My Lords, I declare my interest as the unpaid chair of Dignity in Dying. My Bill has three informal co-sponsors: the noble Baroness, Lady Davidson of Lundin Links, who will make her maiden speech today; the noble and learned Lord, Lord Falconer of Thoroton; and the noble Baroness, Lady Brinton. I thank them for their support. Indeed, I thank every noble Lord in the Chamber.
Today, in England and Wales, assisted dying is prohibited by the Suicide Act 1961. Anyone who assists a person to end their life is liable to prosecution and imprisonment for up to 14 years. It turns compassionate friends and family into criminals and causes thousands of dying people to attempt to take their own lives alone in order to safeguard their relatives.
How many of us fear that we may be one of the unlucky small minority—I emphasise “small minority” —of people who suffer a traumatic dying process in which our precious palliative care services cannot relieve our suffering and cannot enable us to have a dignified death? Some 52% of the population report that they have witnessed a loved one suffer unbearably at the end of their life. Assisted dying will reduce those fears of dying so that we can live better. Then, when we are given a terminal diagnosis, the legal right to an assisted death will give us and our families great comfort and reassurance, knowing that we will have a choice and some control over how long we can tolerate our suffering.
The benefits of the Bill to dying people and their families will be huge, yet this is a truly modest Bill based on tried-and-tested laws from overseas. It is an overwhelmingly popular Bill in society. We know that 84% of the population at large support assisted dying, including 80% of people who declare themselves religious and 86% of disabled people. That is not surprising, because the sole aim of this Bill is to reduce unnecessary and unbearable suffering.
What do I mean by intolerable or unbearable suffering? There are forms of suffering that even the best palliative care cannot alleviate. A small but significant minority of dying people will experience intolerable symptoms. Let me give some examples. One is constant nausea and vomiting, night and day, which, because of an allergy to antiemetics, cannot be alleviated by palliative care services. Another is fungating wounds from a cancer protruding through the skin, perhaps in the cheek; I have a friend who suffered that recently. Such wounds exude pungent and deeply unpleasant odours described by doctors as “ward-clearing” because all the other patients have to leave due to the odour. However, the dying person can never leave, can they? That is, unless they are given the opportunity to take their own life.
Motor neurone disease is totally different but, day by day, week by week, it eventually deprives the person of every possibility of moving a muscle anywhere in their body. Some of those people will end up unable to speak, to swallow, to eat or to drink. How many of us want to go through that? Should we not have the right to avoid the very end of all that suffering? Often the loved ones of these people go through years and years of nightmares and panic attacks, thinking back and remembering the pain and suffering that their nearest and dearest went through. This Bill could end that suffering.
My Lords, is a great privilege to follow the noble Baroness, Lady Meacher, for whom I have huge respect. In my career delivering babies, I have also seen some of the terrible and moving things she describes. I have great respect for her important speech and her great work in moving this Bill. But many noble Lords have received vast correspondence, and it is clear that there is massive public interest in this debate, as almost never before, and many misunderstandings about its implications, which can be seen from what has been written. It raises the most important moral question and needs clarity without euphemism. “Assisted dying” could equally be applied to palliative care, so the Bill’s title does not represent what is really intended. The word “euthanasia”—from the Greek “eu”, meaning well or good, and “thanatos”, meaning death—is what we are actually talking about.
I met a teenager in a school last week who asked me this question: do you think we should strive for a perfect society? She went on to ask whether that is really desirable. I said that, in an imperfect world, we have to do the best we can, and this is what we are to debate today. I hope that we do so in a respectful and thoughtful manner. I will say no more but will hear what other noble Lords have to say. I beg to move.
My Lords, every possible argument will be rehearsed today by the 140 speakers, and many passionate and eloquent speeches will be made, showing this House at its best. I know both sides will debate and disagree with courtesy, and with an understanding of the importance of our role.
