. It provides far more dignity in dying than we allow, and shows far greater humanity than we do towards those who experience unbearable suffering at the end of their lives. Unless one is obsessed with theological principle, that is surely what matters. When it comes to what we allow some people to suffer when they die—well, you would not do it to an animal.