May 12th 2006. Debate On The Joffe Bill to permit assisted suicide.


For the text of the full debate, click here

Lord Alton of Liverpool: My Lords, this is the third time that a Bill of this kind has been laid before your Lordships’ House. We have had a full Select Committee, 21 hours of parliamentary debate on the issue, 10 sitting days of the Select Committee of your Lordships’ House and, of course, visits to three foreign countries to look at the law there. It is quite clear from this long and very balanced debate that there is no consensus here today—admittedly, more speeches have been made against the Bill, but some powerful speeches have been made in favour of it—nor was there consensus in the Select Committee. For that reason alone, your Lordships should think very seriously about moving from debate to legislation.

My noble friend Lord Joffe and I have stood together on many issues in the past, and I would repudiate anyone who has cast doubt on his integrity. I told him at the outset of the debate that I believe there should be robust parliamentary debate about what is clearly a crucial ethical issue of our times and I believe that  has now taken place.

The time is coming when we must reach a conclusion about the principles of a Bill which, as the noble Lords, Lord Brennan and Lord Carlile, and others have said, is not capable of amendment in a way that would be acceptable to a majority, not only of your Lordships’ House, if today’s speeches are to be believed, but also, of course, the royal colleges, which have been much cited, disabled people’s groups, which have also been mentioned during our proceedings, and public opinion. Public opinion is difficult to gauge: correspondence has been overwhelmingly against, and polls cited but they are only barometers and should not be the determining factor. They are very much divided. Surely, the next step should not be a Committee stage but a debate and a vote in another place on the principles behind this Bill. If we are to test parliamentary opinion, should that not be the logical way to proceed?

Much has been said in this debate about the overriding principle of choice. GK Chesterton once famously said that to admire mere choice is to refuse to choose. We all know that freedom for the pike is inevitably death for the minnow; freedom for the hunter, death for the hunted. Our noble friend Lady O’Neill of Bengarve, a very distinguished philosopher, said in a note to your Lordships yesterday:

    “Legalising ‘assisted dying’ amounts to adopting a principle of indifference towards a special and acute form of vulnerability: in order to allow a few independent folk to get others to kill them on demand, we are to be indifferent to the fact that many less independent people would come under pressure to request the same”.

She was saying that choice itself is not a trump card, which we have to bear in mind today when we consider the effects on society if a Bill of this kind were to be enacted.

We have heard many personal stories. When I was a child one of my uncles, in a fit of acute depression, took his own life. The repercussions on his immediate family, and on society at large when there are suicides, should not be underestimated in this debate. We must think about that effect very carefully. Once a life is taken, it cannot be given back.

Much has been made of the experiences in Holland and Oregon. In Holland, it started with turning a blind eye; then voluntary euthanasia; and then involuntary euthanasia, with 1,000 deaths now occurring each year. As others have said, that has led to the killing of spina bifida children. It has happened already at Groningen Hospital where it was done in order to push the law further. That is what happens when we move in that sort of direction. Other noble Lords have given further examples.

We heard from the noble Earl, Lord Arran, about Oregon. I simply draw to the attention of your Lordships’ House the 2004 report by Fromme, Tilden, Drach and Tolle, entitled, Increased family reports of pain or distress in dying Oregonians: 1996 to 2002. It states that those dying in,

    “2000-2002 remained approximately twice as likely to be reported to be in moderate or severe pain or distress during the last week of their lives”

than in 1996–97. The evidence therefore on Oregon is at best conflicting. There are many doubts about this legislation. We should think very carefully. Yes, let us have powerful debates like the one which we have had today, but do not let us proceed with legislation.

Debate on Lord Joffe’s proposals for assisted suicide and euthanasia

Lord Alton of Liverpool: My Lords, when we last debated the issue of euthanasia and assisted suicide I set out my own reasons for opposing such a change in the law, but I supported the reference of these complex questions to a Select Committee. Along with others in your Lordships’ House today I should like to pay tribute to the Select Committee for the honourable and diligent way in which it has discharged its duties. I pay tribute particularly to the noble and learned Lord, Lord Mackay of Clashfern, for chairing that committee so well.

Before considering whether we should legislate in such a controversial area surely four things would be necessary. Let me take those in turn. The first is: is change really necessary? The existing law and the General Medical Council’s guidelines have hitherto provided a good framework. As my noble friend Lady Finlay of Llandaff said in her powerful speech earlier today, through the palliative care movement we can provide the answer for those who are in suffering and pain. There is no division in your Lordships’ House today that where bad medical practice exists, it needs to be put right, but is this the way to do it?