I believe an assisted dying law is needed in the UK to address the unacceptable suffering of dying people and the lack of protections in the current law. The Assisted Dying Bill—supported, as the noble Baroness said, by 84% of the British public—would enable terminally ill, mentally competent adults in England and Wales to die well and on their own terms, should they choose it. It would provide choice to those who are suffering, even after receiving our world-leading palliative and end-of-life care.
The Bill would place greater protections and upfront safeguards than those that exist in the current law. Laws from around the world, including the United States, Australia and New Zealand, show that choice at the end of life and protection for potentially vulnerable people are not mutually exclusive but key features of a robust assisted dying law.
The current blanket ban on assisted dying does not work well: it thwarts open discussion between dying people, their doctors, and friends and family, forcing some people to suffer unbearably against their wishes or plan other ways to die on their own terms—whether this is an assisted death overseas or a lonely, violent death at home. I know this Bill may go no further today, but I look forward to the day when we have a Bill that does.
10:29 am
The Archbishop of Canterbury
My Lords, I am grateful to the noble Baroness, Lady Meacher, and listened with great attention to her extremely powerful speech. This is an issue on which many of us have personal experiences, often painful and difficult. There is unanimity on these Benches that our current law does not need to be changed, but I know that people of faith hold differing views. No doubt we will hear those today and I look forward to them.
Everyone here shares the best of intentions. We should recognise that in how we listen and respond to each other. I hope no one will seek to divide the House today, but I welcome the amendment from the noble Lord, Lord Winston, because it draws our focus towards our use of language. We need clarity and precision in our terms.
Christ calls his followers to compassion, but compassion must not be drawn too narrowly—a point made indirectly and powerfully by the noble Baroness, Lady Meacher. It must extend beyond those who want the law to provide help to end their lives to the whole of society, especially those who might be put at risk. Our choices affect other people. The common good demands that our choices, rights and freedoms must be balanced with those of others, especially those who may not be so easily heard.
Sadly, I believe this Bill to be unsafe. As a curate and parish priest, I spent time with the dying, the sick and the bereaved. I still do. All of us have personal experience; I have as well. We know that the sad truth is that not all people are perfect, not all families are happy, not everyone is kind and compassionate. No amount of safeguards can perfect the human heart. No amount of regulation can make a relative kinder or a doctor infallible. No amount of reassurance can make a vulnerable or disabled person feel equally safe and equally valued if the law is changed in this way.
All of us here are united in wanting compassion and dignity for those coming to the end of their lives, but it does not serve compassion if, by granting the wishes of one closest to me, I expose others to danger, and it does not serve dignity if, in granting the wishes of one closest to me, I devalue the status and safety of others. I hope your Lordships will reflect and, while recognising the good intentions we all share, resist the change the Bill seeks to make.
My Lords, it is a great privilege to follow the most reverend Primate the Archbishop of Canterbury and to be able to support my noble friend Lady Meacher, who I believe has brought forward the best drafted and most effective of the four Bills on this subject that I have been involved in in my time in your Lordships’ House.
I was a member of the Select Committee that investigated the Joffe Bill. It was that experience that led me to become a strong supporter of compassionate, structured and safe legislation in this field. I listened—with huge respect of course—to the most reverend Primate, but, when he says that this would not be a kind and infallible system, I have to say that we do not have a kind and infallible system at the moment, and I believe that our legislation would be kinder and less fallible in many areas if we pass this Bill.
I have a specific point on kindness. One of the reasons I became so strongly committed was the experience of going to Oregon and seeing its legislation in place. What struck me most was the number of people who entered the system and got a prescription but never cashed it—the number of people who, because they had the security, the insurance policy and the peace of mind about what would happen if things became intolerable, actually did not need to avail themselves. I think it is 35% of the Oregon cohort that does not follow through. I believe that there are penumbras here: not just the people who go into the system but the people given a terminal diagnosis and know that, if things become unbearable, there is a way out. I believe that comfort goes far wider than the people who actually enter the system.
