Assisted Dying - Question for Short Debate

– in the House of Lords at 7:46 pm on 6th March 2017.

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Photo of Baroness Jay of Paddington Baroness Jay of Paddington Labour 7:46 pm, 6th March 2017

To ask Her Majesty’s Government what assessment they have made of recent legislation on assisted dying in North America; and whether those laws provide an appropriate basis for legislation in England and Wales.

Photo of Baroness Buscombe Baroness Buscombe Baroness in Waiting (HM Household) (Whip)

My Lords, I remind all Back-Bench speakers that they are time limited to one minute—and we have to be strict about that.

Photo of Baroness Jay of Paddington Baroness Jay of Paddington Labour

My Lords, I am grateful for the opportunity to raise this Question for Short Debate today. This House has a very distinguished record of authoritative, informed and wise debate about the very complicated and difficult issue of assisted dying. However, since 2015, when my noble and learned friend Lord Falconer’s Bill made considerable progress in this House but was then dropped at the time of the general election, and following a Bill in the House of Commons that failed, there has been very little opportunity to reopen the question of changing our law. I must say that the number of speakers this evening suggests that interest has not declined, and I apologise for the very short time that has been given to the debate.

While the UK Parliament may have been inactive in the recent past, the international picture has changed significantly. This is particularly true in North America, where Canada and several important jurisdictions in the United States have passed, and indeed implemented, laws to enable assisted dying. Overall, these new laws bear a striking similarity in their provisions and safeguards to those proposed in the Falconer Bill.

I have just spent a few weeks in the United States, including in Washington DC, where, as noble Lords are well aware, the political atmosphere is febrile and deeply divided. Nevertheless, on 18 February, the capital city of the United States became the latest place to bring an assisted dying law quietly into effect, without, as far as I know, even a single presidential tweet. It is too early to judge how that will work in practice, but what surprised me was the calm acceptance which greeted its introduction. The same has been true in California, the most populous and diverse state in the union, where legislation was passed in 2015. Colorado followed suit in 2016, after a referendum in which 65% of the population supported the law change.

Canada’s Parliament also acted last year, with Canada becoming the first Commonwealth country to legalise assisted dying. The Canadian decision came after a constitutional ruling from its Supreme Court. There are some lessons in that experience for the British situation, and my noble and learned friend Lord Falconer will address those.

It is very important to note that all the lawmakers in the USA have closely followed the state of Oregon’s original Death with Dignity Act, which was introduced as long ago as 1997. The citizens of Oregon now have two decades of experience of the Act, and the most recent report shows, once again, the stability that has always characterised its practice of assisted dying. In total, 1,127 Oregonians have made this choice in the past 20 years, amounting to less than 0.19% of all deaths over the same period. Interestingly, in 2016, the number of assisted deaths fell slightly, from 135 in the previous year to 133. The original tightly drawn eligibility criteria have not been challenged or extended beyond the terminally ill, and there have not been proven cases of abuse. The argument that changing the law leads always to a slippery slope of rising numbers and looser guidelines has been shown to be wrong.

Interestingly, Oregon’s hospice movement, which in the 1990s was opposed to a change in the law, now acts to support end-of-life options. Palliative care there is very highly rated, as indeed it is in this country, but unlike in Britain there is no suggestion that palliative care may always be an alternative to an assisted death. More than 90% of the state of Oregon’s citizens who choose to end their lives are already enrolled in the hospice system and the vast majority of them die at home in comfort. That same kind of experience is reflected in the newer statistics from other states where monitoring is now in place.

This is a gentle and compassionate approach to dying which is working effectively and safely for the minority who make the choice. I emphasise again that all the American laws are very similar to those proposed in the Falconer Bill, although my noble and learned friend’s proposals contain even more stringent safeguards, partly of course as a result of amendment in this House. Surely the expanding transatlantic experience should act as a positive guide to future legislation in this country.

Of course it would be wrong to suggest that although death with dignity is now an accepted choice for many North Americans, there was not fierce controversy when it was first mooted. However, what I find surprising is that some of the types of opposition which have so far seemed insurmountable in this country have not prevented change there. Let us take, for instance, the question of religious faith and belief. Americans are known to be more religious and certainly more observant than the British. Surveys suggest that almost three times as many citizens in that country attend a religious service about once a week, and yet religious practice and faith do not seem to have been the intransigent opposition to the concept of assisted dying either by faith leaders or their flocks that we have often heard here.

