My Lords, as many noble Lords know, last year I chaired the panel reviewing the use of the Liverpool care pathway. It is important that we found no evidence that it had been used to hasten people’s deaths, but it was nevertheless clear that many older people, who often have complex physical and emotional needs, were frightened that it might be used in that way. The sense of vulnerability of older people, particularly in hospital, emerged time and again. Indeed, the Liverpool care pathway review only highlighted on a small scale what came out of the Mid Staffs inquiry: that where care is less than good, it is older people, particularly the most vulnerable, who receive the worst care and are the most frightened. They should be able to trust their healthcare professionals, and now, for reasons of poor care, sometimes they do not.
That is why I do not believe that the decisions about who should receive medication to terminate their own lives should rest with doctors or our healthcare system more generally. Indeed, it is unclear that doctors themselves want to be the gatekeepers for this. Although I do not entirely oppose the prescription of drugs for the ending of people’s lives in very limited circumstances, the Liverpool care pathway review and my pastoral experience have taught me to be very careful indeed about the involvement of healthcare professionals in this matter, and I would prefer to see an examining magistrate, or High Court judge, as the person who scrutinises whether a person is of sound mind and is clear that they want to do it and is not being pressurised by relatives or others. I totally take on board what my noble and learned friend Lord Brown of Eaton-under-Heywood said about the decision of the Supreme Court in the Nicklinson case, but nevertheless I think the principles apply. In that case, my noble kinsman-in-law, who is the president of the court, said:
“Indeed, it appears to me that it may well be that the risks to the weak and vulnerable could be eliminated or reduced to an acceptable level, if no assistance could be given to a person who wishes to die unless and until a Judge of the High Court has been satisfied that his wish to do so was voluntary, clear, settled and informed”.
An examining magistrate might also apply.
Secondly, there is the timeframe of six months. I speak as the daughter of a mother who had a prognosis of a few weeks but was in the care of the North Camden palliative care team for five years. There are many others around of whom that could be said. Six months seems arbitrary and, as the noble and right reverend Lord, Lord Harries of Pentregarth, said, possibly even unkind because suffering that is longer than six months is suffering that we should take even more seriously.
Thirdly, it does not seem to me that the requirement in the Bill that someone comes with the drugs and is with you while you do it or takes them away if you do not is the right way to go forward. My pastoral care experience is that those who want it want it for reassurance, a form of comfort blanket, if you like. They want to have the wherewithal there should they become desperate. This proposal goes nowhere towards that. If people are worried about the drugs afterwards going on to the open market, we should remember that people who have palliative care at home often have far more dangerous drugs around and no one worries that much about them.
I believe that although there is an argument for allowing people to have the wherewithal to kill themselves in very limited circumstances, this Bill does not provide sufficient safeguards and leaves too much power in the hands of doctors. I therefore oppose the Bill as it stands, but not the nub of the principle within it.