I have one last point. The most reverend Primate accepted that there is no unanimity of view among people of faith, doctors, lawyers and members of my Select Committee. There is not; there are differences of opinion and they are compassionately and ethically held. But the public know what they think on this issue. They have been consistent on the issue, and I believe we should respect that and support the Bill.
My Lords, it is a privilege for me to follow the noble Baroness. I commend the noble Baroness, Lady Meacher, for her Bill and I too look forward to the maiden speech of the noble Baroness, Lady Davidson, with another Scottish perspective—because it is 17 years since my Bill in the Scottish Parliament to change the law in Scotland to allow a terminally ill patient greater power to determine the place, manner and precise time of their death.
During that time, much has changed, but some things have remained. As the noble Baroness said, 11 jurisdictions in the United States, New Zealand, five Australian states, Austria and Spain have changed their laws. Like the noble Baroness, Lady Hayman, I have visited Oregon. I did it then and I have studied the annual report on its legislation closely every year since. The well-managed, careful legislation, with suitable transparent oversight and mature discussion of its operation among the population, will have its 25th anniversary next year.
What has remained? In the absence of a clearly regulated, transparent legislative framework with judicial oversight here, we maintain the position that, if you have been given a prognosis that your life now has a limited time, you have the legal right to ask medical staff to deliberately withhold food and hydration until you starve to death. Patients might be pressurised, either by family members or by feeling that they are a burden, and they ask for medication, food or hydration to be halted and to be permanently sedated until they die. There is no legal test about mental capacity or whether financial pressure is being brought to bear on them in these last moments of their life.
Doctors may decide themselves, without consultation or recourse to legal approval, to provide lethal medication under the morally ambiguous doctrine of double effect, or place the person into continuous deep sedation. An extensive and comprehensive review in 2008 found the prevalence of patients dying under continuous deep sedation at 17% of all deaths—the highest in Europe.
My Lords, I support the Bill so eloquently proposed by the noble Baroness, Lady Meacher. I am, like her, a member of the All-Party Parliamentary Humanist Group, which gives support to all those seeking the freedom to make choices about their own death. It is the mark of a humane and enlightened society that this should be so.
The group supported Paul Lamb, left paralysed and in daily pain after a car accident, who, with his fellow activist Tony Nicklinson, spearheaded the 2012 legal bid to change the law on assisted dying. In its landmark judgment on that case in 2014, a majority on the Supreme Court ruled that they were indeed open to changing the law on assisted dying, but they felt that Parliament should first debate the matter. That is where we are today.
Today I speak to assisted dying for the terminally ill. The last time such legislation was proposed, by my noble and learned friend Lord Falconer, I arranged a play reading in the House of Lords. The play, “Cancer Tales”, was by Nell Dunn, the famous author of the TV plays “Cathy Come Home” and “Up the Junction”, both of which informed public attitudes to the subjects they dealt with. The discussion that followed the performance showed that both sides of the debate had much in common. I think that will be seen today.
Since then I have witnessed deaths. I sat beside someone who was dying in great pain. I called on the palliative care nurse, who examined the patient and then slightly increased the morphine drip to reduce their suffering. On another occasion, I was present when a family member of a dying patient beseeched the attending nurse to help relieve the awful suffering. The nurse paused, said “This can have significant effects”, and then increased the morphine drip. On both occasions, the final moments of life passed in peace and compassion. Easeful death is a gift the compassionate should legally bestow on patients in their dying days. As expressed in this Bill, this depends on agreed consent, mental capacity and the declared wish of the dying.
