The Bill stipulates the need for a “settled” state of mind for those contemplating assisted suicide. A feeling of not being wanted or of being a burden on others can, importantly, tip the balance towards a settled state of mind of not wanting to live. The proposed legislation moves us even further from focusing on enhanced care and compassion for the vulnerable in society. Worse, it can encourage uncaring or greedy relatives to persuade vulnerable people that their lives are not worth living.

All of us can at times feel that what Shakespeare called the,

“slings and arrows of outrageous fortune”,

are too much for us. However, it is also true that loving care and compassion can change our mood. This is particularly true for the infirm and vulnerable. Daily

18 July 2014 : Column 870

reports of abuse of those who cannot care for themselves by family members or in care homes remind us how far we have moved as a society from our duty to help the vulnerable. Sikh teachings remind us that our own sense of well-being lies in devoting time to the well-being of others. It is a sentiment echoed by all major faiths.

Near where I live there is a new housing development with a large hoarding advertising it with the words “Assisted living”. The need of the hour is not to look at ways of helping people to kill themselves in the name of compassion, but to make compassion and concern for the vulnerable central to the life of a civilised society.

4.27 pm

Baroness Young of Old Scone (Non-Afl): My Lords, this has been a pretty amazing fortnight of public testament that the time is now right for the Bill to be given serious consideration and, I hope, passed.

For some whose poignant stories we have all heard, it is already too late. This legislation is overdue to ensure that dying adults facing unrelievable and unnecessary suffering at the end of their lives can, if they wish, choose not to go through the last few dreadful days or weeks, but choose the time and manner of their dying. It is a tightly and narrowly defined Bill, with several layers of safeguards. It puts the dying person back in the driving seat, as they should be, to be able to decide how they want to die. The noble Baroness, Lady Campbell, for whose determination I have huge respect, regretted that the Bill is about pity. The Bill is not about pity; it is about power—the power of being in control of one’s own death.

The Bill is also about terminally ill people being able to have proper, advance discussion with their family and, above all, with their healthcare professionals. Evidence given to the Commission on Assisted Dying, on which I had the privilege to sit, showed that under the current law doctors and nurses feel at risk if they discuss the full range of options with their patients. This is not acceptable. As the noble Lord, Lord Gordon, said, we do not talk enough about dying.

I will tackle the issue raised by the noble Baroness, Lady Neuberger, that decisions about the settled, sustained and competent views of dying patients on having an assisted suicide should be decided by a judge. We considered that during the Commission on Assisted Dying, but felt that we were seeking that death and decisions about death should be taken normally and appropriately with families and medical advisers, without the hurdle of an artificial, judicial-level process which would take away the very autonomy of the individual that we are trying to achieve.

Some of those concerned about the Bill worry that dying people may opt for an assisted death because they feel, or are made to feel, that they are a burden. I believe that the ability for the certifying doctors to seek additional evidence, should pressure be suspected, is an important safeguard and should be clarified in the code of practice that the Bill enables. If the law is passed, the ability for patients to have a full and transparent upfront discussion with the certifying doctors about all the options, and the recording of those discussions, would add a further safeguard.

18 July 2014 : Column 871

At the moment, under the current legislation, we simply do not know whether pressure is being exerted or not. An estimated 300 people are helped to die each year by friends and family, an estimated 1,000 people are assisted to die by medical practitioners and a number of people travel to Dignitas. We do not, at the moment, under the current legislation, know at all whether they have been put under pressure.

We all consider the impact of any decision we make on those who are close to us. We take it into account in decisions such as choosing which movie we go to with the family or what job we are going to take or deciding whether we are going to move house to a different part of the country. It is appropriate that we take the emotions of the people around us into account when we are making an important decision about our death—that is part of human life. The evidence from Washington is that concerns about loss of autonomy and loss of dignity, and the prospect of a struggling, joyless end, figure far higher in people’s decisions to seek assistance to die than feeling that they are a burden.

If the Bill passes, people will not have to choose assisted dying. I have had to have quite distressing correspondence and e-mails with people who seem to think that, if the Bill goes through, they will have to choose to die. They will not have to choose to die; they will have the right to choose the death that they think best. I commend the bravery and energy of the noble and learned Lord, Lord Falconer, and his team in promoting the Bill and call on the House to allow it to proceed to a full and proper analysis in Committee. That is where our House excels, with its wealth of expertise in tackling these very difficult issues.

4.32 pm

Lord Berkeley of Knighton (CB): My Lords, they said that this would probably be the hottest day of the year and, emotionally and intellectually, I think they were probably right. The noble Lord, Lord Alli, hit the nail on the head when he said that there are no absolute rights or wrongs in this; we all bring our own feelings to it and it is impossible to say something is absolutely right or absolutely wrong. The letters we have all received are so deeply moving and passionate about the perceived primacy of their position that I found them to make almost unbearable reading—particularly those, which in my case were in the majority, that recount the helplessness of watching a loved one die in agony. One farmer told me that if he allowed his animals to die in this way he would be locked up.

Consultants in palliative care, who have been very persuasive in what they have said, say that nobody should suffer in this day and age in that way. However, they still do: the evidence is there in the letters and is all too familiar to families up and down the land. As a young man, I worked for a while as a phlebotomist at St Bartholomew’s Hospital. It is strange to reflect that since those days, and in the aftermath of the appalling deeds of Harold Shipman, doctors have in many ways found themselves hamstrung in their dealings with the terminally ill and the dying. The days are gone when a country GP visiting a patient he or she has known for decades could quietly and gently ease them on their way. Perhaps some still do—I know many doctors who have done it. However, in curtailing

18 July 2014 : Column 872

the ability to carry out this compassionate care, through the forensic analysis of deaths, I believe we have created the need for the Bill of the noble and learned Lord, Lord Falconer.

We have heard very strong medical and legal arguments, which nobody of intellect could simply dismiss. I certainly do not and, rather, would love to see them used to improve the Bill, which I still support.

The church seems divided on this issue and rightly talks of the sanctity of life. There could be no greater subscriber to the sanctity of life than me, but surely part of that sanctity is constituted by—how can I put this?—a sacred stillness, a dignity, a precious humanity that is undone by rendering a dying human being into a screaming animal, a shadow of their former and real self, utterly deprived of the inalienable right of personal autonomy. Here we come to that great conundrum of faith. No one from the church or anywhere else has ever been able to explain to me how I should try to comprehend the notion that an all-seeing, all-merciful God would want this sort of terrible suffering to be endured rather than relieved.

A natural death is what we all hope for, and we would all like to think that, if needed, we would be given enough drugs to make us comfortable, but what if, to achieve that, a doctor prescribes so much morphine that it leads to depression of the respiratory system, bringing about death or, perhaps, the old man’s friend, pneumonia? My father, who had severe Alzheimer’s, got, as I prayed he would, pneumonia. I had months before asked the sister in charge that, should that be the case, please not to treat it with antibiotics. He slipped into a peaceful coma. Yet was I not in one sense part of an assisted death? Are we are not dealing in semantics in saying that a withdrawal of treatment is not actively bringing life to an end? Is this Bill not in a way simply spelling out, trying to clarify, the right of each and every one of us to have the final decision about our lives should disaster strike and to have as peaceful a death as possible?

4.36 pm

Baroness Kennedy of The Shaws (Lab): My Lords, this is one of the most challenging moral issues of our times. On the one hand, we are dealing with the right to individual autonomy and to bodily integrity, and with the right to make decisions about our own lives. So it is a profound issue of human rights. On the other hand, there is the need to preserve the wider fabric of an ethical society with an overriding principle that human life is to be valued and guarded against violation and abuse.

That is the bigger picture of sustaining the culture in which human rights, particularly those of the vulnerable, will be protected. This Bill, I have no doubt, is derived from good motives. I respect the aims of those who wish to relieve the suffering of people at the last stages of their life. But it is about respecting the individual. The conception of human rights that we have developed in Europe is different from that in America. We believe that it is not all about individual rights; it is about striking a balance with other rights and it is always about considering the impact on wider society. It is why we here find it so baffling that in the United States

18 July 2014 : Column 873

they cannot get control of their gun laws, because the individual right trumps the needs of the wider community. That is not so here.

This Bill carries us unfortunately across a line. It takes us to a different place and to deny that is not right. I believe that it will change the moral landscape. The question is whether we are creating a climate of greater compassion or stimulating a climate of chillier decision-making. Are we raising the bar of humanity or are we creating a society where our ethics are made of coarser cloth? We could with good intentions be planting a seed that bears unexpected fruit, so that we end up with different calibrations about the quality of life and about humanity. What is exceptional today so easily becomes standardised tomorrow. Sometimes that is to the good, but sometimes it is to the bad.

It is a fundamental principle of law that we should safeguard life—it is an absolute principle—and I think that it is too important for us to abandon it. Like the noble Lord, Lord Macdonald, I am concerned that this Bill creates immunity from inquiry, and I would like to hear more from the movers of the Bill about that matter. Is there to be no inquest after a death, so long as it ostensibly conforms to the Bill, with the forms filled and the consents secured? Is there to be no examination of the quality of the consent or the judgment of the doctors? Perhaps it is my experience as a criminal lawyer that makes me concerned about such total immunity from the processes of law and how the malign or reckless can misuse such processes. As the former Director of Public Prosecutions, the noble Lord, Lord Macdonald, said, these cases are currently examined. They cross the desk of not just any prosecutor but of the most senior in the land. In virtually every case nowadays, there is no action. However, it is important for people to know that there will be close consideration of the process and that there will be consequences for wrongdoing, because that is what prevents abuse.

We must ask ourselves whether this legislation will lead progressively to other changes in end-of-life care that we would not want to see, even if we can decide when the end of life is imminent—and I question whether we are able to do that with much success. It is inevitable that the creation of powers of attorney will be the next step. We can be sure that people will say, “I’d like to be able to name a person to whom I will give a proxy consent, so that when I lose my faculties they can make the decision for me”. Many would want to see that happen.

Like everyone, I am moved by the terrible stories of miserable ends. I think that sometimes doctors err too much on the side of caution in assisting the gentle passage of the dying because we have created a society laden with fear of accusation and litigation. We need to do more about the adequate training of all doctors in dealing with pain and death. Nor are we supporting doctors and nurses well enough as they make difficult decisions. Our medical world has been infected by a model of care that is increasingly commercialised. Reforms to our health and care system are reducing trust between patients and their carers—their doctors and nurses—and sometimes reducing compassion because there is so much pressure on the time of the carers.

18 July 2014 : Column 874

Relationships are built through consistency and time spent, as they were in the past when we had the GP whom we knew, rather than saw someone different every time, and there were teams who consistently worked together with sets of patients. However, I am afraid time is in short supply in our market-driven regimes.

I share concerns about the pressure that we put on the aged and the disabled, expressed powerfully by many in this debate. I know that choice is the great aim of our age—choice in all things, as though we were all shopping. But who gets the choices? How many people in our communities have real choice? The issue of choice is a snare and a lure. I look around and I think that compassion is in short supply. Our society is becoming a harder place—harder on the elderly, the young, offenders, the unemployed and the poor. Society is full of people who have very few choices.

We must be careful about creating huge moral changes when we see austerity policies already having such an impact on the disadvantaged. We keep being told that this is just a small step and we will not go further. However, I am afraid I am not so sanguine about our society’s sensibilities. I look around and see such cruelty to refugees and asylum seekers. I see what is happening to the destitute and the effect of cuts on the poor. I am not so confident that our expressions of altruism can be relied on into the future. I am not so sure that there is enough commitment to the vulnerable.

Changing law is very important. Law is the bedrock of our nation; it is at its foundation. Some laws matter more than others, and this law will certainly matter. It speaks to who we are and how we want to be. Law is our national autobiography. There are good chapters and bad chapters. We should be very careful about what we are writing now.

4.44 pm

Lord Rees of Ludlow (CB): My Lords, we have all been much influenced and moved by the letters we have received and we surely all welcome the extensive discussion that the Bill has catalysed in the media. However, all this has perhaps obscured how circumscribed the Bill is. It identifies a small category of person to whom the general law against assisted suicide should not apply, allowing those of sound mind and firm intent with a terminal disease to end their lives in a time and place of their choosing, rather than suffer a lingering decline marked by loss of autonomy and pain that can be eased only by drugs that blur the mind. It is estimated that only two people in every thousand would choose that route, although many more of us would be comforted by knowing that the option was available.

Very few people consider extension of life at all costs to be a moral imperative. We can already make choices that make our lives shorter. We can ask not to be resuscitated if we have heart failure; we can decline invasive cancer treatment; we can be prescribed pain-relieving drugs that have the secondary effect of hastening death. None the less, some survive beyond the stage where they feel that life is worth living. That is why 300 people a year with terminal illnesses commit suicide. That is why about 30 make the one-way trip to Switzerland and why the lives of loved ones are sometimes ended

18 July 2014 : Column 875

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.

So the Bill should be welcomed. Unlike the present DPP guidelines, it mandates upfront safeguards and greater clarity than what now prevails. It is a misperception that support for the Bill betokens less admiration for the hospice movement or less motive to enhance palliative care. We surely need to prioritise those and, incidentally, the tackling of mental illness more broadly, and to support the far larger numbers who are driven to suicide by depression or social deprivation.

Likewise, it is a misperception that the Bill would render disabled and vulnerable individuals vulnerable to being threatened or pressurised. That concern has been expressed movingly by the noble Baroness, Lady Campbell, and others, but some offer contrary perspectives, including Professor Stephen Hawking, my colleague for 40 years. His crescendo of achievement against all the odds has been astonishing. He still craves new experiences and absolutely does not want to die. He thinks that suicide would be wrong unless one were in great pain, which, thankfully, he is not, but—this is the key point—he says that, none the less, the disabled should have the option, as others do, to choose to end their lives. Like him, I firmly support the Bill, although the safeguards may need scrutiny, especially the six-month rule and, perhaps, the need to assess emotional state as well as intellectual competence.

We in this House are not obliged to follow popular opinion, but it would surely be wrong if we did not fully scrutinise a measure with such broad national support.

4.48 pm

Lord Finkelstein (Con): My Lords, when Harold Macmillan was asked by Rab Butler in 1961 to legalise suicide, he replied: “I do not see the point of it. It is just to please a few cranky Peers”. He said that he thought that the voters would be unimpressed if the best that the Tories could boast after 10 years in office was that people were free to go ahead and kill themselves.

