July 18th 2014 Debate on the Assisted Dying Bill. 6.36 pm
Care Not Killing Alliance interview about the Bill…
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 was chaired with such distinction by the noble and learned Lord, Lord Mackay of Clashfern, covered some 246 Hansard 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”.
“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 actual questions that are asked in those polls are the issue. Prudential judgement is required by Parliament.
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 judgement is ultimately 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”.
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 MP, 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, to that,too, we should pay great attention.
Why I Oppose The Assisted Dying Bill
Those seeking to change the law are orchestrating a well organised and well-funded campaign to set aside the earlier decisions of Parliament to keep the law as it is – a just law which protects the vulnerable but is also merciful and compassionate. The House of Lords will make an error if it rushes pell-mell into a law which, in due course, will lead to Dutch style euthanasia laws, where it is now lawful to kill the patient without the patient’s consent, or Belgian-style euthanasia laws which include the euthanasia of children.
Lest you doubt the danger of incrementalism consider the situation in the State of Washington, which has been detailed in the following Early Day Motion, No 86, in the House of Commons (which you could ask your MP to sign):
That this House notes the results of the Washington State Death With Dignity Act Report, 2013, published on 10 June 2014 which concludes that the number of deaths through physician-assisted suicide has tripled since the first year of implementation and increased by 43 per cent between 2012 and 2013; expresses grave concern that 61 per cent of those who received lethal drugs in Washington in 2013 gave as a reason for seeking assisted suicide being a burden on family, friends or caregivers; recalls that those who introduced the law in Washington assured the public that it would only apply to terminally ill, mentally competent patients; and reiterates its belief that a corresponding change in UK law would endanger the lives of the most vulnerable in society
Repeatedly, British Parliamentarians have asked the question whether is it possible to allow euthanasia for a determined few without putting much larger numbers of others at risk – and they have concluded that it is not. When the House of Lords considered an earlier attempt to change the law a Select Committee’s inquiry covered some 246 Hansard columns and two volumes of 744 pages and 116 pages respectively. There were 15 oral sessions; 48 groups or individuals giving evidence; 88 witnesses giving written evidence; 2,460 questions were asked and the committee received 14,000 letters. The idea that the issue has not been exhaustively considered is absurd.
The House weighed the evidence and said it simply isn’t safe to change the law.
It is significant that the media frenzy which accompanies this debate never mentions that evidence or the opposition – predominantly on the grounds of public safety – of the British Medical Association, the Royal Colleges of Physicians, Surgeons , the General Practitioners the Royal College of Anaesthetists and the British Geriatrics Society, the hospices and Disability Rights Organisations and the Palliative Care movement – who eloquently set out all the negative outcomes which would result from a change in the law. 95% of Palliative Medicine Specialists – these are the people who care for dying patients day in and day out – are opposed to a change in the law. Are they – or those who oppose a change in the law – all uncaring?
The Association of British Neurologists warn that severe depression will lead to cases of assisted dying and that a law which says two doctors can determine such cases will offer few safeguards. Do they have no understanding of either patients or law? Are they, too, uncaring and lacking in compassion, opposed to dying with dignity? They know that you don’t need a doctor to kill you to die with dignity.
When he gave evidence to the Select Committee the author of the first Bill to legalise “assisted dying” ,Lord Joffe, very honestly said that he saw his Bill as “the first stage.” And Baroness Warnock has given us a glimpse of where future stages will take us.
Baroness Warnock has said: “If you’re demented, you’re wasting people’s lives – your family’s lives – and you’re wasting the resources of the National Health Service.” Suggesting that we have a “duty to die” she said “I think that’s the way the future will go, putting it rather brutally, you’d be licensing people to put others down.”
This turns the argument into a worth based on someone’s economic value rather than on their true human value and their human dignity.
Imagine what will happen in Britain if the proposed laws are implemented. You have a terminal incurable disease. You have the option of palliative care at £1,000 a week or a glass of barbiturates at £5. What will happen if we accept Lady Warnock’s proposition that “you’re wasting the resources of the National Health Service.”
And consider, also, those with a vested interest who will be tempted to put an inheritance before a life. One in eight current cases of elder abuse currently involves financial abuse by relatives. It would inevitably increase if we change the law.
Supporters of the Falconer Bill will seek to disguise the word “euthanasia” opting instead for the less graphic and more cuddly idea of “physician assisted suicide” But as one senior retired Law Lord said to me “that’s playing with words and splitting hairs, it amounts to exactly the same thing.”
Above all, consider the position of disabled people, like those who have organised the “Not Dead Yet” petition. They believe we have “a hard law with a kind face;” a law which provides protection and safety for vulnerable people; a law which affirms dignity in living as well as dignity in dying.
Baroness Jane Campbell, who launched the petition, and has spinal muscular atrophy, and has been a Commissioner of the Equality and Human Rights Commission, says:
“I and many other severely disabled people will not perceive your support for euthanasia as an act of compassion but one founded in fear and prejudice.”
