My Lords, I strongly support this prospective Bill and warmly congratulate the noble and learned Lord the chairman and his committee on producing such a report, one that enables those who want to do so to understand all sides of the present debate. The report and, in particular, its volumes of evidence, make up a valuable and readable account of where this evolving debate has reached. The changes it highlights since the 1994 Lords report on medical ethics are stark.
I shall touch on just a few aspects that seem important to me. Various opinion polls have been quoted and put into context, but I should like to emphasise the very recent Daily Telegraph YouGov poll which showed what was called huge popular backing for legislation for assisted suicide. Some 87 per cent of those questioned agreed with the statement that people who are terminally ill,
"should have the right to decide when they want to die and to ask for medical assistance to help them".
That is a trend and direction in public opinion which should be taken into account even if the exact figure might not be accepted. Reading it in the Telegraph makes it even more persuasive.
We should be grateful that the various royal colleges and societies seem to be moving from a monolithic view to reflect the fact that in practice their members tend to be significantly divided. In my opinion, there is no loss or shame in that. We should welcome this relatively new attitude taken by these various organisations which, in necessarily different ways, have allowed themselves to be much more neutral in this debate. Reading their oral evidence is almost essential in order to understand the rationale and nuances of their position, although I realise that not all the colleges have changed and that they all have slightly different remits.
As has been mentioned, one of the key concepts influencing this is "patient autonomy". The Select Committee report provides throughout a great amount of detail on how in practice this is balanced in making decisions. I hope that anyone trying to relegate the importance placed on patient autonomy in this context will first at least have read the extensive evidence in the report. Indeed, the speech of the right reverend Prelate the Bishop of St Albans sought to set up what was almost a straw man in order to knock him down, while the speech of the right reverend Prelate the Bishop of Oxford was a slightly more sophisticated version of the same. At the very least, patient autonomy should allow for some form of feedback from the patient. I was under the impression from both the right reverend Prelates that whatever the patient said would not be taken into account because they had a better and more authoritative idea of what would be good for him.
We have been told that the recent remarkable BMA decision and vote was completely within its rules. As has been said, the BMA's decision is,
"not to oppose legislation which alters the criminal law, but should press for robust safeguards for patients and doctors who do not wish to be involved in such procedures".
Whatever pleadings are made about the figures of the vote, it is a remarkable change of attitude.
I realise that the different organisations collect and report on the views of their members in different ways. I read the oral evidence of the Royal College of Nursing, to which the noble Baroness, Lady Thomas, also referred when making a similar point. Some members of the committee asked the representatives to justify why they were reporting as official policy their "collective" and what were called "themed" views against the thrust of the Bill when it was held to be known that a significant proportion of their members might not agree with that position. I understand that my noble friend Lord Joffe, despite being given assurances of further information and figures from the RCN about the basis of its claimed "themed" position, has still received nothing. One can only guess that this is the way it chooses to show so-called "leadership" to its members.
Another, alternative voice on this subject in the report comes from a nurse. It is set out on page 95 in Volume III. The nurse, the elected chair of the RCN Ethics Forum Steering Committee, submits a most reasoned submission; one made, as she rightly has to say, in her personal capacity. She states that she believes that,
"the submissions received during the RCN's formal consultation process were overwhelmingly in favour of changing the law".
In the first sentence of her conclusion she states her belief that:
Whatever the percentages on either side, I believe that the present RCN approach is counterproductive.
Finally, perhaps I may point out a slight paradox. We are told by opponents of this Bill that the uptake of what might be available is likely to be on a considerable scale. Given that the nearest parallel will probably be the Oregon system, if I may use rather round figures, it is remarkable that out of around 30,000 deaths a year in Oregon, about 60 people are given the prescriptions they request and only 40 actually use them. On such a scale, that is not likely to cause a major change or upset in our attitude to death. The significant proportion of people who ask for the option but then do not use it points to the additional benefit for an even larger number who have the reassurance that a "back-up" system is there and is available to be called upon if they need it. That is a recognised phenomenon and was described very well by the noble Earl, Lord Arran.
When my noble friend Lord Joffe brings back his revised Bill, I strongly hope that this House will follow the recommendation made in the committee's report that it should have a formal Second Reading before going before a Committee of the Whole House, where I sincerely hope that we can have a rational and considered debate on the details of the Bill.