Assisted Dying for the Terminally Ill Bill: Select Committee Report

Part of the debate – in the House of Lords at 5:40 pm on 10th October 2005.

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Photo of Lord Carlile of Berriew Lord Carlile of Berriew Liberal Democrat 5:40 pm, 10th October 2005

My Lords, I, too, join in the applause for the chairman of the committee, the noble and learned Lord, Lord Mackay of Clashfern. His wisdom, his judgment and just occasionally his Scots instincts made possible a task that most of the rest of us would have found wholly impossible.

In the evidence before the Select Committee in this House and elsewhere, I have heard abundant repetition of a proposition—that death by choice somehow provides a more dignified end to life than death by the process of nature, a process which, of course, includes disease. To that proposition, I for one am unable to subscribe. I take that view not from any religious viewpoint—if anyone detects my religious viewpoint, would they please kindly let me know what it is, because I have been struggling to find it for the whole of my life. If I ever find it, it will probably be on my deathbed, if I am given the opportunity. My viewpoint on this matter is framed, to an extent, by 10 years' experience as a lay member of the General Medical Council—hardly a religious experience; possibly a paradigm utilitarian experience; certainly an experience which, if you were on the road to Damascus, would make you likely to turn off into the nearest service area.

My view is that a new law on this subject, whether it relates to voluntary euthanasia or assisted suicide, must achieve two ends if it is to stand the test of being a good law. First, it must have ethical integrity for any profession that is involved, whether they are doctors, lawyers or, possibly, a new profession of thanatologists—why should doctors be involved in this? Secondly, it must have legal certainty.

I turn to the first of those, ethical integrity. I do not believe that any ethical framework concerning voluntary euthanasia or assisted suicide could be accepted other than under the heading of "therapeutic benefit". Therapeutic benefit can be judged objectively. It commonly is judged objectively in the everyday work of doctors by their peers, and occasionally even the doctors will allow their therapeutic benefit to be judged by us, the patients. As between human and human, therapeutic benefit in carrying out death by a deliberate act can never be justified objectively if there is an alternative available. I have read all the evidence and I have listened to some of it. In every case—and I mean every case—there is a therapeutic alternative available. It may not be a perfect alternative, but there will be an alternative. I am told that the alternative may not be one that we would choose, but I do not seem to remember being given the choice of being born. We do not exercise true choice in many things that happen in life although we may often delude ourselves that we do.

So in therapeutic benefit, at the very least, in every case there is some type of end-of-life therapeutic medication that can remove the pain. We have to face that. If once in a million cases there is a case in which the therapeutic benefit cannot remove the pain, is that the hard case that makes for a bad law? I do not believe so.

Secondly, I turn to legal certainty. If these cases are allowed to proceed under even a modified version of the Bill of the noble Lord, Lord Joffe, they will from time to time lead to homicide trials. I am basically a criminal law practitioner. I know that we are regarded by our commercial practitioner colleagues rather as the physicians sometimes view the orthopaedic surgeons in the medical world. However, we wrestle on a daily basis with asking ordinary people—juries—questions that can be difficult to address. What is the question that they would have to address in this area? It would not be, "Are you sure that this is homicide, before you can convict?". Rather, it would be, "Are you sure that there is not some therapeutic benefit that could be given before you can convict?". It is inevitable that many cases of homicide would be allowed to slip through the net if this kind of Bill became law.

I turn to the question that I have asked myself many times—why do people want death in the way that is prescribed by this type of legislation? Can we be sure that they are exercising their free will? How on earth can we be certain that there is not undue influence? I found that the Dutch evidence, which I heard in the Netherlands, extremely unconvincing. One of the figures that comes from the Dutch evidence, from research that was published this year, is that 50 per cent of cases are not reported by doctors who carry out voluntary euthanasia although they are obliged to report every one. Why do they not report about 50 per cent of the cases? Because they know not what they do in many of those cases. We cannot brush those figures aside. I fundamentally agree with my noble friend Lord Taverne when he asserts that the Dutch experience is not one in which we have confidence. Having heard the evidence there, I have very little confidence not only in what doctors do in Holland, but in the way in which the Dutch authorities seek to ensure that the practice is carried out carefully.

I would add this on assisted suicide. Some noble Lords, some who are present today, have a particular interest in mental illness. Some of us, unfortunately, have had to deal with mental illness in our own families. It is a very troublesome thing when you come across it for the first time. It becomes a very important issue in your life once you begin to understand it. It leads me to ask myself, why do people assert that they wish to have their life ended by voluntary or assisted suicide? My belief is that in many cases it is because they are ill that they are not able to make the essential judgment that is required for the decision to be one which is governed by sound medical ethics and certain law.

If we enacted legislation along the lines suggested by the noble Lord, Lord Joffe, we would send a completely false message about the state of the law in this country and the ethical judgments that we would wish to impose on doctors. I am against it.