Do we have a better understanding of how disabled people view euthanasia than the organisations which represent them? Are they lacking in compassion, too?
The introduction of euthanasia will be cloaked in words like dignity, mercy, compassion and autonomy but the reality will be – doctors who will be required in future to kill patients; disabled people encouraged to believe they would be better off dead; patient safety compromised; and politicians will use the new law as a pretext to withdraw resources from the care of the sick.
The so-called right to die will soon become a duty to die – and to die quickly – and that is why, for reasons of public safety, I oppose this Bill.
I am opposed to the Bill both on principled and pragmatic grounds. I do not believe that the law should license doctors to involve themselves in knowingly and deliberately bringing about the deaths of some of their patients. That would represent a major change both to the criminal law and to the principles that underpin medical practice. Before Parliament could agree to make such a law, it needs clear evidence that the law that we have is defective and, if that is so, that what would be put in its place would be better. On neither count has any convincing evidence been offered.
The Bill itself is flawed with serious defects. It contains no safeguards to protect the vulnerable, just a vague promise of safeguards at some future date. It defines terminal illness in such a way as to encompass large numbers of people with chronic conditions and disabilities as well as terminal illnesses. It contains no compliance system – not even a requirement for a doctor supplying lethal drugs to report. It places responsibility for assisting suicide on the shoulders of a profession that does not want it and most of whose members would have nothing to do with it – thereby placing people seeking assisted suicide in the hands of a minority of willing doctors who know nothing of them. And it ignores worrying evidence from the handful of jurisdictions overseas that have chosen to go down the ‘assisted dying’ road in one way or another.
Disabled people’s organisations, the palliative care movement, the BMA and Royal Colleges representing medics oppose this Bill. They do so, not because they lack compassion but because they know that if you pass this Bill, patient safety will be compromised; and, as time goes by, politicians will use the new law as a pretext to withdraw resources from the care of the sick.
Lord Alton is a Crossbench Peer.
Also – see a 2013 two-part BBC World Service radio documentary entitled, “When Assisted Death is Legal” and which is available to listen to here:
Assisted Dying Bill: Faith Leaders’ Statement
16th July, 2014
The Archbishop of Canterbury, the Cardinal Archbishop of Westminster, the Chief Rabbi of the United Hebrew Congregations of the Commonwealth and the Secretary General of the Muslim Council of Britain are amongst the 24 faith leaders who have today voiced their shared concerns about Lord Falconer’s Assisted Dying Bill. In a joint statement to Members of the House of Lords they say:“While we may have come to the position of opposing this bill from different religious perspectives, we are agreed that the Assisted Dying Bill invites the prospect of an erosion of carefully tuned values and practices that are essential for the future development of a society that respects and cares for all.”
The leaders and senior representatives are drawn from a broad coalition of Christian churches and denominations, and from the Jewish, Muslim, Hindu, Sikh, Buddhist, Jain and Zoroastrian faiths.Lord Falconer’s Bill will be debated in the House of Lords on 18th July 2014. The statement in full, with signatories, is below.To Members of the House of Lords:As leaders of faith communities, we wish to state our joint response to Lord Falconer’s Assisted Dying Bill. We do so out of deep human concern that if enacted, this bill would have a serious detrimental effect on the wellbeing of individuals and on the nature and shape of our society.
Every human life is of intrinsic value and ought to be affirmed and cherished. This is central to our laws and our social relationships; to undermine this in any way would be a grave error. The Assisted Dying Bill would allow individuals to participate actively in ending others’ lives, in effect colluding in the judgment that they are of no further value. This is not the way forward for a compassionate and caring society.
Vulnerable individuals must be cared for and protected even if this calls for sacrifice on the part of others. Each year many thousands of elderly and vulnerable people suffer abuse; sadly, often at the hands of their families or carers. Being perceived as a burden or as a financial drain is a terrible affliction to bear, leading in many cases to passivity, depression and self-loathing. The desire to end one’s life may, at any stage of life, be prompted by depression or external pressure; any suggestion of a presumption that such a decision is ‘rational’ does not do justice to the facts. The Assisted Dying Bill can only add to the pressures that many vulnerable, terminally ill people will feel, placing them at increased risk of distress and coercion at a time when they most require love and support.
A key consideration is whether the Assisted Dying Bill will place more vulnerable people at risk than it seeks to help. We have seen, in recent years that even rigorous regulation and careful monitoring have not prevented the most serious lapses of trust and care in some parts of the NHS and within a number of Care Homes. It is naïve to believe that, if assisted suicide were to be legalised, proposed safeguards would not similarly be breached with the most disastrous of consequences, by their nature irrevocable.
The bill raises the issue of what sort of society we wish to become: one in which life is to be understood primarily in terms of its usefulness and individuals evaluated in terms of their utility or one in which every person is supported, protected and cherished even if, at times, they fail to cherish themselves. While we may have come to the position of opposing this bill from different religious perspectives, we are agreed that the Assisted Dying Bill invites the prospect of an erosion of carefully tuned values and practices that are essential for the future development of a society that respects and cares for all. Better access to high-quality palliative care, greater support for carers and enhanced end of life services will be among the hallmarks of a truly compassionate society and it is to those ends that our energies ought to be harnessed.