I was impressed by the statements of Governor Jerry Brown of California when he signed that state’s End of Life Option Act. Noble Lords may remember that Jerry Brown, who was indeed a Jesuit seminarian in his youth, said that he did not know what he would do personally if faced with a terminal illness but:

“I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others”.

I am delighted that the noble and right reverend Lord, Lord Carey, is speaking in the debate, and I hope that others of our faith leaders will be able to follow what I would regard as the more open approach shown both by the noble and right reverend Lord and people like Governor Jerry Brown.

Another source of rather adamant opposition to change in this country has been some of the professional organisations representing doctors. Obviously doctors must play a vital role in the safe practice of any assisted dying legislation. Again, the North American experience is instructive. In California and Canada the medical associations, which were initially concerned, have now adopted appropriate positions of neutrality to the new laws. This pragmatism has therefore usefully meant that they, doctors and other health professionals can be actively involved in both shaping good practice and guiding the development of safeguards for everyone involved.

While all this has been happening on the other side of the Atlantic, the situation here remains frozen, and today’s Parliament really does seem to be out of step with the overwhelming majority of the British public who, when they are surveyed, always support change. The evidence suggests that more and more people here are now assuming control over the end of their lives by taking the law into their own hands. In 2016, a record number of 47 Britons—those who could afford both financially and physically to do so—travelled to the Swiss organisation Dignitas for assisted deaths. A recent freedom of information request to local authorities revealed that each year more than 300 terminally ill people die by suicide, sadly often taking their lives alone so that they do not involve or incriminate anyone else.

It is now more than 20 years since I first became involved in this issue as a member of a Select Committee of this House. I said earlier that noble Lords have taken a leading role in the assisted dying debate, and perhaps unusually we have been widely commended for our thorough and proper approach. Now, in 2017, the North American experience shows that laws which closely resemble Bills that have been introduced in this House before can operate safely and successfully. I hope that the Government will make a positive assessment of these developments and reflect seriously on how they might be relevant to this country. I also hope that the business managers of the House will make it possible to have a more lengthy consideration of the current issues.

I am grateful to all those who are taking part in this debate, although as I say, I regret the shortness of time to speak. I am sure that noble Lords will continue to play a central part in developing legislation to reform our own laws.

Photo of Baroness Grey-Thompson Baroness Grey-Thompson Crossbench 7:56 pm, 6th March 2017

My Lords, I raise the legitimate concerns of many people. The current US legislation and the concerns around it certainly impacted on the decisive vote in another place in 2015. After the last debate in the Chamber I was told by a member of the public, as they looked me up and down, that I must have thought about killing myself many times. The answer is a resounding no, but I was shocked. I am resilient, but imagine if you are constantly told that you have no quality of life or you are persuaded that you are worthless.

The disability rights campaigner Liz Carr has said that, “euthanasia denies the value of people who have illness or disability”. The noble and learned Lord, Lord Falconer, stated in his commission report that assisted suicide is not meant for disabled people, “at this point in time”. If legislation in this area is passed, I and others like me are merely in the waiting room.

Photo of Lord Carey of Clifton Lord Carey of Clifton Crossbench 7:57 pm, 6th March 2017

My Lords, I am grateful to the noble Baroness, Lady Jay, for introducing this debate, but what can one say in one minute? For me the fundamental issue that underlies this debate is that of autonomy or, to put it differently, human rights which enable us as individuals to determine the manner of our own death. It was central to the argument of Kay Carter in Canada and Brittany Maynard in the state of California. It will, I dare say, be a central argument for the case launched in this country by Noel Conway.

As a Christian leader, although I acknowledge that I am out of step with my Church and mainstream Christian Churches, it is love and compassion together with personal autonomy that has led me to identify with this struggle. For all its claims, medical science cannot deal with many cases of intractable pain and suffering, and least of all the indignity that often accompanies them. The example of Canada and other countries shows that laws can be made that protect the most vulnerable and therefore halt the unnecessary prolongation of life which, for some, is not worth the candle.