Let me briefly explain why the Assisted Dying Bill is not just about a few cranky Peers and why I welcome its introduction. I thank noble Lords for many wonderful speeches, which have been a privilege to listen to, particularly those noble Lords who have been brave enough to share their stories of the deaths of relatives. The question before us is not whether there ought to be a choice about how to die. That question has been answered by medical science: there is a choice. The question is, therefore, who makes that choice: whether I am allowed to make it for myself or whether the state should make it for me. The suggestion that I may not be able to make a good choice—that I may make it for the wrong reasons or under the wrong influences—is an argument that can be used against allowing people control over almost anything important. In fact, the noble Baroness, Lady Kennedy of The Shaws, made that point almost exactly.

I remember, when running for Parliament, encountering a woman who told me that she was not going to vote Conservative because she thought that William Hague

18 July 2014 : Column 876

had a silly voice. “If you don’t mind me saying so”, I replied, “that’s not a very good reason”. “I do mind you saying so”, she said, “because it’s my reason”. It was her reason; she was entitled to it.

Failing to legislate for assisted dying is substituting our reason—Parliament’s reason and the state’s reason—for that of the dying person on the grounds that we are of sound mind and strong, and the dying person is not. We are even doing this explicitly. We say, for instance, that people should not have this power because they might use it as a result of a fear of being a burden on their relatives. But why should that feeling be illegitimate? Not wanting to be a burden is a perfectly understandable and naturally human attitude. One might try to dissuade a relative—one certainly would in my case—but it is wrong to make that emotion illegal. The state is arguing, “If you don’t mind us saying so, that isn’t a very good reason”. I want people to be able to reply, “I do mind you saying so, because it is my reason”.

We are told that this choice is different from others because it is a matter of life and death, but it is not. The Bill is for the terminally ill, so it is not about a matter of life and death but about the manner of life and death and over that—in harmony, of course, with the rights of others—I should be able to exert control. Of course, the vulnerable should be protected. The law should not allow anybody to tell anybody else how to die. However, that is an argument for the Bill, not against it.

If the growth in abortion is a convincing argument against legalising assisted dying, it must surely be an even more convincing argument against legalising abortion. Yet very few, or a minority, in this House would hazard that we should make abortion entirely illegal. The supporters of the Bill seem to be asking for something that is very modest but also basic in a free society. We live as free people and now we want the right to die as we have lived.

4.51 pm

Baroness Turner of Camden (Lab): My Lords, I support the Bill. I have listened with interest to a number of noble Lords who have spoken in opposition to it this afternoon but I have still not changed my mind. I have received more letters on this subject than on any other that has been before the House. The majority of the letters that I have seen have been in favour of the Bill.

Like many other noble Lords, I have friends who are, sadly, no longer with us and I think that most of them would have supported the Bill if they were aware of it. One of my friends died recently. When she found out how ill she was, she refused to eat. In fact, what she did was to starve herself to death. That was terribly sad. Something like that should not happen to anybody.

I believe that there are adequate safeguards in the Bill against individuals being pressured. It is clear that the decision has to be taken by the individual who is ill, not by relatives, neighbours or friends—not even by doctors. It is very important that the individual who is most affected has the job of making the decision for himself or herself. Also, two doctors must certify

18 July 2014 : Column 877

that the individual is terminally ill and in a position to make his or her desires clear and that they have the capacity to do so. Moreover, the individual must be told of palliative and hospice care, as well as other sorts of care that are available. In other words, there are attempts in the Bill to make sure that there are adequate safeguards against people being processed in a direction which they do not want to go in.

Some Members have been saying that disabled people and elderly people would sometimes feel threatened. I do not think so. The intention is to ensure that that is not the case and that the individual concerned has been certified, more or less, to be in a dangerous situation. If they do not have the option available in the Bill, they may well face many weeks—perhaps even months—of pain and suffering. I do not think that anybody in this House would want to see that. I therefore support the Bill and I hope that we shall proceed with it by giving it a Second Reading and moving on to Committee. I believe that this is a matter for Parliament and that Parliament should do its job by making sure that the Bill eventually proceeds with the support of both Houses and lands on the statute book.

4.54 pm

Baroness Howe of Idlicote (CB): My Lords, it has been an amazing day so far. I think that we are about three-quarters of the way through. Like the noble Baroness, Lady Turner, I have had amazing numbers of letters. I have the solid bunch of them all here with me and every single one of them is against the Bill. It is only fair to put that into the balance.

The last time that the House was asked to consider a Bill to legalise what is being called “assisted dying” was shortly after I joined it. The first thing that I did when I saw the Bill tabled by the noble and learned Lord, Lord Falconer, was to look back at the Bill that the noble Lord, Lord Joffe, presented to the House eight years ago. The thing that struck me immediately was the title. The noble Lord, Lord Joffe, presented the Assisted Dying for the Terminally Ill Bill, but this Bill is the Assisted Dying Bill. Is that just an attempt at brevity or is it significant? The noble and learned Lord is insistent that his Bill would not offer assistance with suicide to anyone who was not terminally ill, but I cannot help thinking that, if I were presenting such a Bill and I had in mind that it might subsequently be extended, I might well think that it ought to have the more general title of Assisted Dying Bill rather than the narrow one that the noble Lord, Lord Joffe, used eight years ago. But maybe I am being overly suspicious.

Moving on from the title, I noted that the Bill of the noble Lord, Lord Joffe, set out a procedure for a doctor who supplied lethal drugs to a patient to report doing so. It also contained provisions for a monitoring commission to examine these reports to ensure that the law had been complied with. Yet when I turned to the Bill of the noble and learned Lord, Lord Falconer, I saw none of this. There is no requirement for a doctor to report, nor is there an arrangement for ensuring that the terms of the law have been observed. The Bill of the noble Lord, Lord Joffe, contained a

18 July 2014 : Column 878

requirement, in line with the Oregon assisted-suicide law, that a doctor who had any doubts about the mental health of a person seeking assisted suicide must refer that patient for specialist examination. Once again, there is nothing like that in the Bill of the noble and learned Lord, Lord Falconer.

I raise these issues because those who argue for a law of this nature are insistent about what they call upfront safeguards, but there is nothing upfront or indeed safeguarding here. All that the Bill contains are broad and general statements of whom it is meant to apply to. These are not safeguards. It is not enough to say that having two doctors agreeing on a request is a safeguard. This is quite literally a life-or-death Bill and we need to be able to assess whether it is safe to unleash it on the public.

We are told that all this will be settled later by others and that we should focus on the principles of the Bill. Surely, though, safeguarding the public is itself a central principle of all legislation. To give the green light to a Bill with such far-reaching consequences for the safety of vulnerable people simply on the basis that it sounds fine in principle, without being given even a hint of how those people might be protected, would be nothing short of a dereliction of our duty as legislators.

4.59 pm

Lord Haworth (Lab): My Lords, it is exactly 10 years this week since I joined your Lordships’ House but this is the first time that I have spoken in a debate on this subject. Throughout all that time, assisted dying has remained one of the most vexed and divisive unresolved issues, but I believe that public opinion is changing.

I do not personally have a religious or principled objection to assisted dying or assisted suicide but I found myself unable to support the Bill of the noble Lord, Lord Joffe, in 2006 because I had been hugely impressed by the arguments of those who opposed the Bill and who argued for better palliative care as the answer, particularly the noble Baroness, Lady Finlay, whom the whole House rightly respects and admires. I was deeply worried about the slippery slope argument that a change in the law would somehow inevitably morph into something different and undesirable where an elderly person or perhaps a disabled person would find themselves increasingly pressurised into ending their life prematurely.

Down the years I have wrestled very hard with these points, and I have changed my mind. I believe that this Bill deals clearly and convincingly with these worries. It is tightly drawn. It does not permit assistance to die for anyone who is not already terminally ill. Indeed, as has been pointed out, this may be its biggest shortcoming in that it will not offer comfort to those who wish to be released from their unbearable suffering because they cannot be diagnosed as actually terminally ill. I have no ready answer to that except to say that if the public and Parliament were to want at some point in the future to modify the tightly drawn categories or relax the safeguards, there would clearly need to be fresh primary legislation. This Bill is not the thin end of the wedge.

18 July 2014 : Column 879

This Bill will give reassurance and peace of mind to an admittedly small number of people who fear that their impending death will be painful and their suffering unbearable. This is a humane measure and the evidence suggests that it has widespread public support. My mailbag suggests the same. I have received many very moving letters over the past few weeks from real people, by which I mean from individuals rather than from campaigning organisations or organised lobbying, and the letters I have received have been almost all—not quite all, but about 90%—in favour of the Bill. They also appear mostly to have been written by elderly people and often refer to some previous experience of the painful and distressing death of a loved one. They express a strong desire to have the right and ability to end their own life in a manner and time of their choice.

Not every dying person wants to have palliative care, even if it is widely and freely available. If people approaching the end of their life seek that degree of ultimate personal autonomy, and provided they have mental capacity and a settled view, the law should not deny them.

5.02 pm

Lord Phillips of Sudbury (LD): My Lords, like other noble Lords, I thank those who have brought this Bill before us. I particularly thank the noble Lord, Lord Joffe, who has been the hero of this cause for more years than it would be polite of me to mention. He is still with us and still giving us the benefit of his advice. We must also thank the noble and learned Lord, Lord Falconer, for having taken on leadership of this cause. Like other noble Lords, I thank the extraordinary number of people who have written. I do not know about other noble Lords, but I expect all of us have had extraordinarily moving letters—not Cyclostyle letters with just a name at the beginning and a name at the end, but very particular, individual and moving letters. I am sure they have moved all of us and given us more wisdom and determination to scrutinise this Bill in subsequent readings to make sure that if it goes though, it goes though in the best possible form.

I should say very briefly that at the beginning of my legal career, a long time ago, I was a coroner’s officer for many years and sat occasionally as a coroner. I was also a family lawyer and worked for 10 years for the Samaritans, so one way or another I have seen quite a lot of the pressures of life, suicide and all the rest of it, and that very much affects my view now.

This is without question an epochal Bill and, because it is genuinely that, I suspect that the public have never been more interested in what we are talking about and the way we are talking about it. The fact that it is so fundamental a change brings out the cautious side in me and in many noble Lords.

The other thing that must be made clear is that there are no perfect answers. Quite a lot of the speeches today—and how wonderful they have been—have implied that there is a perfect answer one way or the other, but there is not. As a long-in-the-tooth lawyer, I can assure noble Lords that this is a heck of a messy terrain and there is no conceivable way of wrapping it

18 July 2014 : Column 880

up neatly so that it is waterproof and watertight. It is impossible. In the end you have to come down more on one side of the answer than on the other; more on safety and caution, perhaps—I do not know because it is not the right language. There is no competition in compassion either. I am sure that we have all been moved by the plight of people. I will not name those who have spoken, but we have heard some extraordinary examples of that plight this very day.

I would also like to say that whether or not one kills oneself is not an individual decision. It is surely one of those situations that John Donne would have been thinking of when he said:

“No man is an Island, entire of itself”.

There is no conceivable way that me killing myself is just for me. It is not just a question of the repercussions for one’s family, there are repercussions for society as well. I have to admit that I am very concerned about that because of the pressure that will inadvertently be brought to bear on vulnerable people if this measure goes through. It is absolutely certain to happen, and I believe that it will happen often. I do not think that we should pretend that by tinkering with the language we can overcome that problem because it is huge.

I want to say a brief word about the context in which we are discussing the Bill; it is one that is in marked contrast to Oregon. We are not a nice country state; we are an urbanised, mobile and materialist culture in which loneliness and distress are rampant. They play straight into the argument vis-à-vis pressure on individuals when they feel that they are offending their relatives, outliving their days, or whatever else it might be. I believe that the status quo is actually not bad. The DPP has made it clear that he deals with things personally; I think that we have had only one prosecution. We therefore should not assume that we can easily improve on that.

Finally, the onus in this great debate should surely be on the movers of the Bill to satisfy the House that the fears which have been expressed and the anxieties that are felt can be better dealt with by this legislation than by the status quo.

5.07 pm

Lord Kerr of Kinlochard (CB): My Lords, I am not sure about that. I find all this very difficult, and this excellent debate makes it no easier. I am envious of those for whom it is clear and set out in black and white, but it seems to me to be a matter of balance. One is balancing personal autonomy against society’s rules, prohibitions and taboos, and that is difficult. I have huge respect for those who argue against the Bill, and in particular I have huge respect for the noble Baroness, Lady Grey-Thompson, but I do not think that she is being quite fair when she urges the noble and learned Lord, Lord Falconer, to quantify what would be the precise effect in terms of the number of cases if his option became the law of the land. He has given the Oregon numbers—80 cases out of 30,000 deaths annually—but we all know that in Oregon there are many more people who equip themselves for an assisted death but in the end do not choose to go that way. What they were seeking was the comfort of knowing that they had the option.

18 July 2014 : Column 881

Moreover, if we turn the question put by the noble Baroness, Lady Grey-Thompson, on its head, no one here knows for sure—with all due respect to the noble Baroness, Lady Young of Old Scone, and her estimates—what the numbers are in this country right now. No one knows how many people currently try to do an amateur job on themselves and botch it. No one knows how many are helped by compassionate friends, relatives, nurses or doctors running the risk of a police investigation. Lastly, no one knows about the ill intentioned. The noble Lord, Lord Tebbit, has said that the Bill is a, “breeding ground for vultures”. Well, if there are vultures around, they must be out there now because, presumably, they are not sitting on the benches waiting for the Bill.

What about the safeguards? There would be two doctors, acting independently, and four tests, including the doctors’ need to satisfy themselves that the decision the patient was making was informed, voluntary and free from pressure. Will those safeguards not reduce opportunities for ill intention? It is quite hard to see how we could increase them. Does the noble Lord, Lord Mawhinney, really believe that no one now is persuaded to worry about becoming a burden on others—that that risk will arise only if the Bill becomes law? The noble Baroness, Lady Finlay, was very critical of the safeguards; she mentioned Dr Shipman, as did the noble Baroness, Lady Masham. My respect for the medical profession is rather greater than that. However, whether the safeguards are sufficient or not seems to be an excellent issue to explore in Committee.

Finally, I hear the slippery-slope argument. I heard it brilliantly argued by the noble Lord, Lord Brennan; we also heard it from the noble Lord, Lord McColl, and it was very strikingly argued by the noble Lord, Lord Haworth. The noble and learned Lord, Lord Falconer, gave the answer to it in advance. The law would not change again unless Parliament changed it. That is the correct answer to the slippery-slope argument. However, I can see that the slippery-slopists have a point. The Mansfield judgment was followed in due course by the Wilberforce Bill and the abolition of slavery. We used to hang little boys for pinching a purse. In the end, we now do not hang anyone at all. Society’s rules on the rules changed; the point of balance moved. Currently, public opinion is clearly behind the law; the DPP, wisely, applies the law only partially. The Supreme Court has nudged us to revisit the law. The status quo—with respect to the noble Lord, Lord Phillips—is a mess. That is why it is right that the Bill should proceed. I pay tribute to its opponents, who have agreed that that should be the case.

