My Lords, I join other noble Lords in congratulating the noble and learned Lord, Lord Mackay, and his committee on such a knowledgeable and balanced guide to this very difficult subject. No one who heard the dramatic and sad account of the noble Lord, Lord Puttnam, could be other than sympathetic and very concerned about the conditions in which those whom he described died. However, if the Bill introduced by the noble Lord, Lord Joffe and not the Select Committee report were before us today I should be unlikely to support it.
Apart from the concerns of the healthcare professions, to which I shall return, my reasons for caution fall mainly into the "slippery slope" category, which I think both exists and is very relevant. There is also the risk of masking the need for a huge improvement in the availability and quality of palliative care for those with terminal illness.
On the slippery slope concept, I am concerned that such a Bill could all too easily increase the risk of legalising assisted dying and euthanasia well beyond the three currently named qualifying groups. The report rightly draws attention to the need for those categories to be much more clearly defined, but would that be enough?
There are, I fear, also some economic factors at work. We are an ageing population, and that means higher costs as well as benefits. Most citizens have little need of healthcare so long as they are young and healthy, but when and if they reach the point of being unable to care for themselves they deserve proper and, above all, pain-free—I insist on that—and, inevitably, increasingly expensive healthcare. Yet we know that they do not always get it. Indeed, far too often they do not get it.
Inevitable pressures exist—have always existed—on NHS budgets. Concern about delays in securing rapid enough approval for the latest cancer drug, about which we have heard over the past month or so, is just one example. The postcode lottery aspect of whether the health services needed are available in your area is another. So I share the concern, for all those reasons, that the basic human rights of the elderly and other vulnerable groups could all too easily slip still further down the priority list.
I turn now to the concerns of the caring professions. There is, rightly, much discussion of the role and responsibilities of doctors. That is entirely reasonable, for they are the people who would be prescribing lethal drugs or administering lethal injections. As the Select Committee made clear, hospital doctors would bear the main burden of euthanasia requests. Even so, I was disappointed to see how little emphasis there was in the report on the position of nurses.
Many years ago, I served on the commission, under the distinguished chairmanship of the noble Lord, Lord Briggs, on the future of the nursing profession. Its membership included every kind of medical, nursing and manpower expert. Being none of those, I gave myself the title of "Patients' rep", and from the patients' viewpoint, and in so many other ways, I came away with a profound admiration and respect for the nursing profession.
In the context of this report, nurses, in some respects, occupy an even more central position than doctors. They are generally the member of the healthcare team to whom patients feel most able to speak freely; they are usually with the patient all the time. The doctor, by definition, is generally a visitor and, albeit under the doctor's supervision, the continuing burden of patient care falls inevitably on the nurse. Of course, it is exactly the close relationship which develops between patient and nurse that is so critical in today's debate.
As the RCN has pointed out,
"there is a real danger that the proposals in the Bill could undermine the nurse-patient relationship, leading to a culture of fear amongst vulnerable people at a time when they most need to feel supported by their clinical team".
Many of your Lordships have raised that point. Yet, despite that, nurses seldom appear in the noble Lord's Bill either. Almost the only reference to the nursing profession is the general phrase "member of a medical care team". That is a serious deficiency.
Finally, let me say a word about palliative care—others have touched on it as well. The Bill would enable an applicant for euthanasia to ask for a palliative care consultation, but, as the committee wisely observed, experiencing good pain control is different from being told about it. To have reached the despair of requesting euthanasia, a patient is likely to have received inadequate care and to be completely worn down, unable to conceive of anything that would really improve quality of life. It is therefore insufficient for any Bill that purports to see palliative care as complementary to euthanasia simply to offer the option of a consultation. We should not agree to end the life of patients who have not experienced good palliative care.
All that begs the question: why have those dying people not received good care? After all, the report tells us that Britain has the best palliative care in the world, so why are people still dying in despair? The answer, I fear, is simple. As with so much else in the NHS, Britain leads on quality but is deficient on quantity and, sadly, distribution. Up to now, the gap has been filled, to a large extent but by no means sufficiently, by the voluntary sector's herculean efforts. Where there are specialist palliative care centres, as has been so brilliantly argued by my noble friend Lady Finlay, and doctors and nurses who have had specialist training, the ability to alleviate the suffering of terminal illness is little short of dramatic. The problem is that such centres of excellence are too few and far between, with the result that many people who are dying do not receive the end-of-life care that they deserve. Yet, we are debating assisting patients to commit suicide or giving them euthanasia, when, with some reallocation of NHS resources, we could solve the problem without changing the law and putting people at risk. Would it not be much wiser to concentrate on that vitally important second alternative?