Photo of The Earl of Arran The Earl of Arran Conservative 7:58 pm, 6th March 2017

My Lords, together with the noble Baroness, Lady Jay, I first visited Oregon some 12 years ago as part of this House’s consideration of assisted dying. Back then it was the sole state in the US to have legalised assisted dying for the terminally ill. Since then, as has already been said, Oregon has been joined by Washington, Montana, Vermont, Colorado and even the District of Columbia. Most importantly, it was joined last year by the state of California, the largest and most diverse state in the nation. These states represent some 18% of the total US population. Canada too has become the first Commonwealth country to legalise assisted dying nationwide. Law change is also imminent in parts of Australia, where the Government of Victoria have committed to introducing an assisted dying Bill by the end of the year and private members’ initiatives are likely in both Tasmania and New South Wales.

As the evidence from overseas continues to grow, our own reasons not to legislate become less and less convincing. The tide is coming in. Rather than fight in vain to prevent it, we should work together to give those in terrible pain and suffering the same rights as are given to our closest cousins in North America.

Photo of Lord Falconer of Thoroton Lord Falconer of Thoroton Labour 8:00 pm, 6th March 2017

My Lords, English law shows such an arrogant lack of compassion on this issue. In the Carter case in Canada, the Canadian Supreme Court set aside an identical law on three grounds: it forced people to go to an earlier death when they went to a jurisdiction that allowed assisted suicide; it manifestly infringed individuals’ right to dignity and autonomy at the time of their death; and the protection it gave to the vulnerable, which is vital, was overwide because it provided protection to too many when it did not need to be done in that way.

In the Nicholson case in our country, the noble and learned Lord, Lord Neuberger, said that the protection currently provided is less than the protection that would have been provided under a Bill that I proposed—less, because an investigation after death is a lot less protection than making sure a court said that it was okay beforehand. The time has come for this country to follow Canada, not with a great fuss or a great to-do, but to change the law to reflect what everybody wants: proper protection, but autonomy for people who want to die in the way they choose.

Photo of Baroness Masham of Ilton Baroness Masham of Ilton Crossbench 8:01 pm, 6th March 2017

My Lords, opening the door to assisted dying legislation will put many frail, elderly and disabled people at risk of pressure from their families, who fear losing the house if it goes on payment for expensive care homes. There is immense pressure on the NHS and social services. The insecurities of Brexit have already lessened nursing and care help coming from Europe. It will be a disaster if it dries up. Severely paralysed people cannot cope without help. In desperation, they might turn to assisted dying.

Patients need to trust their doctors. Do not forget Dr Shipman: a GP from Yorkshire who killed many of his trusting patients. What we need is the availability of good palliative and end-of-life care across the country.

Photo of The Bishop of Worcester The Bishop of Worcester Bishop 8:02 pm, 6th March 2017

My Lords, I oppose assisted dying not on religious, but on human grounds. Surely the only place in North America where legislation has been in place long enough to draw any reasonable conclusions is Oregon. The claim of those pressing for assisted suicide here, that there have been no documented cases of abuse or coercion in the two decades since it was passed, is highly contentious. The US Disability Rights Education & Defense Fund—a leading national civil rights law and policy centre—has documented cases of complication and abuse arising from the law in Oregon and neighbouring Washington state. Writing in the Wall St Journal, William Toffler, a doctor in Oregon, described how the law there has had adverse consequences for the doctor-patient relationship, and how a developing climate of “secrecy” and “fear” has worsened the situation of the most vulnerable.

Little wonder that here in the UK, alongside medical professionals, those who have been most vocal in their opposition to assisted dying are grass-roots groups of disabled people. Disabled activists see it as a step towards a society that develops social and cost-related judgments about a person’s quality and value of life, which then become inevitable factors in the conversation around eligibility for assisted suicide. That is why investing in palliative care, not offering legal assistance with suicide, is the only truly progressive way forward.

