Select Committee on Liaison Third Report


APPENDIX 1

Memorandum from Lord Joffe

Patient (Assisted Dying) Bill

1.  BACKGROUND TO THE REQUEST

(a)  The issue of assisted dying is of intense public interest upon which there are passionately opposing views within the House, amongst the public, health and legal professions and religious groupings.

(b)  The purpose of these briefing notes is not to rehearse the arguments for and against the Bill but rather to outline why I suggest that the House can only make an informed decision on the Bill if it has the benefit of the findings of a Select Committee.

(c)  The purpose of the Bill (as amended by the amendments of which I have given Notice) is to prevent unbearable and unnecessary suffering by allowing competent terminally ill patients to request assistance to die. The Bill is accordingly very limited in its application. It does not apply to patients who are mentally incompetent nor to any patients who are ~ terminally ill.

(d)  Opponents of the Bill, many of whom are concerned that assisted dying is contrary to their religious beliefs, mainly base their opposition upon concern that if assisted dying is decriminalised, the vulnerable members of society will be put at risk and trust between doctors and patients will be destroyed.

(e)  In drafting the Bill, it was recognised that there could be risks to vulnerable members of society and to prevent these risks, a range of safeguards was introduced. However, the Bill's opponents argue that these safeguards are inadequate.

(f)  Inevitably the views of the Bill's opponents on vulnerability and trust break-down have to be based on conjecture rather that upon fact.

(g)  As there is no available experience of assisted dying in the UK, it is natural to turn to the experience of other countries with similar health provision and similar standards of living which have actually implemented similar legislation. The Netherlands and Oregon qualify under all these headings with experience of patient assisted dying going back to the 1980s in the case of the Netherlands and 1997 in the case of Oregon.

However, the supporters and opponents of the Bill have interpreted the experience of the Dutch and of Oregon very differently. The supporters are convinced that the Dutch and the Oregon experience provides positive support for the view that assisted dying does not place vulnerable people at risk and that there is no evidence of a break down in trust between doctors and patients. The Bill's opponents however argue that the Dutch and the Oregon experience illustrates the dangers to the vulnerable and to doctor/patient relationships.

2.  BASIS OF THE REQUEST

The House would be immeasurably assisted in making an informed decision on the Bill if a Select Committee had taken evidence and considered the issues set out below:

(a)  The current experience of assisted dying in the Netherlands and Oregon and in particular, whether the vulnerable members of society have been put at risk and whether doctor/patient relationships have been adversely affected.

(b)  Whether palliative care can in all cases provide the care which will enable terminally ill patients to die with dignity and free of unnecessary suffering.

(c)  Whether recent polls that show 80% percent of the public supporting assisted dying accurately reflect public opinion.

(d)  Whether the safeguards contained in the Bill to protect vulnerable members of society are adequate and if not, what further safeguards are necessary. The Joint Committee on Human Rights in its report on 23 March 2003 was of the view that they were but the Bill's opponents are not persuaded.

(e)  The effect, if any, on resources for palliative care if the Bill became law.

(f)  The effect, if any, on health staff and the families of patients if the Bill became law.

(g)  The different views within the medical profession.

3.  CHANGES SINCE THE 1994 SELECT COMMITTEE

The Lords Select Committee on Medical Ethics which reported in 1994 recommended that the existing laws which make assisted dying illegal, should remain in force. That was ten years ago and much has changed since then including the following:

(a)  At the time there was no legislation similar to the Bill in any other country. Since then such legislation has been introduced in the Netherlands, Oregon and Belgium.

(b)  The views of the Select Committee were significantly influenced by what they were told about the Dutch system. In the light of developments in the Netherlands since then, I believe that a new Select Committee may form a different view particularly having regard to the facts that

  • the Royal Dutch Medical Association (of which the great majority of Dutch doctors are members), the Dutch Government and the overwhelming majority of the Dutch population strongly support the existing system
  • the most recent Remmelink Report (an in depth series of reports commissioned by the Dutch Government) published earlier this year found no evidence of vulnerable people being put at risk nor any increases in voluntary euthanasia in the last five years.

(c)  Three of the surviving members of the previous Select Committee, Baroness Jay, Baroness Warnock and Baroness Flather now support this Bill. This is particularly significant as it demonstrates that a new Select Committee might well come to a different conclusion from the previous one.

(d)  The UK is now faced with the sorry spectacle of terminally ill patients dragging themselves in desperation to Zurich to be assisted to die.

(e)  Surveys in the UK amongst doctors have shown that a considerable number of doctors have felt compelled on grounds of compassion to agree to requests by their patients to assist them to die even though this is against the law. This sits uncomfortably in a democratic society where the rule of law should prevail.

(f)  Likewise wives who have openly broken the law on assisted suicide in order to assist their husbands to die in Switzerland, have understandably not been prosecuted and hopefully never will be.

(g)  The issue of assistance to die is now being looked at afresh by the Council of Europe which had previously expressed opposition to voluntary euthanasia and the French National Assembly has just agreed to set up a Parliamentary Commission to investigate issues relating to the end of life and formulate proposals for addressing these issues.

(h)  There is widespread support for the Bill amongst Peers on all sides of the House.

(i)  The terms of reference of the previous Select Committee were much wider than what is proposed and most of the other findings of that Committee are not being questioned.

I respectfully submit that having regard to the above there is a powerful ease for a Select Committee, the findings of which would ensure that the House is able to make an informed decision on a Bill of significant importance.

22 October 2003


 
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