10:41 am
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What can the dying person do under the current law to avoid such suffering? The options are grim. We can starve ourselves to death—a horrible way to die. We can refuse treatment, with more uncertainty about how much suffering that will cause. We can take our own lives—thousands of people try to do that every year and nine-tenths of them fail with the most appalling consequences. We can poison ourselves with stored up pills and alcohol, alone, to protect our loved ones. I had an aunt who had terminal liver cancer. The tumour was the size of a football. In the middle of the night, all alone, she took all her pills and whisky and the next morning her husband, who knew nothing about it, found her dead. That death left an indelible mark on me and probably explains why I am here today. The law leads dying people who desperately want medical assistance to die to travel to another country, long before they are ready to die. Imagine going to take your life before you really feel that that is what you want to do.
Now I will tell you something that you will find a little surprising. Our colleague, the noble Lord, Lord Field of Birkenhead, who is dying, asked me to read out a short statement:
“I’ve just spent a period in a hospice and am not well enough to participate in today’s debate. If I had been I’d have spoken strongly in favour of the Second Reading. I changed my mind on assisted dying when an MP friend was dying of cancer and wanted to die early before the full horror effects set in, but was denied this opportunity … A major argument against the Bill is unfounded. It is thought by some the culture would change and that people will be pressurised into ending their lives. The number of assisted deaths in the US and Australia remains very low—under 1%—and a former Supreme Court judge in Victoria has concluded about pressure from relatives that ‘it just hasn’t been an issue’. I hope the House will today vote for the Assisted Dying Bill.”
Why are we bringing another Assisted Dying Bill before Parliament? Those who oppose this Bill will remind us that over six years ago such a Bill was defeated overwhelmingly in the House of Commons, but a great deal has changed since then. We have seen a radical shift in the views of doctors. In 2019, the Royal College of Physicians ended its opposition to assisted dying. Last month, the BMA did the same thing following a survey that showed that 50% of its members supported assisted dying and 39% were against. My belief is that, about 10 years ago, maybe 5% of doctors supported assisted dying. The change has been extraordinary. I had a meeting with the Royal College of Surgeons the other day. It is considering reviewing its position. If it does, all the royal colleges will have moved from opposition to neutrality.
In this same period, seven more US states have legalised assisted dying. Now 11 US states have it, as well as five states in Australia. New Zealand is introducing assisted dying; it will be available for people from next month. All those jurisdictions have an Act of Parliament very similar to the Bill that we are discussing today. Other countries have broader models of assisted dying. Canada and Spain are among the latest countries to legalise euthanasia in the past few years, in which a doctor administers a lethal medication. Italy will have a referendum next year. When a country has a referendum, it will introduce a law, because this is an incredibly popular measure. Debates are under way in Portugal, Austria, Germany and Ireland. Perhaps most important is the likelihood that within a few years the Scottish Parliament will legalise assisted dying—there is a majority for it in the Parliament. My challenge to our Prime Minister is: “Boris, do you really want to be upstaged by Scotland on this issue, an issue of such historic proportions?”
This Bill is an attempt to drag our assisted dying legislation out of the 1960s and into the present day. It is not a euthanasia Bill; it would read very differently if it were. What are the main provisions of the Bill? It would give terminally ill, mentally competent people over the age of 18 the right to choose the manner and timing of their death. To be eligible for an assisted death, two independent doctors would have to confirm that the person requesting assistance had a life expectancy of no more than six months. Prognoses are a little unreliable but, in the countries that have this law, people take the medicine only in the last week to two weeks of life and, at that point, the prognosis is much more certain. People must have mental capacity and have reached a clear and settled decision to have an assisted death without pressure or coercion from any person. If at any stage there were doubts over their capacity, either doctor could refer the person to a specialist. The patient’s nearest relatives would be interviewed to check their motivation. Having seen this evidence, the entire process would need to be approved by a judge of the family division of the High Court.