Photo of Baroness Finlay of Llandaff Baroness Finlay of Llandaff Crossbench 8:03 pm, 6th March 2017

My Lords, North America’s evidence is worrying. Oregon’s reports show that some people given lethal drugs, based on a prognosis of under six months, lived for up to three years before killing themselves. Who knows how long they might otherwise have lived? Two-thirds of Oregon’s doctors want no involvement. “Doctor shopping” is widespread as campaign groups steer patients to ready repeat prescribers. In the two-week delay required, they cannot possibly know a person’s domestic pressures, masked depression and subtle coercions, nor adequately assess capacity. Almost half cite not wanting to be a burden as their reason. Lethal prescription numbers far exceed such deaths. What happens to uningested drugs? No one knows whether ingestion is ever coerced.

Canada’s recent law, like the Netherlands’ and Belgium’s, includes euthanasia beyond terminal illnesses, with predictions of around one in 20 of all deaths through medically provided lethal drugs. That would equate to around 25,000 such deaths annually here. Violent suicide rates do not fall where assisted suicide is the norm.

Photo of Baroness Howe of Idlicote Baroness Howe of Idlicote Crossbench 8:05 pm, 6th March 2017

My Lords, last year Canada followed Holland and legalised assisted suicide and euthanasia. Reports emerging from Canada suggest that the outcome is likely to be similar. There are also reports that, after only six months, campaign groups were pressing for relaxation of the rules.

We are told there has been no extension of Oregon’s assisted suicide law. The pressures to do so are certainly there. Last week, as it happens, an amendment was tabled in Oregon’s state legislature seeking to extend the law there so that lethal drugs could be administered to someone who loses decision-making capacity. I am concerned too about the effect of multiple prescribing in Oregon. In 2015, one doctor issued 27 prescriptions for lethal drugs; in 2016 a doctor—perhaps the same one; we are not told—wrote 25. On present figures alone, Oregon’s law would give us 2,000 assisted suicides here every year. That is not a prospect that I believe any of us should view with equanimity. I am far from convinced that our law should be changed. I look across the Atlantic with increasing concern at what is happening where it has been changed.

Photo of Lord Low of Dalston Lord Low of Dalston Crossbench 8:06 pm, 6th March 2017

My Lords, I went to Oregon nearly three years ago. I asked people what they thought of their law on assisted dying. No one could understand why we did not all have one.

Some disability rights groups oppose assisted dying legislation, yet polling consistently finds that more than 80% of disabled people support such legislation. I cannot emphasise too strongly that no one is obliged to avail themselves of assisted dying legislation unless they wish to.

Research in Oregon demonstrates that groups that might be considered vulnerable, such as disabled people, are not negatively impacted by assisted dying legislation. In fact, they are underrepresented in the numbers of those who make use of it. As far as I am aware, no cases of malpractice or abuse have been reported. Nor is impairment of the doctor-patient relationship general.

We should learn from our friends in North America how best to give dying people the choices they want at the end of life, while ensuring that robust protections are in place for potentially vulnerable people.

Photo of Lord Cavendish of Furness Lord Cavendish of Furness Conservative 8:07 pm, 6th March 2017

My Lords, the frequency with which this topic comes before us suggests to me a degree of attrition on the part of those who believe in assisted suicide. Much but not all of my thinking on the subject derives from my experience as a founder of St Mary’s Hospice in south Cumbria 25 years ago. I remain its patron, as appears in the register of interests.

My reason for opposing the introduction of new legislation may be summarised as follows. The evidence from North America is patchy and largely anecdotal. What we do hear is hardly reassuring. I remain unpersuaded that the existing law here needs changing—a view quite recently upheld convincingly in another place. Assisted suicide would dangerously alter the doctor-patient relationship. In countries where it is legal, doctors are discontinuing the practice because it impacts so heavily on their workload, with a consequence of doctor shopping, as the noble Baroness, Lady Finlay, said. It also compromises the nursing profession: some have been quoted as saying that they would be forced to collude in taking life whether they like it or not. It would encourage elder abuse and suicide contagion, and it is unsafe. Greater access to our ever-improving brilliant system of palliative care is the safe, humane and moral alternative.

Photo of The Earl of Glasgow The Earl of Glasgow Liberal Democrat 8:08 pm, 6th March 2017

My Lords, I have long associated myself with the campaign to legalise assisted dying in Britain—as long, of course, as the necessary safeguards are in place. Judging by a number of polls taken over the last 20 years, more than 75% of the public also want to see assisted dying legalised. They believe, like me, that in the right circumstances it is a compassionate and humane way of alleviating suffering for those who are terminally ill. It also helps to alleviate the suffering of the patient’s family, who, for many months sometimes, must witness the indignity, pain and distress of someone they love.