5.11 pm

Lord Hollick (Lab): My Lords, I, like other noble Lords, have been deeply moved by the many personal letters that I have received from those diagnosed with a terminal illness, and from their relatives and the relatives of those who have died after enduring long and painful illnesses. Those letters were on both sides of the argument, but the stories and testimonies provide a context so we can understand what is in their minds and what their concerns are. The concern of many is to be able to take a degree of control at the very end of

18 July 2014 : Column 882

their life. I respect that, and I think most of us would respect it as well. Many are prepared to endure great suffering, eased by palliative care, while others wish for a swifter end to avoid the suffering, indignity and helplessness of their last days. Faith provides an important guide, and indeed an inspiration for many, but not all those of faith reach the same conclusion.

None of us can truly know how we will respond until our time comes. Will we wish to do all that we can to live for a little while longer, despite the pain, or will we want it to end sooner? Frankly, I do not know how I will answer that question, but I know that I want everybody to have that choice. The manner of one’s going should be a matter of personal choice. The right to die in peace is surely a personal choice, which should be upheld and recognised in law. It is wrong that a person should be forced to endure great suffering because of the genuinely strongly held views of others. We live in a democracy where citizens have the right in personal matters to make up their own minds and to act accordingly. Society should respect and protect the right to choose how you wish to die in the same way we respect other important personal freedoms.

Many important freedoms have been protected by law over the last 50 years. The right to make a choice to end your life in peace and dignity if you suffer from a terminal illness is a freedom which must also be protected and entrenched by law. The Bill will do that, and in so doing will enhance our freedoms and provide proper protection to those who help us to die as we choose. It will replace the rather murky, opaque and confusing status quo that we now have, where there is a lack of transparency and accountability. It will offer those whose only option—we have heard testimony on this today—is to starve themselves to death in lonely isolation.

The Bill is tightly drawn to permit only those with all their faculties intact, who have been diagnosed terminally ill and can be reasonably expected to die in six months, to choose the time of their death. In Committee, the Bill must be carefully scrutinised to ensure that, in both its principles and in its detailed implementation, it strikes the right balance between freedom to choose and the important protection of the vulnerable from harm. For instance, we must look carefully at the clause that defines terminally ill as someone who,

“is reasonably expected to die within six months”.

Many of us know people, or know of people, who have outlived that prediction, sometimes by many years. With medical advances, forecasting will become ever more treacherous. Perhaps a shorter period would provide greater certainty and assurance. How are the two registered medical practitioners to satisfy themselves that the decision to end life,

“has been reached voluntarily, on an informed basis and without coercion or duress”?

Key principles of the Bill will be underpinned by codes of practice, which in this instance we will wish to scrutinise most carefully.

There is much work to be done, and do it we must—otherwise the Supreme Court will take it out of our hands. This is an important and timely Bill, which is widely supported in the country, and it has my full support.

18 July 2014 : Column 883

5.16 pm

Lord Rowe-Beddoe (CB): My Lords, I wonder how many noble Lords have seen a poster on the wall of Westminster Underground Station commending legislation on assisted suicide. The poster bears words typical of the sleight of hand that some campaigning for this legislation have used. It says, “No more will die, but fewer will suffer”. Let us look at that statement for a moment. It is telling us that, if we agree to change the law and supply terminally ill people with lethal drugs so that they can end their lives, no more people will die as a result. That is self-evident, I suppose—but the same argument will surely be used to justify supplying lethal drugs to anyone else, because we are all going to die sooner or later. If we die by suicide, in the words of the poster, “No more will die”. It is a very dangerous statement.

A fundamental issue here is not how many people are going to die, for as many of us will die as are alive. That is clear. A fundamental issue is how many deaths by suicide we are prepared to assist. As a society, we go to considerable lengths to discourage and prevent suicide deaths, and rightly so. But the noble and learned Lord’s Bill, whatever its good intentions, stands this on its head. It is saying, in effect, that there are some people whose suicides we should actually assist. This difficulty cannot be explained away simply by redesignating assisted suicide as assisted dying; it is assisted suicide, and the face of the Bill should so reflect. The package should accurately describe the contents. I was pleased to hear as the debate went on how more Peers were using the word suicide rather than dying.

Although the Bill will not result in more deaths—it could not do that even if it wished—it will clearly increase the number of suicides. Oregon and Washington have already gone down that road, and we see a steadily up trend in deaths from assisted suicide, in Oregon’s case punctuated by occasional dips while in Washington the rise has been steep and relentless. The death rate from this source has more than tripled in four years. In 2012 there were 4,800 suicides in England and Wales. Taking Oregon’s current death rate from assisted suicide, referred to by the noble Baroness, Lady Grey-Thompson, some 1,200 assisted suicide deaths can be expected here annually. Would these be additional suicides or would there be an overlap between the two? There is no hard evidence, obviously, but the number of suicide deaths to be expected from this Bill is significant enough, I suggest, to make us stop and think, and think again.

Let us therefore reflect on the deeply moving and most eloquent contribution of the noble Baroness, Lady Campbell of Surbiton, and the vitally important nursing voice that was given us by the noble Lord, Lord MacKenzie of Culkein. Let us also remember the slippery slope mentioned by so many of your Lordships today, and which the noble Baroness, Lady Cumberlege, more accurately renamed a slow-moving glacier. Let us recall the 1960s for a moment, which saw, inter alia, abortion legislation with all its safeguards. Today, you cannot find them; they are unrecognisable.

Let me say a final word, as a former deputy-chairman of the United Kingdom Statistics Authority—I am

18 July 2014 : Column 884

sorry that my noble friend Lord Moser is not in his place. I am aware that responses to polls are heavily dependent on the drafting of the questions.

5.20 pm

Lord Judd (Lab): My Lords, no one who has sat through this debate could possibly imagine that there is not an immense amount of work to be done in Committee. The complexity of the issue has become increasingly clear. The sincere and convincing convictions of people on both sides of the argument have been very forcefully expressed. Like many others, I have wavered on this issue. I have given it a great deal of thought and, indeed, it has caused me a certain amount of anguish. However, at the end of the day, two prevailing principles have swayed me firmly to support the Bill. First, if you believe in the right to life and that it must be protected at all costs, you cannot dodge the secondary question about what life is. If a person has reached a stage at which they say, “What I am going through and experiencing cannot be described as life, as I understand it”, how can those of us who believe in life, if it is to have any sense, meaning or fulfilment, possibly reject that request? That is one of the arguments.

I have toyed very much with the question of whether I should present my next argument. I regard myself as being at the social end of Christianity. My Christian values affect very much what I am about in life. To me, what is really important in those values is love. There have been honest and brave references to love—not just compassion, but love—in this debate. As someone who takes second place to no one in the argument about the importance of love in our society, I say to those in the Christian church who have come to a different view that it is because of how I understand love that I have come to the conclusion that the situations with which we are dealing will sometimes demand the action which this proposed legislation envisages.

We have to return to the front. We have all had a mass of correspondence from people on both sides of the argument and I have been very impressed by it. Noble Lords will know how, when you are getting such correspondence, one letter particularly hits you and stays with you. I want to read one letter that I received. It states:

“My uncle, a foreman toolmaker and a strapping six-footer who played football for the works team, developed cancer of the spine. He screamed until all his strength was gone, then he whimpered like a puppy. Twenty-four hours before he died his wife implored their GP to stop his pain. The GP replied: ‘I dare not give him any more morphine. It would kill him’. Twenty-four hours later the cancer had killed him”.

These are some of the harsh realities in the front line of what is happening. I have the privilege to be deeply involved in the work of Hospice at Home West Cumbria, of which I am president. I was having a conversation with the chairman last weekend about some of the issues we face and the things we want to do. I asked him about the Bill. He is a fine man, a doctor with years of wide experience and deeply committed. He said several things and I asked, “Can I quote you?”. He said, “Yes, of course you can”. He said, “First of all, the devil is in the detail”. That is why your Lordships’ scrutiny in Committee will be so

18 July 2014 : Column 885

important because, in the end, does the Bill really do what we want to do in the way we want to do it? “Secondly”, he said, “I am worried about this mental capacity issue. In terms of my experience, how certain are we that people have the mental capacity in their situation in order to make a rational decision?”.

In this debate, we should have been talking far more about palliative care. I have limitless regard for the quality of work being done in hospices across the country—the dedication, devotion and effective work by so many volunteers and staff. However, one of the things that is so crucial, which we have come to see in west Cumbria, is that part and parcel of the care for the patient is also the support work and counselling for the family. If we are taking this Bill seriously there has to be a real choice for the people about whom we are talking. That means: is there a convincing alternative that meets the situation? We all know that palliative care is patchy in this country. Some of it is very good and very advanced but it is not available to everybody on the scale it should be. That should be a priority, as should be the training of doctors who in the course of their work will spend an increasing proportion of their time dealing with the dying.

5.27 pm

Lord Gold (Con): My Lords, be under no illusion as to what will happen next if this Bill becomes law. Pressure will mount for further change. Whatever those supporting this Bill may believe or say, this will be the start of creeping euthanasia.

In the lead-up to this important debate today, we have seen much press reporting of heart-rending cases of really ill or disabled people who support a change in the law. The recent Supreme Court case brought by Paul Lamb and the family of Tony Nicklinson has highlighted the plight of patients who suffer acute physical incapacity. However, in Mr Lamb’s case, he is not “terminally ill” within the definition of the Bill; he is not reasonably expected to die within six months and would therefore not be entitled to seek assistance for his suicide if the Bill became law.

That is the case of many people supporting this Bill. Inevitably, it is only a matter of time before they seek a further change in the law to enable them to end their lives. Those noble Lords who might doubt this should look at how legislation of this kind has developed in Belgium and the Netherlands. Euthanasia for adults was legalised in both countries in 2002 and the number of deaths by euthanasia has increased substantially. It is expected to reach 6,000 this year in the Netherlands. This steep rise has been put down to the introduction of six mobile euthanasia units which travel around the country. With more than 70% of doctors in this country being opposed to this Bill, I believe that we will see a similar development. The noble and learned Baroness, Lady Butler-Sloss, asked where people will find a doctor. They will find them travelling around the country, looking for patients. Belgium now permits euthanasia for children. Identical twins Marc and Eddy Verbessem were both killed by lethal injection in December 2012, not because they were terminally ill, but because they were born deaf and were going blind.

18 July 2014 : Column 886

The supporters of the Bill claim that they have provided adequate safeguards. These safeguards are fundamentally flawed. They will not prevent abuse. First, they do not protect against doctors getting it wrong or acting badly. Secondly, the two certifying doctors may have known the patient for only a very short time. Will they truly be able to say that the decision to commit suicide was voluntarily made? The Bill requires that the patient must have capacity to make the decision to end their own life. We know that many terminally ill patients suffer from clinical depression. Does such a patient have the capacity to decide to end their own life? How are these short-term doctors, travelling around the country, able to certify capacity?

I am worried about abuse in the form of what I will call low-key coercion: subliminal messages coming from what appears to be well-thinking family members, demonstrating to their loved ones how distressed they are at the condition they are in, at the pain they are experiencing. They will say, “We will be there with you. We will be with you constantly to give support”. We know from research undertaken in the United States that the majority of patients who have suffered assisted suicide have done so out of compassion for their family and loved ones, not because they have formed a clear and certain intention to end their own lives. Add to that the subliminal coercion to which I have referred and we have a most worrying risk that the Bill demonstrably fails to address.

We are concerned with some of the most vulnerable people in our society, whom I believe we in this House have a duty to protect. By passing this law, I truly believe that we will be failing to discharge that duty for the vast majority of these people, purportedly by giving a choice to some. What we should be concentrating on is not making it easier for patients to choose death. We should be concentrating on life and on improving the care of the terminally ill. We can deal with pain far better today, but let us really work on enhancing the quality of life for the terminally ill in their final days.

5.33 pm

Lord Low of Dalston (CB): My Lords, I echo the tributes that have been paid to those who have brought this legislation before the House; to those who have written to us, often by hand, with moving and compelling testimony; and to the quality of the debate. The Bill arouses strong passions, but it behoves us to approach it in as dispassionate a manner as we can. The speeches we have heard have largely done that.

There is little doubt that the Bill is wanted. I have had people come up to me in the street, urging me to support it. My postbag has been running 4:1 in favour, closely reflecting the sentiments of the general public. One woman told me her dog had had a better death than her mother; another said her grandmother died under harrowing circumstances, palliative care having proved entirely inadequate.

I want to concentrate on just one area of the debate: the impact on disabled people. It is said that the Bill defines terminal illness in such a way as to encompass large numbers of people with chronic conditions and disabilities, as well as terminal illnesses. However, this is not the case. It is a very narrowly and

18 July 2014 : Column 887

precisely targeted measure aimed at assisting those who are terminally ill to avoid further suffering by assisting them to take their own life. It does not license voluntary euthanasia by authorising someone to take the life of a person not covered by the Bill. It relates only to someone who is likely to die within six months and is mentally competent in making the request for assistance to die. It would not license assisting someone who is simply disabled, having, say, broken their neck playing rugby or, as in some recent cases, someone who suffers from locked-in syndrome, although there may be some overlap at the margins, it is perfectly possible to distinguish between the disabled and the terminally ill. I am disabled but I am certainly not terminally ill, as is plain for anyone to see.

It is said that the Bill gives carte blanche to anyone who thinks that a disabled person’s life is not worth living, but what is forgotten here is that, all importantly, the disabled person has to ask. Questions of the robustness of safeguards do not arise until that hurdle has been cleared. So the Bill actually protects anyone who does not have a terminal illness and it will give dying adults peace of mind. As the poster says, no more people will die as a result of a change in the law, and not just self-evidently, as the noble Lord, Lord Rowe-Beddoe, says; importantly, I would stress, fewer people will suffer.

The leaders of disabled people say that disabled people are against assisted dying, but that is not borne out by the facts. It is not just particular individuals like me who take a different view; as a YouGov poll recently found, 79% of registered disabled people, very much in line with the rest of the population, support assisted dying for adults of sound mind with a terminal illness.

