My Lords, I thank my noble friend for clarifying his position, but I urge him to think very carefully about it, because we would all like death by nature, but as I said earlier, a lot of people do not achieve that because other people will not let them have it. They prolong their lives unnecessarily.
When asked whether they had had any evidence of vulnerable people being forced into receiving assistance to die, both the Oregon Medical Association and the Royal Dutch Medical Association said that they could not give any examples. The patients to whom we are referring in this regard want to maintain control over their life and death, and they can do so in Oregon and the Netherlands.
Asked about the "slippery slope" argument, both Oregon and the Netherlands responded with demographic evidence that the law is being used as intended and that the number of people opting for doctor-assisted dying is stable and not rising. Evidence from the United Kingdom published in the Lancet a year or so ago, to which I believe my noble friend Lord Russell-Johnston referred, suggests that there are already about 18,000 medically assisted deaths in the UK per annum. I do not know where that figure comes from, but presumably those assisted deaths are performed by doctors without any regulation or oversight. I wonder how many of those deaths were done with informed patient consent. Surely that could be the slippery slope that we so dread. It must be regulated, and the doctor-patient relationship must change, with patients being in control of their lives and their deaths, not the doctors. The Oregon Medical Association found it difficult to assess whether the new law had affected that relationship, while in the Netherlands the problem had been the number of doctors who refused the patients' request; they said that 66 per cent of requests were not met because the doctor felt that the criteria for assisted suicide had not been met.
The problem of palliative care was another question posed. As we have heard, some practitioners of palliative medicine claim that if we had better facilities in the United Kingdom, no patient would want to be helped to die. I would argue with that. Pain and its relief is not the only issue; total paralysis is the fear of many with incurable neurological disease. The most famous cases, such as that of brave Diane Pretty, fall into that category. No palliative care can alleviate the suffering of total paralysis, being unable to speak, swallow, blink or scratch—a complete nightmare. Many patients in intractable pain would prefer not to end their days in a diamorphine-induced trance, unable to communicate with their loved ones properly and eventually succumbing to the "double effect" when their breathing fails. Palliative care is much needed for those people who want it, and the responses from the Oregon Medical Association and the Royal Dutch Medical Association—from authoritative associations—suggest that the reverse is true of the fears expressed in this House. In Oregon, task forces delightfully called "comfort teams" have been set up to help clinicians, and they say that no one in Oregon now goes without palliative care if that is what they want.
In conclusion, many of the objections to doctor-assisted dying come from people with a political-religious viewpoint—which is fine for them, but they should not impose their view on others. Many other objections are based on anecdotal so-called evidence, which is inadmissible. We have assurances from both the medical associations that have seen the proposals in practice. We hear much about choice nowadays; terminally ill patients have a right to choose, too. Whether they choose palliative care or assisted suicide or opt to continue suffering is their decision—and they must be allowed to decide for themselves.