Yet still in Britain, helping someone to end such misery is a criminal offence. Some feel compelled to travel to a strange clinic in Switzerland where assisted dying is legal, but in British law the relatives are committing a criminal offence by assisting the patients to get there. In practice, the public prosecutor rarely prosecutes and rightly so, but it shows the law to be an ass. It is surely time the Government took assisted dying more seriously.

Photo of Lord Alton of Liverpool Lord Alton of Liverpool Crossbench 8:10 pm, 6th March 2017

My Lords, the noble Baroness’s Question asks whether legislation in North America on what is called “assisted dying” forms an appropriate basis for such legislation here. I will answer that question in just one word: no.

Quite apart from any issues of principle, just look at what is now happening in Oregon. When Oregon’s assisted suicide law was enacted, it was to allow people with decision-making capacity to administer lethal drugs to themselves. Now a Bill has been presented to Oregon’s state legislature to enable someone to collect lethal drugs for a person who has lost capacity since they were prescribed and to administer those drugs to that person, as the Bill puts it,

“for the purpose of ending the patient’s life”.

So there we have it: assisted suicide plus, in some cases, euthanasia—not necessarily voluntary.

What price now all those repeated reassurances we have received from the “assisted dying” lobby that there would be no pressure to extend Oregon’s law? That and the evidence from Washington, where 62% of those in favour of physician-assisted suicide believe themselves to be a burden to friends and care givers, should give us pause. It is why the House of Commons voted against such proposals. Care and kill should never be used as synonyms.

Photo of Lord Carlile of Berriew Lord Carlile of Berriew Liberal Democrat 8:11 pm, 6th March 2017

My Lords, in my view, even official Oregon health division data show how dangerous this law is.

First, non-terminally ill disabled individuals are receiving lethal prescriptions contrary to the law. That is the evidence.

Secondly, in any given case, the certifiers of non-coercion and capability need not even know the person being killed. Furthermore, one witness may even be an heir with a financial interest in the death.

Thirdly, there is no reliable way of checking whether the death is a suicide, and therefore lawful, or administered by a third party and therefore unlawful.

Full euthanasia is being introduced by the back door in some cases in Oregon. In all, it is a dangerously unreliable law which contains unsatisfactory safeguards. My answer to the noble Baroness’s second question is a resounding no.

Photo of Lord Rees of Ludlow Lord Rees of Ludlow Crossbench 8:12 pm, 6th March 2017

My Lords, even with the best palliative care, some will survive beyond the stage where they feel life is worth living. That is why 300 people a year with terminal illnesses commit suicide and why the lives of loved ones are sometimes ended in ways that are, strictly, illegal. Those acts may not result in prosecution, but a shadow of criminality hangs over them and adds to the grief of those whose motive is compassion. A well-drafted Bill would allow assisted suicide, with safeguards. Few would choose this route, but many of us would be comforted by knowing that that option was available.

Support for such a measure is just as strong among the disabled. Among this majority is Stephen Hawking, my friend and colleague for 40 years. His achievement against all odds has been astonishing. He still craves new experiences and does not want to die. He thinks that suicide would be wrong unless one were in great pain, which, thankfully, he is not. None the less—this is the key point—he says that the disabled should have the option, as others do, to end their lives. Like him, I firmly support an assisted dying Bill and hope that the “nudge” from the Supreme Court will give it a fairer wind.

Photo of Lord Fairfax of Cameron Lord Fairfax of Cameron Conservative 8:13 pm, 6th March 2017

My Lords, I am in favour of this change in the law proposed by the noble Baroness, Lady Jay, and others, because, as we have heard from noble and right reverend Lord, Lord Carey, it is the civilised and right thing to do.

Allowing people to make their own end-of-life decisions is supported by more than 80% of the population polled here and is seemingly the preferred route of the Supreme Court. The safeguards proposed provide the necessary protection. I remind those who have spoken to the contrary that such protection constitutes two GPs and a High Court judge.

Why should people not be allowed to choose the time and place of their death, especially if they are in great pain? I therefore hope that the Government will follow the North American example and support this much-needed change in our law.