The argument for assisted dying is fundamentally that it gives people choice and control at the end of life. It is curious that the leaders of disabled people campaign for choice and control in every other aspect of life but balk at it in this one. I wish to speak for the overwhelming majority of disabled people who do not welcome the tendentious advocacy of their self-appointed spokespersons but, rather, wish to see this Bill progress. I very much hope that the noble Lord, Lord Cormack, for whom I have the greatest respect, would also want to listen to that majority and not just to the vocal and articulate minority.

5.37 pm

Baroness Sherlock (Lab): My Lords, it is always hard in such an important debate to find myself on the opposite side from colleagues for whom I have both respect and affection, but I cannot support this Bill.

It is a privilege to have been trusted with so many personal stories both in person and in writing. The moving accounts of those who have endured the misery of watching someone they love die slowly weigh very heavily on me, but I have been equally moved by stories of the unexpected richness of the period before death, including the beautiful article by the right reverend Prelate the Bishop of Worcester, who wrote in the Guardian of the death of his wife, Denise, as referred to by the most reverend Primate the Archbishop of York.

18 July 2014 : Column 888

It has been argued today that this is primarily a question of autonomy. We are told that only a small number would exercise the right to assisted suicide under the Bill but that their wish to do so must be taken seriously. I agree. However, although the wishes of the individual are of enormous importance, in this as in every other policy matter, those wishes must be balanced with the needs and interests of society as a whole. That argument, as well as the arguments made from compassion, requires us to evaluate the impact on others of granting this right to some people.

First, doctors would have to help them to die, and most medics and medical organisations that I have heard from are wholly opposed to this Bill. Seventy-seven per cent of GPs told their royal college that they oppose legalisation, as do the medical royal colleges. They do so in part because they recognise the asymmetry of the doctor-patient relationship, and I confess that I worry about the effect on that relationship of introducing assisted suicide as a tool in the doctor’s bag.

What of the wider impact on others? Notwithstanding the speech of the noble Lord, Lord Low, for whom I have a great deal of respect, I was profoundly moved by the speeches of the noble Baronesses, Lady Campbell of Surbiton and Lady Grey-Thomson. It must give us pause for thought that the majority of groups working with disabled people and representing them oppose assisted suicide, including Scope, Mencap and Disability Rights UK. They do so because they fear that we would see the spread of the view that life is not worth living or that their lives are worth less than those of others. If this Bill were to have the unintended consequence of reinforcing that view, we would all be the losers. I also worry about where the interests of the state lie. If the state or its agents cannot kill people or help them to die then it must treat them and it must care for them, and that will always be more expensive.

I come to the slippery slope argument, which was attacked by my noble friend Lord Harrison. There are times when that argument is deployed weakly, but this is not one of them. Today it is illegal for a doctor to give lethal drugs to a patient with the intention of killing him or her. If this Bill passes, it will not be illegal in certain circumstances for a doctor to do just that, although there is clearly not yet clarity on which circumstances would be covered by it. However, for the slippery slope argument to fail, the Bill’s supporters would need to make clear a case for the provisions in this Bill that would not apply to a wider group. The two main arguments that we have heard advanced today are on the autonomy of the individual and compassion for suffering and distress. I have heard no arguments advanced as to why those cases apply only to those covered by the Bill and not to those who may be suffering but are not imminently about to die, or who may have a range of other concerns but could be affected, including the cases articulated by the noble and right reverend Lord, Lord Carey. This Bill has no safeguards and I hope that it will not pass. However, I hope that it will go into Committee. I support the suggestion of a royal commission to look at it.

Personally, I dread the possibility of being a burden. But another way to express that is that I would be reliant on other people to care for me. I confess that in the times of my life when I have been dependent,

18 July 2014 : Column 889

I have hated it; but I have also gained profoundly from it, and the relationship with those who cared for me has been one of the biggest gifts of my life. I confess to an increasing emphasis in our society that independence is always good and dependence is always bad, and it makes me worry about the way that we treat sick, disabled and vulnerable people. Moving on from today’s debate, if every one of us who has spoken today could commit ourselves to going out and campaigning just as strongly for the kind of care we ourselves would want for those who want to live, and not just for those who want to die, something very good could come out of today.

5.42 pm

Lord Stevens of Kirkwhelpington (CB): My Lords, I too would like to draw attention to the amount of correspondence that I have received, as well as the number of telephone calls and conversations in the street. There is no doubt whatever that this is one of the major issues of our time, so I too commend those who brought this Bill in front of the House. I am in general agreement on the issue of assisted dying if it preserves dignity in death and reduces pain and suffering—the choice of a so-called good death. However, there have to be proper safeguards, safeguards which have to be credible and tested.

There is undoubtedly confusion about what this Bill is about, some of which has been addressed by the noble Lord, Lord Berkeley. Some 12 months ago, my family and I had to make a difficult decision about a very close loved one, as to whether she should be resuscitated. We decided against. In conversations with my family and others, some have said to me that this Bill addresses those issues and is similar in that respect. I do not believe that it is, but we have to bear that in mind.

What is certain is that there needs to be certainty in the law. The noble Lord, Lord Macdonald, the previous DPP, has basically plugged the gap. He did a superb job in his directions as the DPP, leaving the police, as my noble friend Lord Blair of Boughton illustrated, with some difficult decisions in sudden and suspicious deaths. As a junior and then a senior detective I went to hundreds of sudden and suspicious deaths, and it was one of the more difficult things that I had to judge and decide on. We in this place should be providing a certainty in law that gives those at the very front line of these issues—the police officers who go to these instances and are rightly called on to investigate—a certainty in how to deal with them. I believe that that is not too much to ask for.

Although I support the Bill in general, I have concerns about a prediction of six months of life. I have seen many cases, and heard noble Lords relate many cases, that demonstrate the uncertainties surrounding such predictions. I have massive admiration for the medical profession, but it is a nonsense that people can say that someone will definitely die within six months. That needs to be addressed.

I worry about the elderly being pressurised. I worry about the question of the agreement of two doctors being a sufficient safeguard. The Abortion Act and what has happened since is in itself evidence that that

18 July 2014 : Column 890

is not good enough. I firmly believe that there should be some judicial safeguards to what we do. But the Bill must go forward. It must go to Committee. It must be discussed. We have been given the responsibility of delivering answers to safeguard the dignity of the vulnerable and the dying. To do nothing is not an option.

5.45 pm

Lord Morrow (DUP): My Lords, we have heard much in this debate today about choice and compassion, so it is perhaps not unreasonable to look carefully at some of the claims we have heard as well as examine the noble and learned Lord’s Bill and ask ourselves to what extent it accords with these principles. We are regularly told by proponents of the Bill that there is overwhelming support for allowing assisted suicide. The contention that between 70% and 80% of the public support this Bill is presented as a foundational justification for the Bill before us today. But how robust is that? Polling conducted last weekend by ComRes for the charity CARE and published by various media outlets today, including the Telegraph, confirms that 73% of people support assisted suicide while 12% oppose it. However, when people are informed about the various public safety considerations, those figures change dramatically. Some 42% of those who initially supported the idea of assisted suicide change their minds. The end result is that the 73% in favour to 12% against becomes 43% in favour to 43% against.

Facts are what matter in this debate. When people are presented with the facts and the complex reality of assisted suicide sinks in, it is clear that there is no apparent consensus among the populace that the proposed change is desirable. Then we are assured by the noble and learned Lord, Lord Falconer, that his Bill facilitates assistance for suicide for terminally ill people and no one else. But if compassion is an underlying principle of his Bill, where does that leave people with distressing, incurable illnesses that are not terminal? On what grounds does the noble and learned Lord exclude them from something that he clearly sees as a benefit?

Again, if autonomy and choice are underlying principles of the Bill, where does that leave people who are suffering but physically unable to end their own lives if supplied with lethal drugs for that purpose? I say this not as a supporter of the noble and learned Lord’s Bill—far from it—but to highlight the fact that inconsistencies such as these cause many people to worry that a law to assist the suicides of terminally ill people will not stop there.

We do not have to look far to see that happening. In Holland and Belgium, assisted suicide and euthanasia are now being offered to categories of people such as those with mental health problems and children who were not intended to be recipients when those laws were enacted only a few years ago. The noble and learned Lord will no doubt say that his Bill is modelled not on Dutch or Belgian legislation but on the assisted suicide law in Oregon. But let us ask ourselves what is the more appropriate comparator for assessing how an assisted dying law would work in this country—a small, sparsely populated and largely rural state on the far side of America or a densely populated and urbanised country just across the North Sea on the edge of Europe?

18 July 2014 : Column 891

Rachel Cohen-Rottenberg, a writer and graduate student who advocates for disability rights and justice, writes:

“Advocates for death with dignity believe that they can put enough safeguards in place”.

However, what happens to people who are sick, in pain and alone, who do not realise that they have worth? They do not realise that we can fight the idea that it is better to be dead than ill or disabled. Their reaction to fear cannot be surrender, not when life is at stake.

Pressure on vulnerable people at the end of life is not novel or imagined, it is very real. It is truly life or death. We have already been warned in the press last week by Professor Theo Boer of the regulators of the Netherlands’ euthanasia law not to go there by changing our law. He was a supporter of the Netherlands’ euthanasia law when it was passed 12 years ago, but soaring death rates and elastic interpretation of the law have convinced him that the mere existence of a law licensing assisted suicide for euthanasia is an invitation to resort to it. Fear of dying, or even of dying badly, should not be motivation for assisted suicide but motivation for improved care. As proof, Boer warns, the issue of assisted suicide represented in the Bill before us today is a genie we should not let out of the bottle.

Many today have made reference to their postbags. I, too, have a postbag, and mine is running at 20:1 against the Bill. I am not talking about Northern Ireland as a region; I am talking about the whole of the United Kingdom.

5.51 pm

Lord Haskel (Lab): My Lords, like many other noble Lords, I want your Lordships to let the Bill proceed so that we can legislate in our usual, well established manner—especially as the Bill is a matter of individual conscience. There is no right answer. Yes, this is a Private Member’s Bill but the same arguments prevail. It is far easier to introduce a Private Member’s Bill in this House, and that is why I have always felt that it is our duty—our constitutional duty, as my noble friend Lady Jay put it—to do so.

We consider Bills in detail. Generally, we have more time and we often have more relevant experience—and, yes, we are less politicised—whereas, in the other place, sometimes large chunks of legislation are not even considered in Committee. That is why we need to debate the Bill in this House and then pass it to the elected House.

Some want the law changed. Some do not. Some want clarification. For my part, I would like to see the law changed. Fortunately for me, death and dying is pretty unfamiliar territory. As I learn more about this from the many letters that I have received, most of which are in favour, and hearing about the experience of others, I certainly want the law to be more compassionate and understanding of unnecessary suffering so that people do not suffer to satisfy my conscience or because they are not able to go to Switzerland.

We also have to move with the times. As a society, we are becoming a lot more aware of choice. Personal choice has become one of our freedoms. As a result,

18 July 2014 : Column 892

our society is moving away from moral certainties towards personal choice. The Bill reflects this.

When considering legislation, public safety has to be at the top of our list of concerns. The law must protect the citizen from the slippery slope, so that assisted dying does not become assisted suicide or dying for the convenience of others. Many noble Lords have expressed this concern, but the law protects society from many other slippery slopes. I do not see why it cannot do so in this case.

I, too, want to be sure that there are safeguards against coercion and depression; that there is consideration for those who believe in the sanctity of life, respect for those who are conscientious objectors and respect for the concerns of the disabled; and that such a change in the law should not diminish the importance and provision of palliative care and hospice care. I want to see respect for the concerns of doctors and nurses, because it is their skill, professional standards and dedication on which this Bill will depend.

I believe that this Bill begins to address those concerns, but they need to be tested—although not by a commission, as other noble Lords have suggested. We tried that in 2006 and, as the noble Lord, Lord Blair, and the noble Baroness, Lady Young, told us, it did not work. Our concerns must be tested in detail in the same way that they are addressed when we debate all legislation. Our concerns will be tested several times as the Bill passes through its various stages, which brings me back to where I started. The way to deal with this emotional, difficult and controversial legislation is to follow our well trodden path. I hope that noble Lords will give this Bill a Second Reading.

5.56 pm

Baroness Emerton (CB): My Lords, the Bill proposes a major change in the criminal law. The title used for the previous Bill was assisted suicide, while this one is assisted dying. “Assisted dying” is a much more attractive term to the public, and I think it has attracted the large number of letters that we have all had. We have to address this, as many noble Lords have said, by seeing that there are enough safeguards to protect people from thinking that they are going to commit suicide. There is a difference between assisted dying and suicide.

I declare an interest, having been 60 years in the caring profession of nursing and as a carer for an elderly, mentally ill friend. My experience in learning disabilities taught me much about the vulnerability and needs not only of patients but of their families. Many of the elderly population today have seen life through two world wars, as well as Iraq and Afghanistan, and understand only too well the preciousness of the word “life”. I live in a retirement development and see 250 people who are over the age of 60. They are concerned for the future.

Recently, Dr John Ashton, president of the Faculty of Public Health, announced his support for the Bill and suggested that, to meet the plight of the elderly, a midwife-type person was required. Midwives are trained to preserve life and work to ensure the safety of mother and baby. What is being proposed in the Bill as it stands at the moment is the exact opposite: it is

18 July 2014 : Column 893

about providing the means to commit suicide. What we need is not legalised help with suicide but much better and larger palliative care provision. We have had comments on palliative care, and I agree entirely that this country has a high reputation for palliative care provision. Its quality is outstanding but there is just not enough and it is not wide enough to meet the need. The noble Lord, Lord Judd, made an impassioned request that this be looked at, which I would support.

In the last eight months, I have been an in-patient in the care of the NHS and the private sector, and a visitor in an NHS hospital where the red flag had gone up and the emergency beds opened. In each case, I witnessed the best possible care being delivered to a very vulnerable group of elderly patients, both in the NHS and in the private sector, including to patients at the end of life, who were receiving the highest level of care. In one establishment, I had to commend very much the multi-professional team that visited each end-of-life patient every morning and had a conference, and the families were involved as well. There is good end-of-life care, but we need to do more.

The Bill before us, as other noble Lords have said, affects medical and healthcare professionals. The Royal College of Nursing, with 415,000 members, adopted a stance of neutrality in 2009, when the previous Bill on assisted suicide was debated. Since then, much research into good practice for end-of-life care has taken place. The RCN has published guidelines and has been careful to see that they are established across the nursing profession.

I pose the question: is this a responsibility that doctors and nurses want to take on or should take on? I believe that very few of them want to do so. It is on the real assisted dying—on supporting and caring for patients as they die—that we in this House should focus our attention, and not on the assisted suicide that this Bill is offering under the name.