How does this Bill relate to palliative care? All of us who support the Bill—and I mean all of us—are passionate about achieving the best possible palliative care across the country. While we are unable, in this Bill, to include additional financial provision for palliative care, we urge the Government to follow the example of Victoria, in Australia, and elsewhere, where the legalisation for assisted dying has been accompanied by a significant investment in palliative care services. The principles of patient choice are rightly paramount in modern medicine but are drastically curtailed when it comes to the end of life. Patient choice means nothing for the dying unless it includes the patient’s right to decide when they can take no more suffering.
The right to an assisted death, where and when the patient chooses, surrounded by loved ones, is an essential and complementary part of high-quality palliative care. The Oregon Hospice & Palliative Care Association was against assisted dying before legislation was introduced there. Today, it is very much in favour. Why? Because it has improved palliative care; now, their doctors and nurses can have honest, expansive conversations about the wishes and fears of dying people. Palliative care has improved in Oregon over those 22 years, and it would do the same here.
I will touch on the report of the Delegated Powers and Regulatory Reform Committee, of which I am a member, although I should say that I did not attend the meeting to discuss this Bill. The report raises valid points about having the affirmative rather than negative procedure, and I will be talking to doctors and lawyers about some adjustments to the Bill to reflect those recommendations.
In my closing remarks, I will briefly scotch some arguments that are likely to be heard today. Might there be a slippery slope, our opponents suggest—I have just had that debate with a doctor on BBC television news. No, there would not be. Our opponents know that not a single jurisdiction in the world that has legalised assisted dying for people who are terminally ill and mentally competent has expanded it beyond those strict criteria, except Canada. The reform there was led by a Supreme Court judgment that, if somebody is not terminally ill but is suffering unbearably, it is contrary to their human rights to be denied an assisted death. The Parliament decided to have a narrow Bill initially, not dissimilar to ours, and, if that worked, to extend the scope of that Bill. Canada is a very exceptional case because of that. The reform was led by a Supreme Court judgment and the Parliament was a bit nervous about doing it, so people today should not refer to Canada as an example of a slippery slope. The laws in Belgium, the Netherlands, Switzerland, Canada, Spain, Colombia and elsewhere may be raised today. I hope they will not be, as they have always been more broadly based. References to those laws are irrelevant to our debate.
We will also hear much today about vulnerable people, which is absolutely right, but there are no legal safeguards for dying people who decide to end their lives early, whether by starving or, on occasion, shooting themselves. We propose a rigorously safeguarded system that would end these barbarous deaths and protect vulnerable people.
Some say that pain can always be controlled; cancer specialists know better. Some have written to me referring to the terrible suffering of terminally ill cancer patients from physical pain—a small minority, but each and every one of them is important, nevertheless. The Association of Cancer Physicians, in its excellent and balanced book End of Life Choices for Cancer Patients—it is careful not to come down on one side or the other—concludes that
“we do not see the comprehensive provision of high quality palliative care and the introduction of assisted dying as alternatives in competition with each other.”
In other words, they work well together when they exist together. The current law is unsafe and results in untold suffering. No civilised society should tolerate such a law. I beg to move.
I respectfully disagree with those who will argue today to continue a system that lacks transparency and accountability, with limited judicial oversight and scarce public reporting. Every Member of this House will have been touched by the care, the professionalism and, in many cases, the love of those who work in our care sector and NHS, including in my family right now in the current situation—but we cannot carry on with a system that gives the balance of rights to others at the end of their life, not the person themselves.
One of the most respected Members of the Scottish Parliament, a Deputy Presiding Officer and the MSP for Orkney, Liam McArthur, is carefully and consensually bringing forward a coalition that will likely now bring a majority for legislative change in Scotland. This will allow the people of the nation where I live the legal protections, rights and dignity of control which, for far too long over these 17 years, has been denied them. I support the Bill.
The Bill does not threaten the disabled. They are not ill and they are not dying in agony. It does not threaten people who feel they are a burden to those around them. They are not ill or dying in agony. The safeguards are many. The involvement of responsible people is mandatory. This is a measure of great humanity ringed around with practical and moral constraints. It deserves our support.