Photo of Baroness O'Loan Baroness O'Loan Crossbench 8:14 pm, 6th March 2017

My Lords, there are two questions before your Lordships’ House this evening. The first is whether this House, this Parliament, wants to revisit the issue of the creation of law enabling assisted suicide in this country and the second is that posed by the noble Baroness in her Question. This House and the other place have answered the first question repeatedly in the negative.

Five of the 50 American states permit assisted suicide. Your Lordships have heard tonight of the terrible consequences of the situation in Oregon, and the other four have adopted laws only relatively recently, so there is no information on how they are working.

Analysis of the Canadian Medical Assistance in Dying Act shows that the legislation is perceived by many as fundamentally flawed because of its lack of definition and because of the uncertainty which it has created. It talks about,

“grievous and irremediable medical conditions”, and about “serious illness”, but these basic terms give rise to widespread uncertainty and fear. There is no definition of what constitutes a relevant condition. “Grievous” and “irremediable” are not medical terms. What is an “irreversible decline in capability”? How is to be defined? What of those suffering from mental illness? Can they make a decision? Are they capable? Are they suffering from such a decline? When is natural death “reasonably foreseeable”? There are no time limits and no proper definitions. Medical professionals are invoking their right to freedom of conscience under the law.

To legislate for assisted dying is to cross a line in the sand, making medical practitioners trained at the most fundamental levels to do no harm into dispensers of medicine which does not cure but kills. North America has little to teach us.

Photo of Lord Warner Lord Warner Labour 8:16 pm, 6th March 2017

My Lords, in North America legislatures have grasped the fact that failure to legalise assisted dying is a denial of human rights and autonomy. The North American reform role is impressive. More Americans already have access to this legislation than the total UK population. Even more will do so even during the Trump presidency. US state legislators are simply less timid than UK parliamentarians. Let me cite the recent suicide of a friend in his early seventies when told of his inevitable dementia from an awful neurological condition. He faced a future in which he would rapidly change into a person unknown to his family and with no escape route at a time of his choosing. Had he lived in Canada, he would have been assured of a better end at a time of his choosing. Our legislative cowardice on this issues guarantees continuing human misery of this kind for many UK families.

Photo of Viscount Craigavon Viscount Craigavon Crossbench 8:17 pm, 6th March 2017

My Lords, the message I derive from this debate is that, on this issue, the tide of history is continuing to flow one way. We have heard how things are changing. In this country, as we have heard today, we have used for a long time the uncontested figure of 80% plus for support for changing our law on assisted dying. We all know the many European countries, in particular the Dutch, which have faced up to this issue and the demand from those who choose it, while we are continuing to allow unnecessary suffering which palliative care cannot alleviate.

The Californian development is a significant example, building on the now firm foundation of Oregon, which itself has been adopted in other American states. There are similar developments in Australia: later this year the government of Victoria will introduce a Bill to legalise choice in assisted dying for terminally ill people. Other states are likely to follow. The Government of New Zealand have been taking extensive consultation on assisted dying.

Finally, as in the most recent such Bill in this House—which we did not have time to complete—I believe that there is a majority in favour of change here, but I hope that the other House will not want to continue much longer on the wrong side of history.

Photo of Baroness Meacher Baroness Meacher Crossbench 8:18 pm, 6th March 2017

My Lords, forgive me for speaking in the gap. Following the Canadian and other North American decisions, Dignity in Dying, an organisation of which I am chair, is proud to support Noel Conway, one of our members, who has launched a judicial review. Noel is seeking a declaration from the courts that the blanket ban on assisted dying under the Suicide Act 1961 is contrary to his human rights. Noel has said:

“Having the option of an assisted death would bring me great comfort in my final months. Without this option I could effectively become entombed in my own body”.

What a prospect.

In addition to the human rights argument referred to by many noble Lords, the right to assisted dying for terminally ill patients who are suffering unbearably and are mentally competent is a matter of compassion and also a matter of recognising the right of patients to decide for themselves how and when they die. Noel Conway needs our support.