6.01 pm

Lord Vinson (Con): My Lords, I support the Bill and come from a background of active churchwardens and general practitioners. I am now 80 and am beginning to do a bit of forward planning.

My doctor forebears, in a much less regulated world, applied common sense when coping with life and death. They applied the Hippocratic oath, but they also had at the back of their mind:

“Thou shalt not kill; but need’st not strive

Officiously to keep alive”.

Rules designed to prevent inappropriate outcomes often prevent doctors doing what they think is right, leaving little room for natural morality for fear of prosecution—a point well made by many other speakers today. I hope that this Bill, if it passes—which I believe it will, no doubt with amendments—will help them with their duties and enable them to be even more compassionate.

However, like other noble Lords, I have received many heartfelt letters from those who are against these measures. The common theme is that we must not introduce the Bill because the vulnerable might—I repeat, might—suffer. I understand the concern, but

18 July 2014 : Column 894

does it not beg the question what one is to do about those who are suffering both mentally and physically? Should their needs not also be looked at and should they be denied? However, so anxious are those who oppose the Bill to prevent the vulnerable suffering, which I understand, that they sent me a series of letters. Perhaps I may quote from some of them. The key view that they promoted—like the reverend Prelate the Bishop of Bristol, who I am sure is not a callous man—was that “suffering should not trump all other considerations”. I felt that this was a choice example of preaching what you do not practise. That is carrying the precautionary principle too far. Others have rights, too, and I think that the relief of suffering should trump all other considerations, and that is as near an absolute as one is likely to get. That is why this Bill is important.

When I was ennobled, I chose as my motto, “No freedom without choice”. People should have the right to choose. Freedom begins with freedom of choice and should be extended as widely as possible into all areas of society at all levels. The proposals in the Bill, sensibly regulated, will give greater freedom to people to control their lives—and whose life is it anyway? They will relieve suffering, both mental and physical. The prospect of palliative care in itself gives no reassurance against suffering, but the provisions in the Bill can give that reassurance if the option is either used or unused.

This is an important Bill. It achieves many things. It advances choice; it deepens compassion; and it reduces suffering. We should support it.

6.04 pm

Lord Layard (Lab): My Lords, I support the Bill for many reasons, but time is passing so I want to focus on just one, which is the feeling of being a burden to your family and friends. That issue was highlighted in the letter to the Times from opponents of the Bill. As they rightly pointed out, 61% of people who chose to die in Washington gave as one reason that they did not want to be a burden to their family and friends. That is a fact, but the opponents of the Bill then go on in that letter, and in today’s debate, to infer that if the Bill was passed there would therefore be more pressure on people from family and friends to make this choice. We do not need speculative inference; we have 17 years of evidence from Oregon, where no single instance of undue pressure from family and friends has been discovered. Unless British people are more heartless than Americans, I do not think it is at all proper to conduct an argument not by looking at evidence but just by speculating about what might happen if we did something.

There is also a separate moral issue that has been raised by the Bill’s opponents: is it all right if people take into account the effect on family and friends when they make a decision as important as this? The noble Baroness, Lady Warnock, said everything that there is to be said on this, but I will just say it again because it is such an important point. The main point of that letter is that it is shocking that people should take this into account. However, every moral theory that I have ever heard of encourages us to take into account the effect of our decisions on other people. Why should that principle suddenly cease to apply as a

18 July 2014 : Column 895

person approaches death? If a person is going to die an agonising death, that person is not the only one who will be traumatised. Their family and friends will be traumatised, too. Not only will they lose their loved one; they will be left with horrible memories for the rest of their lives. So if a dying person wants to take that sort of thing into account, how on earth can it be a bad form of motivation? I find it a very peculiar argument. Of course, not everyone will want to. Some people will and others will not, but surely that should be their choice. Why should we prevent people taking altruistic decisions if they want to? Why should we think it particularly shocking if they decide to do this on altruistic grounds?

I come to my concluding points. We have no evidence that the Bill will lead to greater pressure from family and friends and good evidence that it will not. Therefore, because there is not that—if you like—atmospheric effect, the standard principle of a liberal society surely applies in this case. We all know what the fundamental principle of a liberal society is. People on all sides of this House regularly say that a person should be free to do what they want unless it harms someone else. That is the aim of the Bill.

6.08 pm

Lord Pearson of Rannoch (UKIP): My Lords, having listened to all the speeches so far, a point occurs to me that has not yet been made. This is that many, perhaps most, noble Lords who believe in a better life hereafter are against the Bill, while many of those who may believe that death is the end seem to be rather in favour of it. I am happy to exclude from this analysis the noble Baroness, Lady Richardson, and the former Archbishop of Canterbury, the noble and right reverend Lord, Lord Carey, and congratulate them on their courageous and powerful speeches.

However, I would ask other Christian noble Lords and the faith communities generally: why are they so afraid of death? We are all afraid of death, of course. We all know people who have said during their lives that if the day comes when they can no longer look after themselves, they want to be moved on, but who, when they get there, want to cling on to the bitter end. This Bill is helpful because it allows those who are suffering so much that they no longer want to cling on to choose death.

I felt I should speak today because some 37 years ago, I had what is usually called a near-death experience. I was having a two-hour operation, when the anaesthetic steadily failed although the paralysing drug continued to work. In that circumstance, when you cannot scream or even flick an eyelid as the pain grows steadily to the point of endurance and beyond and you know that it will get even worse, there are three routes open to you. You can go mad; you can die; or you can go somewhere indescribably wonderful. Of course, noble and Europhile Lords will have concluded long ago that I took the route to madness; and noble and scientific and humanist Lords may say that my experience of going somewhere which was all the opposite of pain, which was of limitless peace, light, justice, warmth, compassion, love and much more, was merely the release of endorphins in the brain. Who knows? They may be right. Their lack of faith makes them need that sort of explanation.

18 July 2014 : Column 896

But for me, and for thousands of others who have had the same sort of experience, they are wrong. Where we went was and remains real.

I fear that those noble and Christian Lords who oppose the Bill because it breaches the sanctity of human life may not have got that quite right either. I am no theologian, but it seems to me that Jesus Christ was somewhat careless with his own earthly life. After all, he did not need to go to Gethsemane and the cross. He knew that he would be on his way to a terribly painful death; and, perhaps, he was not so sure of his resurrection either, when he cried out from the cross,

“My God, my God, why hast thou forsaken me?”.

I hope that this does not irritate my Christian friends too much. After 37 years ruminating on my experience, I have other heretical doubts, such as whether God really is almighty, or whether good may have always been equal to evil. It seems to me that if Christianity and other faiths were less sure of the eventual supremacy of their God, or the eternal force of good, they might do more to fight the eternal force of evil, or the devil. And the answer to that otherwise unanswerable question, “Why does a loving, all-powerful God permit such terrible suffering in our world?”, might be that he does not; it is just that he cannot stop it; he needs our help in the eternal struggle.

I suggest that the Bill gives us the chance to help to reduce just a little of that suffering, by allowing those who want to relieve their own agony to do just that. We and they should be confident that they are moving on to somewhere immeasurably better. I support the Bill.

6.12 pm

Baroness Mallalieu (Lab): My Lords, the law in this area is a mess. It has continued in that form for so long because of a degree of selective blindness on the part of doctors, police and the prosecuting authorities but, one way or another, it is just about to change. The noble and learned Lord, Lord Falconer, has, I think, earned 10 out of 10 for courage in raising again an issue which Parliament has so far repeatedly shied away from. Other noble Lords—in particular, the noble Baroness, Lady Jay, and the noble and learned Lord, Lord Brown of Eaton-under-Heywood—have mentioned the Supreme Court’s judgment in the Nicklinson and Lamb cases. The references that some noble Lords have made about hoping to be able to stop the Bill later indicate that the full implications of that judgment are not being appreciated. There is a strong probability that on the very next appeal on this issue, the relevant provisions of the Suicide Act will be found inconsistent with the European Convention on Human Rights, which provides the right to private and family life.

In the Nicklinson case, two of the five justices would have made the declaration there and then; the other three said that they would prefer to give Parliament an opportunity to decide on it first. This is that opportunity. If we do not take it, it will not be long before there will be a declaration of incompatibility, and the Government will then be forced to bring forward legislation under pressure and in haste. This is our opportunity to legislate carefully and with proper consideration.

18 July 2014 : Column 897

I support the Bill. If and when I know that I am close to death, I want to know that a provision such as this is available to me, whether or not I decide to use it in the end. So, I believe, do the majority of people in this country. This is a measure whose time has come. It may be a strong word but I believe that the law at present is cruel. The many letters that I have had illustrate that all too clearly, as did the noble Lord, Lord Judd, in the powerful letter that he read to us. To say to a dying person, a mentally competent adult, “You must continue to suffer unbearable indignity or pain, which defies respite, for as long as it takes despite your clear and settled wish to end your life”, is to deliberately cause unnecessary suffering. That is the definition of cruelty.

Nor do I believe that the prolonging of suffering for one individual can possibly be justified by concern for possible vulnerable people elsewhere, who might be put under pressure from unscrupulous relatives—the vultures to which the noble Lord, Lord Tebbit, referred—to do the same, by feeling that they are a burden to others. I have no doubt that there are such people now, as the law stands, but rejecting the Bill will do nothing for those vulnerable people or their situation. If there is a solution to that problem it must surely lie, if it is possible, in changing society’s attitudes to the old, the disabled and the vulnerable. Perhaps that is beginning to happen, but all too slowly.

Would the Bill make their position worse? If there is evidence of people now buying one-way tickets to Switzerland for their old relatives, or calling in a man from Exit—or referring them, as they can so easily do, to the internet—to polish off vulnerable relatives, I have not heard of it. However, that would be a great deal easier to organise than going through the hoops and hurdles of this very modest Bill. That old friend, the slippery slope, has been raised far too many times but I cannot see any gradient in the Bill or scope for extension. Indeed, any of the other categories that people have mentioned would require primary legislation, which would no doubt be informed by the way that this limited measure works in practice.

Like others, I admire those who offer palliative care and the wonderful work of the hospices but for some, those simply cannot provide the answer or the relief from suffering. I also respect those who have spoken from strong religious belief of the sanctity of life, but they should not try to impose their certainties on others who do not share them. If you do not like it, you do not have to have anything at all to do with it. Of course, in many cases we cannot choose the way that we die. Perhaps many of us are hoping to die quietly in our beds, with our family around us, or we may expire from emotional exhaustion after listening to 128 excellent speeches on the hottest day of the year. Yet it must be a right, when possible, to let dying people choose the time and the place. While 70% of us want to die at home, sadly, only 18% manage to do so currently. We should be trying to change that. Experience has shown that relatively few people will choose to use this provision but the fact that it is there will give great comfort to many, of whom I am one.

18 July 2014 : Column 898

6.18 pm

Baroness Berridge (Con): My Lords, as the youngest Peer speaking today, I suppose that I should be the least concerned about a Bill dealing with death. However, I believe that it is mine and younger generations who could be most affected by the Bill. We will live out the effects of the erosion of the social norm that we not only dissuade suicide but positively protect people from taking their lives, whoever they are.

The suspect in the custody suite and the convicted criminal in prison are put on suicide watch if necessary. Paracetamol packets are now limited to 32 tablets, Beachy Head is patrolled and the Golden Gate Bridge will soon have a net. King Edgar criminalised attempting suicide—ironically, probably to have men to fight wars—but we want our population alive as we are all equally precious. I have read with interest the reasoning in Hansard in 1961. The law criminalises assistance at a time of someone’s greatest vulnerability: when contemplating taking one’s own life. Although suicide and prostitution are not appropriate to be crimes, assisting suicide and controlling prostitution for gain are. The criminal law is upholding societal values. You may walk past the man on the bridge who is about to jump, as you are not required to rescue him, but if you intervene you do so to preserve life.

Noble Lords need only go online to see how necessary this reasoning is, and how relevant it is to the challenges that today’s young people face. Tallulah Wilson’s mother stated that companies should,

“withdraw their advertising from those sites who continue to host inappropriate self-harming and suicide-promoting blogs to stop this poison spreading”.

Her 15 year-old daughter, caught in a toxic digital world, threw herself under a train. offers “Suicidal Tendencies” music, and it is estimated that between one in 12 and one in 15 young people in the UK self-harm. I contacted the vicar of a busy Oxford church who has spent years dealing with students—there are 1,200 in his congregation—and said, “What about self-harm?”. His text reply was, “EPIDEMIC”.

We are so much more than autonomy. Even in our youth we are actually dependent and often weak and vulnerable. Society’s value of human dignity cannot be collapsed into mere autonomy, as the Bill seeks to do. “Are you not compassionate to these people’s suffering and their right to choose?”, you might ask me. Of course I am, but law is about more than a small group of individuals’ rights against the state. Herein lies the main weakness of our human rights law; it fails to take into account the rights of the rest of society. I am a supporter of the European convention. We may be heading towards the constitutional irony that even if there were a declaration of incompatibility, Parliament could leave the law unchanged and we might in fact find ourselves backed by the Strasbourg court rather than undermined.

Law creates culture and affects the values of future generations. The decision to give health professionals, of all people, a role in assisting suicide would inevitably send a message about suicide itself and cannot be vacuum-packed away from the rest of our society. We legislate for a real and deeply imperfect world, a world not of speculation but of Westbourne View and Mid Staffordshire hospital—a world where increasingly you

18 July 2014 : Column 899

are valuable only if you are productive, good-looking, rich or in the media regularly. However, we also legislate now for a virtual world that is often explored only by the young, and is often far scarier and far more difficult to police. The Bill undermines the societal value that we discourage suicide, and for this and other reasons I oppose it.

6.22 pm

Baroness Flather (CB): My Lords, I thank all the people who have written to me. Reading all those letters has been a slightly life-changing experience. As other noble Lords have said, both the pain expressed in them and the opposing arguments have been extremely valuable, and I thank every single person who wrote.

I have always supported similar Bills. When we had the first debate on the Bill brought forward by the noble Lord, Lord Joffe, I said that if my disabled husband asked me to help him to die and there was no legal provision, I would still do it out of compassion and love and it would not matter what happened to me. He received two e-mails the next day to say, “Watch out for that woman”. But he is still here; he was here today. Incidentally, he wanted me to tell disabled people here and everywhere that he is tetraplegic. He was diagnosed with MS in 1983 and he has been getting progressively more disabled but he says that disabled people should always have exactly the same rights as able-bodied people and it will be their choice.

