My Lords, I, too, thank the noble and learned Lord, Lord Mackay of Clashfern, for his outstanding chairmanship of the committee. It was a privilege and a pleasure to be a member of a committee chaired by him and an added pleasure to witness his incisive questioning of the witnesses. All the credit for what turned out to be a balanced report, despite the polarised views held by the members of the committee, goes to him, for it was not easy to get a consensus report. The noble and learned Lord achieved that, and I thank him for all his efforts.
As noble Lords are aware, I am a doctor, but I have witnessed thousands more first breaths of life than I have last breaths of life. My experience of dealing with patients at end of life is limited, and I draw my conclusions from evidence as presented to the committee—unbiased.
During the months of the committee's deliberations, we heard from many doctors, as representatives of professional organisations and as individuals, generalists and specialists. Subsequent to the publication of the report, I also wrote to the presidents of all the Royal Colleges and faculties in the United Kingdom to seek their views on the report.
Assisted dying is an issue that increasingly divides the profession, and the views of the professional organisations seem to change. The British Medical Association opposed any change in the law when its representatives gave evidence to the committee, but more recently it has changed its mind and now holds a neutral position, feeling that it is for society and Parliament to decide, as do many of the Royal Colleges, including the Royal College of Physicians of England, the Royal College of Surgeons, London, and the Royal College of Psychiatrists, to name but a few. On the other hand, the Royal College of General Practitioners now opposes any change in the law, in contrast to the view expressed by its representatives when they gave evidence to the committee.
The greatest opposition comes from some of the doctors more closely involved with the care of patients near the end of life. We do not have the results of surveys carried out involving all the doctors in the United Kingdom to be able to know the views of individual doctors, particularly on clearly defined legislation. All we can say for now is that the views of the profession on assisted dying are divided. Although the medical profession is divided on the issue, there is wide consensus that any change in the law must be accompanied by wider availability of good quality palliative care, strong safeguards in the legislation for patients, training and support for health professionals, a robust monitoring of the law and clear conscientious objection clauses, all of which I would strongly support.
I agree with the view expressed in the report that at the end of the day the acceptability or otherwise of a change in the law on assisted dying is a matter for society as a whole to decide and not for any groups of health professionals. I do not, however, believe that the implementation of any change in the law could be placed outside the current system of mainstream healthcare. I say that because of the strong doctor/patient relationship that exists in our healthcare.
In a previous debate on the original Bill introduced by the noble Lord, Lord Joffe, I said that I could not see myself supporting any change in the law, although I recognised that the medical view was divided. My main concern then was how any change in the law would affect vulnerable groups such as the elderly, the disabled and others. During the deliberations of the committee, we heard from many individuals and organisations representing so-called vulnerable groups, and again their views were divided.
Although I was not there to listen to the evidence, I refer to the views expressed in the light of their experience by Professor Raymond Tallis, a respected geriatrician and an ethicist, who gave evidence to the committee on two occasions; Dr David Cole, a clinical oncologist; and Dr Carole Dacombe, a medical director of St Peter's Hospice, an organisation providing hospice care to a wide community. They gave evidence to the committee regarding a small number of individuals for whom legislation related to assisted dying would be appropriate.
Dr Carol Dacombe described her experience,
"of consistently and persistently encountering a small number of patients who despite the whole range of services available to them . . . have felt a need to express a wish to see their life ended".
As she said, they are often people who have a long life history of seeking control over their own destiny and who do not find help and support—as most of us do—in faiths and spiritual concepts. They feel their suffering through illness to be unbearable and wish it to be ended.
All the evidence presented to us, including that from the state of Oregon, suggests that the number of individuals seeking such a course will be quite small. The evidence presented to the committee suggests support for a Bill limited in scope, much in line with death with dignity legislation—which would be a much better title than the one used in the Bill proposed by the noble Lord, Lord Joffe. It suggests support for a Bill as enacted in Oregon, with all the safeguards for individuals and robust monitoring of the law in place, allowing patients to take charge and decide for themselves. Such a Bill would have wider society and health professional support. At least it would allow for a debate that is more focused and confined to a tighter Bill.