Photo of Baroness Barker Baroness Barker Liberal Democrat Lords Spokesperson (Voluntary Sector) 8:19 pm, 6th March 2017

My Lords, the current legislative framework governing medically assisted dying is failing to protect patients, vulnerable people and medical professionals. Therefore, we on these Benches have a policy that in cases of terminal illness or severe, incurable and progressive physical illness where patients are without hope of recovery, medical doctors should legally be able to provide competent adults with assistance to die if they have expressed the wish to do so, within narrowly defined circumstances. That assistance should be strictly limited to qualifying people who are able to demonstrate, to the satisfaction of a doctor with detailed knowledge of their illness, as well as an independent specialist, that their request to die is voluntary, well considered, persistent and motivated by existing or inevitable unbearable suffering.

Requests for medical assistance to die must be made in writing, after a full discussion with each of the doctors about the situation, prospects and options for palliative care. They must also be countersigned by a practising solicitor who has been satisfied that the patient qualifies and that all procedures have been followed. The law should protect the right of medical and legal practitioners not to participate in the process of assisting a patient to die, but they must make a referral. For those reasons we support the noble Baroness, Lady Jay, in her call to take the growing evidence base from America.

Photo of Lord Tunnicliffe Lord Tunnicliffe Opposition Deputy Chief Whip (Lords), Shadow Spokesperson (Defence), Shadow Spokesperson (Treasury) 8:20 pm, 6th March 2017

My Lords, the position of the Labour Front Bench on this issue is one of neutrality. Given the level of support recently in the Commons—330 against and 118 for—it is unlikely that we would press for parliamentary time to take this issue further. If a Bill did come before Parliament I would expect there to be a free vote on the substance of the Bill, but nevertheless I expect that we would participate in the debate on the detail to ensure that safeguards were adequate.

Photo of Lord Keen of Elie Lord Keen of Elie The Advocate-General for Scotland, Lords Spokesperson (Ministry of Justice) 8:21 pm, 6th March 2017

My Lords, I am grateful to the noble Baroness, Lady Jay, for bringing before your Lordships’ House a matter which continues to be of great public interest and concern. As the noble Baroness herself observed in opening, the issue is complicated and difficult. Today is not the first occasion on which this House has debated this difficult and sensitive area of the law. Indeed, as today’s debate has illustrated, there are passionately and deeply held yet divided views on the issue. I certainly take issue with the suggestion by the noble and learned Lord, Lord Falconer of Thoroton, that this is “what everyone wants”. It clearly is not what everyone wants; indeed, I notice that the contributors to this debate are almost equally divided on this very complex and difficult issue. There is no arrogance to be attributed to those who take one side or other of this demanding debate.

It remains the Government’s view that any relaxation of the law in this area is an issue of individual conscience and a matter for Parliament to decide, rather than one for government policy. Of course, we are aware that assisted dying legislation has been introduced recently in some states of America and in Canada—very recently in four states of the United States—but since the Government have taken no policy position on the issue, we have made no assessment of such legislation in North America or elsewhere. I simply note that while five states in the United States have adopted such legislation, 45, of course, have not. Indeed, the only example that has been in place for some years is that of Oregon. As the noble Baronesses, Lady Howe and Lady O’Loan, and the noble Lords, Lord Alton and Lord Carlile of Berriew, observed, there are issues surrounding the attempted development of the law in Oregon. As the Supreme Court said in the case of Nicklinson and Lamb, information from the few jurisdictions where assisted suicide is lawful is,

“sensitive to underlying conditions such as standards of education, the existence of long-term relationships between GPs and patients and other social and cultural factors, which are not necessarily replicated in the United Kingdom”.

So it does not necessarily follow that a law which operates effectively—allegedly—in another jurisdiction would provide an appropriate basis for such legislation in England and Wales.

We should remember that “assisted dying” is not a term that exists in law. It is shorthand for two distinct things; namely, assisting suicide and euthanasia. However one interprets the term, assisted dying is a highly emotive issue. It polarises opinion among the public, in the media and across the political spectrum, even within groups which are generally supportive of or opposed to a change in the law, and it raises the most profound ethical, moral, religious and social issues. Of course, the Government are aware of opinion polls suggesting that there is strong public support for a change in the law. But even if one accepts that the law should change, there is no consensus—in Parliament or elsewhere—on where a line should be drawn and what safeguards should be in place and for whom.