The Bill is about choice; it is not about forcing. Somehow or other it seems to have taken on a sort of hue of people being forced into asking to die. I have no intention of asking to die, but I do not want to go through a whole lot of pain. Medical science has made great progress. What has happened as a result is not just that things can be cured, as there are many things that cannot be cured, but that we can be kept lingering on for very much longer than used to be the case only a little while ago. It was seen as futile to keep people going on with life when life itself was not life. I still believe that to get rid of all pain we will have to be put in the twilight zone. I do not think that is life. I would not like to be in the twilight zone to say that my pain has gone.

We have had a few words about faith and how the faith communities should get together. As a woman, I tell you that I do not have much faith in faith. Women have not been protected by any of the faiths. Faith communities are free and able and can do what they like. This law is not about forcing anybody—I beg your pardon: this Bill. I am just being optimistic. This Bill is not about forcing anybody. This Bill is not about coercing anybody. In fact, when the time comes to debate it, we should have some system of monitoring decisions, which would be very much better for people who are worried about the possibility.

The noble Lord, Lord Tebbit, talked about vultures. I can tell him that there are plenty of vultures now, perhaps even more than there are likely to be if we pass the Bill. We talk about Shipman. Another Shipman could not happen if we brought this Bill in. It would not be possible for us to have another Shipman.

I am running out of time and I have so much more to say. I listened to the lady who is in charge of implementing the Oregon scheme. I was hugely impressed

18 July 2014 : Column 900

by her. She said she started by being against and that bit by bit she realised the need for it. She said that only half the people take the medication which is given to them. She said something which I would like your Lordships to think about carefully. They do not take it because they have a plan. They know what is going to happen, if they need it. They have a plan. I think every human being needs a plan in their life for their death.

6.27 pm

Lord Wills (Lab): My Lords, like many others, I have struggled to reach a definitive view on this Bill, not least because of the many moving letters I have received on both sides of the argument, but in the end I decided that I cannot support it. The Bill addresses the nature and value of human life and such profound issues should not be influenced by opinion polls, which are just snapshots of the popular mood where the answer is determined so much by the way the question is asked. They should not be influenced by PR campaigns, and the experience of other countries should not be determinative. The exemplars for the changes proposed in the Bill are small states that are significantly different from this country, although of course there are lessons that might be learnt from them.

As other speakers have said, making the decision on principle is difficult because the issue pits two generally accepted goods against each another: on the one hand, the autonomy and freedom of the individual, and on the other the sanctity of life. How each of us strikes that balance will be influenced by personal circumstances, including our own life and religious faith. I should declare that I lack religious faith but that my decision has been influenced by the death of my mother.

I accept that the Bill strives to strike a balance between these two principles, but I think it gets it wrong because I believe it will start a process in which the safeguards against the taking of life will continue to be eroded and, as a result, greater harm will be done if this Bill becomes law than if it does not. My concern flows from the fact that the two, linked, principles that appear to underpin the Bill—the right to the individual's autonomy over their own life and the right to end intolerable suffering—are not clearly reflected in the drafting. If the guiding principle is one of autonomy, then a time limit transgresses it. If the guiding principle is one of relief from intolerable suffering, why should a time limit be imposed when the longer the suffering, the greater the case for such relief? In those circumstances, if the Bill becomes law and the principles underpinning it become established, I cannot imagine how, over time, legislators will be able politically to resist the claims of those who argue for an extension of the right to an assisted death. I cite the case, for example, of a diagnosis of an invariably fatal illness such as mesothelioma, where the prognosis is clear and involves great suffering for which very little effective palliative care is available but where the progress of the disease may take 18 months.

The difficulties of definition in the drafting of the Bill, about which other speakers have already said a great deal today, could, over time, further encourage the erosion of the safeguards which almost everyone in your Lordships’ House today seems to agree should

18 July 2014 : Column 901

be there. There may be a case for assisted dying on demand in cases of intolerable and unrelievable suffering, but that is not what we are debating today, and yet that is where we could well end up if this Bill becomes law. And I fear that.

The more the scope for assisted dying is widened, the greater is the potential for abusive pressure on the physically and mentally frail to end their lives. I do not share the idealism of other noble Lords that such pressure will never take place. It will often be subtle and difficult to protect against, and certainly this Bill offers no adequate protections. The more such abuses happen, the more thoroughly our society will be brutalised. The more that the law, which reflects and sets standards for our society, allows that to happen, the more thoroughly our society will be brutalised.

Finally, I want briefly to raise one other subsidiary concern about the Bill and that is the wide and imprecise scope it gives to the state in Clauses 4 and 8. I believe it is wrong that the state should be given such power over the taking of life. In my view, these clauses are unacceptable as they extend executive power into areas where it should have no place. My view that this Bill strikes the balance between competing principles in the wrong place is strengthened by the guidelines issued by the DPP in 2010 which, wisely and compassionately, address the widespread concerns that were raised the last time this issue was debated in your Lordships’ House about the position of loved ones who assist suicide.

By opposing this Bill, I must accept that I am supporting the continuation of suffering in particular cases. But I have, with great difficulty, concluded that to support the Bill would, over time, also result in suffering and abuse and the brutalising of our society. I cannot support it.

6.32 pm

Baroness Brinton (LD): My Lords, I am sure that I am not the only late speaker who has had to tear up their speech and start again after many of the points I had intended to make have been made by others. As a disabled and Christian woman, I support the Bill. I was very moved by the words of the noble and right reverend Lord, Lord Carey, and the noble Baroness, Lady Richardson of Calow, setting the very difficult issues around death in God’s love and compassion. But I want to use my four minutes to explode some of the myths that we have heard in the debate. My noble friend Lord Hylton said that those with chronic diseases are particularly worried about the Bill, while the noble Baroness, Lady Masham, said that disabled people must not be made to feel worthless. Well, this disabled woman with a chronic life-limiting illness, rheumatoid arthritis, does not feel worthless or worried because the safeguards offered in the Bill are so tightly drawn that it would take major legislation to amend them.

Some of the speeches in your Lordships’ House today have either ignored those safeguards or tried to say that it does not matter what they are—that it will be a slippery slope towards euthanasia. But these safeguards are even stronger than in Oregon, and much more tightly drawn than in the Netherlands. That is as it should be. We need to reassure people

18 July 2014 : Column 902

about where the boundaries lie. Not many people know that, very rarely, rheumatoid arthritis can be fatal. Although I did not know her, I admired Emma Suddaby, a blogger with the

Shropshire Star

who had long-term, aggressive and then final-stage disease. She died earlier this year, and around the time she was told that she was terminally ill, she wrote the following:

“I don’t think anyone is afraid of dying, what they are afraid of is ending up in a hospital bed, being hoisted from here to there, legs akimbo, dignity ditto, pain creeping ever higher up the scale and only then realising there is only so much a doctor can do—a very scary realisation, let me tell you.

I can only liken it to being trapped in a tall building which is going up in flames. Desperately fleeing up one corridor and down another, finding exit doors, joyfully wrenching them open only to find them locked and bolted, all escape routes barred. It’s a desperate feeling. It would be enough for some people just to know there is a way open to them, should they need it.

Most, I’m sure would end up not taking their leave until nature intended. It would be enough for them just to know there is a way out should things get too ugly”.

Emma’s words summarise the experience found in Oregon. Of every 200 terminally ill patients who go through the approval process with doctors, counselling and discussion with their families, only two get the prescription filled out, and only one will use the drugs to end their life.

Every doctor and nurse I know wants palliative care to be available for terminally ill patients, and our hospice movement is the best in the world. However, it is not universal, and some diseases mean that death can be very difficult and unpleasant. In this day and age, with more patient involvement and understanding of their illnesses than ever before, the Bill allows them, with real safeguards, to have death in the way that they want, having had the opportunity to say farewell to those they love.

That was not the case for a close family friend of ours who suffered from late-stage MS, who killed himself—in the traditional way, with plastic bags and barbiturates—when his wife was away for two days, because he was so fearful that she would be arrested and charged with helping him. He had wanted to be open with her, but could not, so he died alone, and she found him. The Bill will allow us to be honest—with ourselves, our families, our doctors and as a society. It will allow the dying individual the choice, should he or she wish it, and will provide law to prevent abuse by others.

6.36 pm

Lord Alton of Liverpool (CB): My Lords, since the noble and learned Lord, Lord Falconer of Thoroton, laid the Bill before your Lordships’ House, I have argued that it should be given a proper, considered appraisal in Committee, and nothing that has happened in today’s debate has changed my view about that. This has been a thoughtful and at times very moving debate, on all sides of the argument. However, I express some surprise that the Bill was not laid first before the elected House. After all, it is not as if we have not given this issue any previous consideration.

When the House last asked the question, “Is it possible to allow assisted suicide for a determined few, without putting much larger numbers of others at risk?”, it concluded that it is not. It did so after exhaustive deliberation. The Select Committee, which

18 July 2014 : Column 903

was chaired with such distinction by the noble and learned Lord, Lord Mackay of Clashfern, covered some 246


columns, two volumes of 800 pages, asked 2,460 questions, considered 14,000 letters, and took evidence in four jurisdictions. Since then, the principles involved and the challenges we face have not changed, and there is no consensus and no settled view, as the debate in your Lordships’ House today has demonstrated.

That is reflected in society at large. Consider just two editorials that appeared at different ends of the spectrum in this morning’s newspapers. The Guardian newspaper said that the Bill,

“would create a new moral landscape. It is also, potentially, open to abuse”.

It concluded:

“Reshaping the moral landscape is no alternative to cherishing life and the living”.

The Daily Telegraph said:

“The more assisted dying is discussed, the more its risks will become apparent”.

That point was made very well by the noble Lord, Lord Wills, a few moments ago.

Another reason why the Bill should go into Committee is that the fear that those remarks underline was revealed in a poll referred to earlier on, published only yesterday by ComRes. Yes; it shows that support for assisted suicide has been at 73%, but as soon as the question is asked, “Would you support it if it jeopardised public safety?” that falls to 43%, which, of course, means that it is entirely evenly matched on both sides. As we know, the questions that are asked in those polls are the issue. Prudential judgment is required by Parliament. After all, as a young Member of the House of Commons I was constantly told that I ought to support on the basis of polling evidence legislation against immigrants, to leave the European Union, and to reintroduce capital punishment, none of which I supported, because prudential judgment is more important than polls.

Public safety and incrementalism are my main reasons for opposing this Bill. Great play has been made today by many speakers about choice and autonomy. I thought that the noble Baroness, Lady Kennedy of The Shaws, put it incredibly well in her speech. How much autonomy is there in this Bill? I think that the word “assisted” in the title is the key. Who will be required to do the assisting? It will be doctors, of course, and very few want to do it. One of my sons is training to be a medic, and he tells me that he is deeply concerned about this Bill because of the proposals to change the nature of the healer and defender into the destroyer of life. That is why the British Medical Association, the Royal Colleges, the British Geriatric Society, the hospices and 95% of palliative medicine specialists oppose a change in the law.

We had a reference earlier from my noble friend Lady Grey-Thompson to Professor Theo Boer from the Netherlands. He said that he now regrets that on the basis of the argument for greater autonomy and freedom he supported changes in the law there. He said:

“I used to be a supporter of the Dutch law. But now, with 12 years of experience, I take a very different view ... Pressure on doctors to conform to patients’—or in some cases relatives’—wishes can be intense”.

18 July 2014 : Column 904

Professor Boer admitted he was,

“wrong—terribly wrong, in fact”,

to have believed that regulated euthanasia would work. One reason why he has changed his mind is because of the inevitability of incrementalism. Euthanasia, he says, is,

“on the way to becoming a default mode of dying for cancer patients”.

Since 2008, assisted deaths there have increased by about 15% every year, maybe reaching a record of 6,000 a year.

What of incrementalism here? The 2011 commission of the noble and learned Lord, Lord Falconer, said that assisted dying should not be offered to disabled people who are not terminally ill,

“at this point in time”.

At what point in time will it be right to offer to end the lives of people with disabilities? How long will it be before it becomes expected? Only today the Secretary of State for Health, the right honourable Jeremy Hunt, said that changing the law would “devalue” the lives of people living with permanent disabilities.

And what of public safety? The current law, unlike the Bill, provides safeguards and has rarely had to be invoked. Willy Loman, the central character in Arthur Miller’s “Death of a Salesman”, takes his own life, and the playwright’s plea is that we pay attention, and that,

“he’s a human being, and a terrible thing is happening to him”.

I had an uncle who fought in the last war and, as a result, became deaf. He was a gunner. In a state of great depression—a point referred to by the noble Baroness, Lady O’Cathain, earlier—he took his own life. The suicide of people, assisted or otherwise, affects everyone. We should pay attention to the terrible things that mental illness and depression involve and respond with tender compassion and strong laws to deter exploitation, with laws that safeguard vulnerable people. My noble friend Lady Campbell of Surbiton said that this would become a runaway train, and we should pay attention.

6.42 pm

The Earl of Arran (Con): My Lords, death is not a pretty affair. Thus it was a most humbling experience and a great privilege to have been appointed to your Lordships’ committee in 2005 to take evidence on assisted suicide. Not only did we travel to Europe, including a visit to Dignitas, but we travelled also to the US state of Oregon to examine very carefully the operation of the Death with Dignity Act, which was passed in 1997. I suggest that never has the state of Oregon been mentioned so often in your Lordships’ House. We could almost be forgiven for thinking that we are the Oregon Parliament—but we are not. I mention Oregon for a purpose, and I shall dwell very briefly on a few points.

Seventeen years later, that Act has enjoyed great popular support. There is no evidence of abuse, nor are there calls to extend the law beyond its narrow parameters. Partly as a result of the Oregon example, the states of Washington and Vermont have now followed suit. That must be something for good rather than bad. Despite the hysterical claims of opponents

18 July 2014 : Column 905

that the numbers of assisted deaths in Oregon have risen fivefold, assisted deaths equate to only 0.25% of all deaths each year. These claims obscure the fact that the initial numbers were understandably very low while residents became aware of the choice and, following a steady increase, numbers have stabilised in recent years.

A small minority of patients—around a quarter—cite concerns about inadequate pain control as one of their reasons for pursuing assisted dying. This does not mean that Oregon is not delivering adequate palliative care; on the contrary, it is among the best states in the USA for end-of-life care. Indeed, more than 88% of hospitals in Oregon deliver specialist palliative care compared with the national average of 60%. The vast majority of patients who have assistance to die—more than 85%—are enrolled in hospice care. There, as here, many dying patients face the choice of either being sedated to the point that they lose lucidity or retaining lucidity with less than complete pain control, allowing them to pass away as they wish with friends and family around them.