The arrangements that we have in this country are admired and commended by many. The Select Committee at paragraph 59, page 25 of the first volume noted in connection with the 2002 European Court of Human Rights judgment the court’s view that our laws are,

“designed to safeguard life by protecting the weak and vulnerable”,

and that,

“the blanket nature of the ban on assisted suicide was not disproportionate”

and that there is “flexibility” in our law. Nor could any justification for assisted suicide be found within the convention on human rights. So we should not be propelled pell-mell into change simply for the sake of it.

My second criterion that I think should be met is the argument about whether there is widespread agreement on the need for change. Quite the reverse is true. There is a clear lack of public and political consensus reflected in the thorough way in which the Select Committee has highlighted the deep differences of opinion and practical difficulties-divisions that have been mirrored again during this extraordinarily moving and at times very well-informed debate that we have had in your Lordships’ House today. This should make us all extremely wary of legislating in haste. Many have expressed the fear that this is a first incremental stage-a phrase used in the Select Committee report-towards widespread euthanasia; a view underlined by the opposition of, among others, the Disability Rights Commission. Many of your Lordships will have received their representations over the weekend. I am personally involved as a patron of three hospices. I know that many other noble Lords are also involved in the hospice movement. We are all very well aware of the representations that that movement has made. It is fearful that changes in the law will undermine good palliative care and the work of the hospice movement.

Thirdly, is the medical profession demanding change? We have heard today about the BMA’s neutrality. However, not everyone is neutral. The Royal College of General Practitioners, which represents some 23,000 members, says that,

“with current improvements in palliative care, good clinical care can be provided within existing legislation and that patients can die with dignity. A change in legislation is not needed”.

The Royal College of Nursing holds a similar view. That position was tellingly reinforced in a letter I received last week from Dr. Kathryn Myers. She describes what she calls the “extremely small” number of patients who might seek euthanasia. She states:

“My clinical experience has persuaded me that there is a far larger number of chronically ill patients who have no prospect of cure who might choose, or be persuaded to choose, Physician Assisted Suicide out of a sense of duty to their families and to society as a means of lessening the financial and emotional burden that they perceive their illness places on others”.

In other words, as my noble friend Lady Masham said earlier, doctors fear that the right to die will become a duty to die.

Fourthly, is there political will for change? That point was made earlier by the noble Lord, Lord Carter, in his telling speech at the beginning of our debate. Successive governments and the Leader of the Official Opposition in your Lordships’ House, have said that they will not provide time for this sort of legislation. The elected House would have to be convinced. The last time a comparable measure was introduced there during the time I was a Member of another place it was overwhelmingly defeated. Before going any further the opinion of the elected House ought to be sought again.

But if these four criteria for proceeding have not been met, what of the principles underpinning the Bill? In 1994 the Select Committee on Medical Ethics, so ably chaired by my noble friend Lord Walton of Detchant, unanimously concluded that legalising voluntary euthanasia or assisted suicide would be wrong in principle and dangerous in practice, representing a grave danger for many vulnerable people. Those principles and those dangers have not been eclipsed by the mere passage of time. And what of the Oregon model of which so much has been said during our debate? Those states in America that have examined Oregon as a model have all rejected it. Professor John Keown of Georgetown University in a letter to me quotes the latest position as,

“at least 54 assisted suicide and/or euthanasia measures have been introduced in 21 states. Not one has passed. On the other hand . . . seven states passed laws prohibiting assisted suicide”.

The professor of radiation oncology at Oregon’s only medical school, Professor Kenneth Stevens, is a doctor who has specialised in cancer treatment for 38 years, yet whose views were dismissed as irrelevant earlier in the debate. He says:

“The more I have learned, the more I realise the significant harm and danger of assisted suicide to the vulnerably ill and to society”.

He points to a profound negative shift in attitude towards the terminally ill. He says that the commitment to care has become a commitment to the option of killing, with some non-terminal patients now considering assisted suicide. He says that there has not been a single instance in Oregon of assisted suicide being used for untreatable pain, and there have been problems with safeguards and with monitoring. It was said earlier that numbers have been about static in Oregon since the introduction of the law. I have here the seventh annual report on the Oregon Death with Dignity Act, which shows that the number of assisted suicides in Oregon-though small-has increased by more than 225 per cent over the past seven years.

With great honesty, the noble Lord, Lord Joffe, made clear to the Select Committee that his Bill is, in his words, but a “first stage” and that he would prefer to see a law of much wider application. The House should ponder deeply before endorsing such a first stage, knowing in advance the destination to which we are being invited to travel.