As the law stands, there is no offence—or defence—of “mercy killing”; nor is there any statutory exception to the offence of encouraging or assisting suicide under Section 2 of the Suicide Act. That Act was amended in 2009. By amending the law, Parliament confirmed that an offence should remain in respect of assisted suicide. Whether the present general prohibition in Section 2 of that Act is incompatible with the right to a private life under Article 8 of the European convention was the central issue in the case of Nicklinson and Lamb, which the noble and learned Lord, Lord Falconer, referred to, in which the Supreme Court handed down judgment in 2014.

Like this House, the Supreme Court was divided on some of the issues before it. But the appeal in that case was dismissed by a majority of seven to two on the basis that it was not appropriate for the court to determine the issue of compatibility at that time. While not unanimous in its view, the court explicitly encouraged Parliament to consider the issue further, and Parliament has done so. Both Houses have subsequently had extensive debates on this issue. The Assisted Dying Bill, introduced by the noble and learned Lord, Lord Falconer, passed Second Reading without a vote on 18 July 2014, after almost 10 hours of debate, and was further debated on two full days in Committee, thereby indicating the level of interest and the division between Members over the fundamentally difficult issue that lay behind the Bill.

More recently, the other House debated the Assisted Dying (No.2) Bill in September 2015. That Bill was essentially the same as the Bill of the noble and learned Lord, Lord Falconer, as amended in Committee. It sought to legalise in England and Wales assisted suicide for terminally ill, mentally competent adults who are reasonably expected to die within six months. As the noble Lord, Lord Tunnicliffe, noted, following a lengthy debate, that Bill was voted down by a majority of 330 votes to 118. As things stand, therefore, the will of Parliament as a whole is that there should be no change in the law. Of course, that does not mean that the issue cannot be re-examined either in Parliament or in the courts. Indeed, today’s debate has again illustrated that the law in this sensitive area remains a matter of great concern to your Lordships. Reference was also made to further litigation that is ongoing in the courts. We are aware of that but it would not be appropriate at this stage to make any comment on such a case when it is still before the courts.

The debate on this issue is often characterised as being a choice between legalising assisted dying on the one hand and the provision of high-quality end-of-life care on the other, but the two are not mutually exclusive. Compassion for the dying person drives both sides of the debate. Wherever one stands on the desirability of legislative change, it is of the utmost importance that all dying people receive high-quality, compassionate care at the end of their lives. Equally, we are all as one, I am sure, in our desire to protect the rights of those who are vulnerable from direct or indirect pressure to take such a step. The central issue is then whether a blanket ban on assisting suicide is a necessary and proportionate way of achieving this.

Those opposed to change argue that any relaxation of the law would constitute too great a risk to sick and disabled people, and that safeguards would not necessarily give enough protection to vulnerable people who may feel pressure, whether real or imagined, to end their own lives. Those in favour of change argue that safeguards would protect vulnerable people from such pressure, while affording dying adults the choice of an assisted death if their suffering becomes too great. As the Supreme Court recognised in Nicklinson, there is a diversity of opinion about the degree of risk involved in relaxing the law in this area but not about the existence of the risk. It is unlikely that the risk of vulnerable people feeling pressure to end their lives can ever be wholly eliminated or that every person who thinks he or she has a legitimate right to assisted suicide can be assisted.

Whatever provisions may be proposed, therefore, the real question is: how much risk to the vulnerable is acceptable in order not to deny those who would genuinely wish to be assisted to commit suicide the opportunity of an assisted death? That is a very difficult balance to strike and there are no simple answers, especially when those who are vulnerable are not necessarily easy to identify. Whatever the arguments for and against change, it is important that the ongoing debate should not lead those whose lives are affected by illness or disability to feel less valued. If ever the law is changed, appropriate safeguards will need to be considered very carefully indeed.

The legal, administrative, practical and resource implications of any change to the law in this highly controversial area are considerable. We cannot in the very limited time available this evening do justice to them, although I would observe in response to the observations of the noble Earl, Lord Glasgow, that we of course take these issues seriously. I have no doubt that the debate will continue in one form or another, in Parliament and elsewhere. In the meantime, I thank all noble Lords for their contribution to this debate.

Sitting Suspended.