The law does not endanger potentially vulnerable people. Research tells us that potentially vulnerable groups—the over-85s, people from lower socioeconomic groups, people with disabilities and people suffering from psychiatric conditions—are in fact underrepresented in assisted dying figures. A study from Oregon found that some patients did show symptoms associated with depression, although the authors pointed out that the indicators used to measure depression are also the side-effects of a typical terminal illness—for example, loss of appetite, fatigue and difficulty sleeping.

Claims that patients may be coerced to ingest the life-ending medication by family members are misguided and are not borne out by any evidence. Furthermore, the Bill before us provides additional safeguards that would ensure a patient had a clear and settled intention to die before taking the medication.

Death is a most distressing affair. We must therefore look at this Bill with great care and compassion but, above all, with good, sound common sense. None of us here today asked to come into this world. Should we therefore not have the choice as to how we might wish to depart from it? A very considerable majority of the public are now clamouring for change. Society at large is on the march. It is our duty to listen and act.

6.46 pm

Lord Mitchell (Lab): My Lords, on 9 October in the year 2000, my parents-in-law, Jack and Ruth Lowy, committed joint suicide—double exit, I think they call it. Jack was born in Bratislava in what was then Czechoslovakia. The family were Jewish and, following the events in Munich in 1938, they got out quickly. They went to America and, when war was declared, Jack joined the Czech division of the RAF in Canada and then worked in British intelligence. After the war, he went back to Czechoslovakia as part of a debrief mission. There he saw that his whole family and everyone he knew had been wiped out by the Nazis. He was scarred for ever. He was a brilliant scientist, a professor in biophysics specialising in the movement of muscles. His work required him to conduct experiments

18 July 2014 : Column 906

on animal tissue, and he spent much of his time at the Daresbury particle accelerator. In those days, no one quite understood the long-term dangers of radiation and protection was rudimentary. For him, it was fatal. In 1998, he was diagnosed as having acute myeloid leukaemia, which he knew was 100% terminal. Jack told me, in his usual very direct manner, “Parry, I am bloody well going out with my boots on”. There was not much room for misinterpretation.

Gradually, relations between them and us closed down. They disappeared into their own secret world of preparation and disengagement. Letters were returned, e-mails bounced back and telephone calls went to the answering machine. We were bereft. We had no one to talk to and, to be honest, no one believed us. When we said there was a chance that Ruth would commit suicide along with him, people shook their heads in disbelief. My wife, in particular, was convinced that it was going to happen, but there was nothing she could do and no one to advise her. Even more to the point, there was no one to counsel Jack and no one on hand to help Ruth in what must have been an absolute hell. Being the scarred Holocaust survivor that Jack was and the brilliant scientist that he had become, there was no way he was going to get it wrong. He amassed sufficient barbiturates, and both their deaths were completed to perfection.

If there had been assisted dying legislation at that time, I am certain that things would have turned out differently. First of all, we could have talked about it openly without the fear of legal consequences. We could have engaged all sorts of professional help. My father-in-law would have been able to die in circumstances not clouded by a veil of secrecy and subterfuge. I believe that we would have been able to say our goodbyes to him in an open and loving way, as opposed to being harshly rejected.

I will never be certain why my mother-in-law decided to join him. Was it for love? Was it for duty? Was it because she was frightened? Or maybe, as I suspect, they both knew that she could well run the risk of being charged with committing a crime as an accomplice. I simply do not know. But had this Bill been law then she might have chosen to live. All I do know is that my family could well have been spared a double bereavement that was unnecessarily brutal and psychologically damaging for us, and for that reason I have no hesitation in supporting this Bill.

6.51 pm

Lord Carlile of Berriew (LD): My Lords, the noble and learned Lord, Lord Falconer, has initiated an extraordinary debate. Coming in to bat at number 117, as I think it is now, I am able to reflect a little on that debate.

We have heard some marvellous speeches, analytical and deeply personal in equal measure. The noble Lord, Lord Mitchell, has just given a moving description of what happened in his family. Earlier, we heard an extremely moving speech from the noble Baroness, Lady Symons of Vernham Dean. Those are two stories that I am sure we will all remember as eventually we go into Committee on this Bill, and I am sure will colour our judgment, whichever side we happen to be on.

18 July 2014 : Column 907

However, during this debate there has been running what I submit to your Lordships is an ethical and philosophical fallacy about the primacy of choice. The noble Baroness, Lady Kennedy, referred to this earlier, and I agree with her carefully articulated analysis. I challenge the presumption of the primacy of choice. We are denied many choices in life in the greater public interest. For example, one of the choices that we are denied is that of killing or even injuring those who attack and injure us. If we do, we may have a defence in court but it is very different from a choice. I suggest that the slippery slope that we are really discussing here is more in the context of what legitimate choice is than in this proposed legislation. Exactly the same kinds of arguments about choice are deployed in the United States of America to justify the availability of guns. At the bottom of that slippery slope we know lie the bodies of the many innocent victims. As this Bill continues in this House, we should continue to debate that philosophical question.

How big a question does the Bill really ask? Earlier in the debate, the noble Lord, Lord Joffe, said that the Bill was not a radical innovation in the law. With great respect to the noble Lord, he could not be more wrong. Indeed, a few minutes later, the noble Lord, Lord Brennan, reminded us that this Bill dismantled the Hippocratic oath. As the Guardian’s editorial put it this morning, the Bill attempts to “redraw the moral landscape”.

I therefore ask the noble and learned Lord, before he sits down at the end of the debate, to answer some questions for which we need the answers if we are to be able to judge fairly how the Bill should proceed. They include: why has he not redrafted it in the light of the recent Supreme Court judgment so that the arbitration of these cases would not be by two random and favourably inclined doctors but through the courts? As the noble and learned Lord knows, the courts are very accustomed to these kinds of decision, as they are in vegetative syndrome cases and in cases relating to Jehovah’s Witnesses’ refusal to have operations, on which the courts decide on a regular basis. I urge on the noble and learned Lord that that provides a much better template than two doctors. On this aspect, I agree completely with the noble Baroness, Lady Neuberger.

Why has the noble and learned Lord provided in the Bill for only the possibility of a ministerial code of practice, rather than the certainty? Is it a mere piece of text, or has he obtained from Ministers their acceptance that a code of practice would be promulgated? When will we see an example of the draft code of practice, which we expect to examine alongside the Bill? Why does he not insist in the Bill on doctors who actually know the patient, so that we avoid what has been described, rather extravagantly, as the Shipman problem? Would he please answer the question of the noble Baroness, Lady Kennedy, about whether there will be inquests and inquiries after deaths, as he proposes should take place? These and many other questions require answers.

To sum up, I quote the Guardian leader again:

“Reshaping the moral landscape is no alternative to cherishing life and the living”.

Certainly I shall approach the Committee stage in the spirit of cherishing life and the living.

18 July 2014 : Column 908

6.55 pm

Baroness Hayman (CB): My Lords, I absolutely agree with one aspect of the speech of the noble Lord, Lord Carlile: I too will approach the Committee stage in the spirit of cherishing life and the living.

Today’s debate has illustrated that there is not some enormous divide between those who care about people’s lives and those who do not. Can we agree on one thing: that there is no unanimity on this issue? There is no unanimity between lawyers, between previous Lord Chancellors, between doctors, between people with disabilities, between Christians, between Jews, or, as I believe the noble Lord, Lord Avebury, said, between Buddhists. People of faith can take genuinely different positions on this. I agree with the noble Lord, Lord Carlile, that there is an issue here about the precedent we give to autonomy, to choice and whether we can, as legislators, look at ourselves in the mirror in the morning and say we passed legislation like this without the dire consequences —the road to hell—that we have had described today.

I should have said that I am a member of the General Medical Council, but of course I speak in a purely personal capacity today. Another interest is that I was also a member of the committee so ably chaired by the noble and learned Lord, Lord Mackay of Clashfern. That experience, which I went into not having a settled view on this issue, made me support the Bill. It is my sense that it is possible to find the right balance, to provide compassion without a slippery slope or a criminal’s path. It is difficult in just the same way as when this House chooses to try to balance the needs of security with individual liberty. However, that is what we are here for. With the greatest of respect to the noble Lord, Lord Alton, I do not regret that this debate is taking place in your Lordships’ House and that the legislation will have the line-by-line scrutiny that we know does not happen with Bills in another place. It is right that we should do some of the heavy lifting on the Bill in Committee in order for the Commons to take its part.

The noble Baroness, Lady Brinton, said that she had had to rewrite her speech. I wish she had not pinched mine in rewriting it. I will not say the things that she said, but I will give one quote. I was very struck when I read that wonderful novel Revolutionary Road by a quote that went something like: “He was left standing in the door of his home, dying imperceptibly, as we all are”. But actually that is not right. Some of us are not dying imperceptibly; some of us die in terrible, unbearable physical and emotional pain. I have listened to the stories of some of those people, as well as having read the letters.

I end with the words of a doctor whom I was talking to recently. He told me that he had changed his mind on this subject because he had had experience of a family who had gone to Switzerland. He had changed his mind because, he said, “We have to be able to do better than this for our patients”. I believe that we can do better than this, and it is Parliament’s job to see that we do so.

7 pm

The Lord Bishop of Carlisle: My Lords, a word that is frequently used in your Lordships’ House is “balance”. It has already been used several times in this debate—in

18 July 2014 : Column 909

particular, by my noble and learned friend Lady Butler-Sloss, the noble Lord, Lord Condon, the noble Baroness, Lady Kennedy, and the noble Lords, Lord Kerr of Kinlochard and Lord Wills, and probably many others whom I may have missed. We constantly look for balance in our legislation and in the way that the legislation is applied.

My contention in this brief contribution to our inspiring debate is that the Bill would destroy the balance, however precarious it may be, that we have achieved in the current law on assisted suicide and in the guidelines that have been produced for its enforcement. In the first place, it destroys a delicate balance on compassion. As we have heard frequently today, compassion is the primary argument behind the noble and learned Lord’s Bill. Of course, on these Benches we have the greatest sympathy with that and respect for those who advance it.

However, as several noble Lords have observed, this compassion is highly selective. It offers a seemingly compassionate approach to those who are terminally ill and wish to end their lives, and it sounds compassionate towards those who help them to do so. However, not only does it ignore those whose situations are often even more desperate and who are not terminally ill, as recognised by the Supreme Court, but it also, however inadvertently, disregards the many vulnerable elderly and disabled people in our society who, as we have been reminded many times today, will find themselves under great pressure should the Bill ever become law.

We have all received a huge amount of correspondence on this subject. In my case, much of it has been from precisely such vulnerable people who have expressed their deep-seated fears and worries about the legalisation of assisted suicide, whatever the proposed safeguards. What is more, their very moving and powerful letters have been overwhelmingly reinforced for me by communications from members of the medical profession who have all had years of experience in serving the elderly and providing palliative care. They—and they include my son’s ethics tutor at medical school—are deeply concerned about any possibility of a change in the law and they urge us to oppose any such change.

As for the theology of compassion, mentioned by the noble and right reverend Lord, Lord Carey, accompanying someone to his or her death is what our clergy and others do all the time. It is the very definition of compassion—“suffering with”, from the Latin—and that of course is a big part of what the cross is all about in the Christian faith. However, neither in scripture nor in the church’s tradition has that ever included helping people to commit suicide. Therefore, as various speakers have suggested—particularly the noble Baroness, Lady Hayman—the supporters of the Bill have no monopoly on compassion.

Secondly—the noble Lord, Lord Wills, made this point very powerfully—the Bill destroys the fine balance on choice, or patient autonomy, which our present legislation and the guidelines attempt to provide. The point was made also by the noble Lord, Lord Phillips of Sudbury. How often do we hear people claim that they have a right to choose what they do so long as their choice does not affect anyone else? Let us be clear

18 July 2014 : Column 910

about the kind of choice that we are considering today. A choice to assist someone else to commit suicide does affect other people. It cannot be made in a moral or legal vacuum.

Our true dignity as human beings lies not least in our interdependence and our willingness not only to care for those in need but also, when we are ourselves in need, to be served by others. I believe that that is the love referred to earlier by my noble friend Lord Judd. To quote from one letter I received from a severely disabled person who requires 24-hour assistance:

“There is nothing shameful or degrading about needing personal care”.

My noble friend Lady Campbell of Surbiton made that point earlier in a most powerful way.

The current law makes it clear where we stand on this crucial question of life and death but also takes a sensible, humane approach to breaches of the law, as we heard so clearly from the noble Lords, Lord Macdonald and Lord Condon. The Bill destroys that balance in an irreversible way, and others have indicated where such a change will undoubtedly lead over time. By going down this track we would be sending a clear message to society, and especially its most vulnerable members, about individual lives having a different value according to their circumstances. That is something which, on these Benches at least, we could never accept.

7.06 pm

Lord Ribeiro (Con): My Lords, I am speaking today as a doctor to express the views of some of the medical royal colleges which believe that the law as it stands should remain. They represent the doctors who will have to implement and execute this Bill, unlike the rest of us, who are nearly all retired.

My own college, the Royal College of Surgeons, of which I was president from 2005 to 2008, in a council minute of February 2005, stated:

“The Assisted Dying for the Terminally Ill Bill was discussed by council in July 2004. It was felt that the college should not take a position as this was a matter for individual fellows and members to decide”.

However, in 2011, in its response to the Commission on Assisted Dying, which was chaired by the noble and learned Lord, Lord Falconer, the RCS made a very clear statement:

“The law as it currently stands should not be changed and no system should be introduced to allow people to be assisted to die. The college does not recognise any circumstances under which it should be possible for people to be assisted to die”.

The RCS believes that the Assisted Dying Bill would fundamentally alter the role of the doctor-patient relationship. Doctors should preserve and improve life. If they are also involved in taking life, a damaging conflict of interest will occur, which patients will not understand. My noble friend Lord Sheikh stressed that there is a danger that a right to die may become a responsibility to die, making vulnerable people more vulnerable.

On 16 July, the Royal College of Physicians, stated:

“Today RCP Council reaffirmed its position on assisted dying—that it does not believe a change in the law is necessary. This policy is based on a 2006 survey, in which 73.2% of … fellows”,

18 July 2014 : Column 911

and members voted for no change. A new survey will be conducted in the autumn and we should wait for that.

The Royal College of General Practitioners surveyed 1,700 members during a four-month consultation: 77% opposed any change to the law. Finally, as we have heard many times today, the British Medical Association, of which I am a member and, I have to say, a critical friend, opposes legalising assisted dying. The chairman of the BMA’s council, Dr Porter, added:

“Our focus must be on making sure every patient can access the very best of palliative care, which empowers patients to make decisions over their care”.

We have all received countless letters and we have all recited them, but I was struck by a paragraph in a letter from an oncologist at St Bartholomew’s Hospital, which is a leading cancer centre. He said:

“I am appalled at the negative implications of this Bill for my patients with advanced cancer. In my speciality of lung cancer and melanoma, we are currently experiencing a revolution in medical advances that would have been unimaginable 10 years ago. We should remember that many patients with advanced ‘terminal’ cancer have been cured due to the medical advances that this Bill would deny our patients … from children with leukaemia to adults diagnosed with advanced ‘terminal’ melanoma, that have been cured with novel immune therapies in recent years”.

I plan to table amendments in Committee to Clause 4(4)(b) where the term “a medical device” is mentioned. The Explanatory Notes make reference to “a syringe driver” and we need to be absolutely clear what these devices are intended to do.

The debate highlights the need for better and more widespread palliative care with a focus on individual patients’ needs rather than a focus on assisting a few to die. The noble Lord, Lord Cavendish, referred to mercy killing on compassionate grounds. Perhaps we should revert to this term in the context of this Bill, which also invokes compassion. We should take note of the concerns of doctors and nurses who will, after all, have to implement the Bill.

7.10 pm

Baroness Morgan of Huyton (Lab): My Lords, it has been an honour to listen to the speeches today—well argued, passionate and persuasive on all sides. However, I remain of the view that I had at the start of the day and I will be brief in terms of summarising that. I support the Bill, but I particularly support the Bill going forward for proper consideration in Committee. Issues have been raised today, particularly around safeguarding, where I think intelligent amendment may reassure some of the noble Lords who provisionally support the Bill.

There are three main issues. The first is legal clarity. We are currently in a murky position at best. There is a sort of romantic view of the GP easing people out of suffering. That may have happened in the past, but we know that life has changed. Relatives risk prosecution. The terminally ill may decide to die earlier than they wish because they are scared of leaving it too late. We turn a blind eye to Switzerland for those who can afford it and do not leave that too late. We deny people personal autonomy and wash our collective hands of the legal conundrum that we are in.

18 July 2014 : Column 912

The second issue is Parliament itself and our role here today. We are here to tackle this sort of issue and to take responsibility for clarifying the law. We have a particular responsibility in this House. We can deal with this issue in detail away from the pressure of lobbying from groups, party members and groups of constituents leading up to the general election. We can give this Bill the proper consideration and scrutiny that it deserves and that we know the public want it to have. The Supreme Court has urged Parliament to produce a workable law or else someone else will have to do it—the lawyers, for example. I am perplexed by the argument that I have heard today that we must not support the Bill in case it leads to a further Bill in the future. We will never take this issue lightly in this House or in the other place. We cannot decline to take this Bill forward on the basis that something else may change in the future.

The third issue is compassion and we have heard a lot about that today. Like so many others, I have talked to many friends and relatives and received many letters urging—indeed some of them begging—us to face up to our responsibilities today. The letters speak of suffering and seek compassion from us, but they also speak in many cases of a wish for personal autonomy and control of their own destinies. Whatever our personal views, we must take the debate forward properly in Committee and send it to the elected House.

Like other noble Lords, I was moved in particular by some of the letters, and I have pulled out one that I want to share with the House today. This is a cogent, coherent and in some ways a cool and measured letter. It was from a doctor who also had terminal cancer and he very clearly asked for our help. He said he wanted our help to clarify the law, restore public confidence and provide safety and security for the terminally ill and the medical profession. I find that argument compelling.

7.13 pm

Lord Dholakia (LD): My Lords, many of us have been brought up to believe in the sanctity of life. The matter of death is very seldom discussed. We have been privileged to listen to some remarkable speeches and in many cases that has helped to shape our approach to this important Bill. For that reason, I thank the noble and learned Lord, Lord Falconer of Thoroton, for promoting the Bill and he has my support.

Some years ago, I was called out to a hospital following a near-fatal accident my younger brother had suffered. He was on a life-support machine and brain dead. After advice from those who looked after him, I agreed that the life-support machine should be switched off—a decision I never thought that I would have to make. I had all my happy recollections of him but, in that single moment, I was aware that he would never enjoy the quality of life which we often take for granted. That memory has stayed with me all my life. Do I feel any guilt? No. I wanted to remember him as I knew him and not as being in a vegetative state. He did not have a choice, but I, together with assistance from the medical staff, took the decision which alleviated much of his suffering.

18 July 2014 : Column 913

This Assisted Dying Bill reflects not only compassion and care, but also makes a fundamental point of recognising choice, with those strict, upfront safeguards defined within it. This gives us a unique opportunity to be able further to improve the Bill in Committee. The current prohibition on medical assistance to die causes some terminally ill people to take matters into their own hands. We repeatedly read about such cases. Some relatives also face the risk of prosecution for helping a loved one to die. The Bill would bring clarity to the law, and provide greater safety for terminally ill people and their loved ones. The Bill has strict safeguards and eligibility criteria—which were often omitted from some of the speeches we heard today. People who are not mentally competent and terminally ill, such as the disabled or older people who do not have a terminal illness, would not be eligible.

A number of noble Lords have cited the decision of the Supreme Court a few weeks ago. If we fail to make a decision, we will ultimately have to do so on the instruction of the Supreme Court. As a law-making body, we cannot ignore this challenge.

Comments have been made repeatedly about religious support. A YouGov poll in 2013 found that, of 1,200 people who identified as belonging to a religion, 62% were supportive of assisted dying for terminally ill people, with only 18% opposed. Examination of the results revealed that 78% of those who attended a place of worship once a month supported assisted dying, 59% of those who attended several times a month support assisted dying and this fell slightly to half of those who attended once a week. I make no comments about how often you should visit your place of worship, but there are a range of views on assisted dying from religious leaders. Those who are opposed have tended to dominate the debate, in direct contrast to the religious public’s support—a point well made by the noble Baroness, Lady Blackstone.

I will quote some of these religious bodies. In March 2013, the Hindu Council UK stated that it supported assisted dying with safeguards:

“Compassion ought always over-ride the argument for the sacredness of life”.

Just this last weekend, the former Archbishop of Canterbury the noble and right reverend Lord, Lord Carey—we are delighted with his presence in your Lordships’ House—very publicly stated that he had moved away from his long-standing opposition to assisted dying, declaring that it would not be “anti-Christian” to support a change in the law:

“Personally, I find it a shameful blot on our country’s great reputation for caring for others that we have not come up with a better alternative than the Zurich clinic ... Today we face a central paradox. In strictly observing the sanctity of life, the Church could now actually be promoting anguish and pain, the very opposite of a Christian message of hope”.

I hope that I quoted the noble and right reverend Lord correctly; I have taken that quote from the Daily Mail.

Noble Lords: Ha!

Lord Dholakia: Similarly, my Lords, Desmond Tutu has openly backed the right of the terminally ill to end their lives with dignity:

18 July 2014 : Column 914

“I revere the sanctity of life—but not at any cost ... why exit in the fog of sedation when there’s the alternative of being alert and truly present with loved ones?”

There are also many Jewish clergy who have come to view assisted dying as a religiously valid choice for those who so wish. Rabbi Dr Jonathan Romain writes:

“There is nothing holy about agony. If a terminally-ill person does not wish to live out his/her last few months in pain, for what purpose should they be forced to do so, and in whose interest is that life being prolonged?”.

Over the years, Parliament has faced many serious issues: the abolition of slavery, the reform of abortion laws, the reform of laws on homosexuality, the abolition of capital punishment and, as recently as last year, the promotion of same-sex marriages. These issues do not sit comfortably with many in our community, but your Lordships’ House is well equipped to deal with this particular matter in Committee.

7.20 pm

Baroness Hollins (CB): My Lords, I welcome all discussion that would help us to be less fearful about death and to end the taboo. However, I have to ask your Lordships a question: have your Lordships discussed your end-of-life choices with those closest to you? Today, the key point has been made many times that there is a big difference between choosing to withdraw a futile or life-prolonging treatment—a legitimate everyday occurrence—and taking a prescribed lethal drug.

One of many welcome letters that I have received opposing the Bill was from an oncologist specialising in lung and pancreatic cancer. She says that most of her patients have a prognosis of less than six months and would be directly affected by a change in the law. Over 20 years, she says that she has treated in excess of 10,000 patients, and only one in that time has made persistent requests to be helped to commit suicide. The fact that the law explicitly prevents it enabled her to fully explore the reasoning behind the request. It was due to a poor experience with a family member many decades previously, which had left the patient fearful. She wanted to live, but wanted to be assured that she would be properly cared for at the time of her dying. The oncologist says that the majority of her patients remain in control and have a peaceful death, with family present and nurses nearby, through falling asleep and not waking up—contrast that with a complication rate of 23% for physician-assisted suicide in Holland.

Assisting a peaceful death is not about supporting suicide; there are so many other options. Depression has scarcely been mentioned today but there is evidence of increasing depression and anxiety as death nears for people with cancer. In those who request assistance to die, there is an association with depression and hopelessness. This was borne out in an Oregon study of those who had been prescribed lethal drugs to end their lives despite depression.

We in this House are in a somewhat privileged position. We are accustomed to making lifestyle choices with confidence. We know the law and our rights. In a word, we can look after our own interests. The present law may not give determined and strong-minded people such as ourselves what we want, but it provides protection for those who cannot speak up for themselves—people such as those I worked with as a doctor and psychiatrist.

18 July 2014 : Column 915

The noble and learned Lord’s Bill assumes that a doctor can readily assess a patient’s mental state, but most doctors have little or no training or skill in capacity assessment, as was a matter of considerable concern for the post-legislative scrutiny committee for the Mental Capacity Act, which I was a member of. Doctors are also insufficiently familiar with normal death, which is why they strive too hard to keep us alive. Death is seen by many doctors as a failure, and the public are afraid too. However, many of my correspondents affirmed their experience of death and dying as being a precious time. A friend of mine who died of motor neurone disease last year died gently and peacefully, his wife said, when the oxygen was removed—when he was ready. A similar situation was referred to earlier by my noble friend Lady Finlay. This is not an intellectual argument: we need emotionally intelligent people here and, as my noble friend Lady Campbell said so powerfully on the “Today” programme this morning, to start listening to people who are terminally ill, not just to those who think that they will be able to anticipate their own feelings when their time comes.

7.24 pm

Baroness Howells of St Davids (Lab): My Lords, I asked for permission to speak in the gap because there was some mistake over whether I had put my name down. I do not know how that happened but there we are.

The Assisted Dying Bill provokes strong feelings and has sparked widespread debate across the country, and rightly so. It affects the most vulnerable in our society and is literally an issue of life and death. We have all received numerous pieces of correspondence from members of the public from all walks of life—in my case mostly from the community to which I belong—in the days leading up to this Second Reading, vociferously objecting to the Bill. This reflects the deep concern held by many that the Bill flies in the face of the fundamental principle that we are all equal in dignity, and that it lacks significant adequate safeguards, thereby posing an unacceptable risk to the most vulnerable members of our society. It is difficult to think of a group of people more vulnerable than those who are dying.

A key reason for opposing the Assisted Dying Bill is the fundamental principle that human beings are equal in dignity. This is a principle that has been preserved through the legal and medical prohibition on intentionally killing patients and intentionally helping them to kill themselves. It is a prohibition that was aptly described in 1994, by the noble Lords who constituted the House of Lords Select Committee on Medical Ethics, as,

“the cornerstone of law and of social relationships. It protects each one of us impartially, embodying the belief that all are equal”.

The Bill deals a sharp blow to respect for the equal worth of human life, a principle that so many in this country hold dear. We have been entrusted with the privilege of helping to shape the laws that govern this country, and we have a duty to do so in a manner that ensures that such laws protect the people of this country, particularly the most vulnerable among us.

18 July 2014 : Column 916

We must be mindful of the message that the Bill sends to the public. Disturbingly, it signals an acceptance of the view that some people’s lives are no longer worth living, or are inferior to the lives of others. Who are we to determine that another person’s life has no further value? This is a concern shared by leading disability charities such as Scope and Disability Rights UK, which fear that the disabled would be prime candidates for such discriminatory designation.

While I acknowledge that the Assisted Dying Bill is born out of an attempt to be compassionate to those who wish to be assisted in ending their lives, there is a risk that it would have the opposite effect. Undue pressure would be placed on the terminally ill to end their lives, thereby causing further distress to people who are at the most vulnerable point of their lives. This risk was highlighted in a survey of disabled people conducted by Scope, which found that 70% were concerned that a change in the law would create pressure on them to end their lives prematurely. The correlation between pressure and people deciding to end their lives is evident in places such as Washington, where it has been found that 61% of those requesting to end their lives did so because they felt they were a burden on their friends and family or on care givers. Here in England and Wales, abuse of the elderly is a problem that persists.

I thank noble Lords for their kind attention.

7.29 pm

Lord Beecham (Lab): My Lords, although I speak today from the Opposition Front Bench and in favour of my noble and learned friend’s Bill, I do so from a purely personal perspective. This is not an issue on which the political parties should take a position; nor have they. Members of all three main parties have spoken on either side of the debate today. The subject of the debate is quintessentially one demanding the exercise of individual judgment, touching, as it does, on the most profound concerns—issues of life and death, freedom of choice, responsibility and ethics. Members of your Lordships’ House have demonstrated in this and previous debates a keen appreciation of the complexities which confront our society in contemplating the plight of those suffering from conditions that are not only incurable, but, in the terms of the Bill, terminal. The sincerity and motivation of proponents on either side of the argument justify the confidence which the Supreme Court displayed in its recent call to Parliament to review and clarify the law.

It is just over four years ago to the day that my wife returned to hospital in the last stages of incurable bowel cancer, diagnosed two years earlier, and we are exactly seven weeks short of the fourth anniversary of her death. As I revealed to the House in the debate on the Motion of my noble friend Lord Dubs last December, she had been a nurse, health visitor and counsellor, and the daughter and sister of doctors. She had seen her grandmother, mother and brother die of cancer. From the start of her journey, she made it clear that if the pain became unendurable, she would wish to be helped to die. She lived as fully as possible during those two years, not least by raising awareness about bowel cancer. In the event, she died peacefully, without excessive pain, under sedation in the hospice where

18 July 2014 : Column 917

she spent those last few weeks. But I know that she would have wanted me to support the Bill. She would have wanted those whose suffering could not be sufficiently alleviated to have the choice which the Bill, with proper safeguards for both patient and clinician, affords.