Signatories:Bhai Sahib Mohinder Singh Ahluwalia, Chairman, Guru Nanak Nishkam Sewak Jatha
Mr Yousif Al-Khoei, Director Al-Khoei Foundation
Rev Dr Martyn Atkins, General Secretary of the Methodist Church and Secretary of the Conference
Bishop Eric Brown, Administrative Bishop, New Testament Church of God
Mr Malcolm M Deboo, President, Zoroastrian Trust Funds of Europe
Rev Jonathan Edwards, Deputy Moderator Free Churches Group
Pastor John Glass, General Superintendent, Elim Pentecostal Churches
Revd David Grosch-Miller and Mr John Ellis, Moderators of the United Reformed Church General Assembly
Colonel David Hinton, Chief Secretary, The Salvation Army United Kingdom
Rev Stephen Keyworth, Faith and Society Team Leader, Baptist Union of Great Britain
Ayatollah Fazel Milani, Dean of the International Colleges of Islamic Studies
Chief Rabbi Ephraim Mirvis, Chief Rabbi of the United Hebrew Congregations of the Commonwealth
Most Rev Dr Barry Morgan, Archbishop of Wales
His Eminence Cardinal Vincent Nichols, Archbishop of Westminster
Rev John Partington, National Leader, Assemblies of God
Mr Ramesh Pattni, Secretary General, Hindu Forum of Britain
Bishop Wilton Powell, National Overseer, Church of God of Prophecy
Maulana Shahid Raza OBE, Leicester Central Mosque, Leicester
Venerable Bogoda Seelawimala, Chief Sangha Nayake of Great Britain, London Buddhist Vihara
Dr Shuja Shafi, Secretary General of the Muslim Council of Britain
Dr Natubhai Shah, Chairman/CEO Jain Network
Lord Indarjit Singh, Director Network of Sikh Organisations (UK)
Most Rev and Rt Hon Justin Welby, Archbishop of Canterbury
The Guardian view on assisted dying: safeguard life
Lord Falconer’s bill sounds modest but it will redraw the moral landscape
The law against killing someone is absolute. The law that makes it illegal to help someone to die is also clear, retained in the 1961 legislation that first removed the criminal taint from suicide itself. But the ever-expanding capacity of medicine to keep people alive even when they want to die has led to the forging of some opaque compromises between real life and the law. The current situation is unquestionably messy. But it does not follow that it will be easy to tidy up.
Lord Falconer’s bill on assisted dying tries to bring clarity to one narrowly defined area. For the benefit of a very specific group of people, it asks that the law modifies what has until now been an absolute principle: the safeguarding of human life. In individual cases, that can seem the overwhelmingly compassionate decision. Nevertheless, and heartbreaking though such cases can be, the absolute principle is too important to jettison.
The courts have been repeatedly challenged to declare that it is within the law to help someone to die. Most often – as in the case of Debbie Purdy or the late Tony Nicklinson – they are victims of an illness which prevents them, or may in future prevent them, from taking their own lives, and they want the courts to rule that anyone who helps them would not be prosecuted. Ms Purdy won the right for her partner to accompany her to the Dignitas clinic in Switzerland without fear of prosecution. Mr Nicklinson’s wife lost the argument, begun before her husband died,that doctors should be able to help her husband end his life. Last month, the supreme court warned that either parliament must clarify the law, or it would.
The Falconer bill would not make any difference at all in these high-profile legal battles. It applies only to people who are terminally ill, whose doctors believe they have less than six months to live. It specifies that two doctors must certify that the patient is mentally capable of taking the decision, and that they are of settled mind. There is a cooling off period. The patient must be able to administer the medication themselves. But it legitimises the supply of the lethal dose of medication by a health professional, in a form that the patient can ingest.
This is a clarification of the outstanding area of uncertainty in the guidelines that the DPP drew up in February 2010 setting out the circumstances in which there might be a prosecution of someone who had helped another to commit suicide. The effect of the Falconer bill is to end in law the bar on helping to kill someone. In any given case, that may seem a necessary price to pay for an end to the extreme suffering that can only be escaped in death. There have recently been many intensely moving descriptions by people who have been witness to those moments, or who fear that they will experience them personally.
But most of us do not live or die alone. Death is never a completely private matter, as anyone who has experienced the suicide of someone close would testify. Nor is the value of life something that can be assessed independently of family and friends, or of wider society, as the bishop of Worcester argues on these pages today. Making their involvement legal will test all those relationships at a time when they are at their most vulnerable.
It would create a new moral landscape. It is also, potentially, open to abuse or, as those with experience of nursing elderly relatives will recognise, to the fear of abuse. Lord Falconer’s bill echoes the law in Oregon which has been in force since 1997. Last year, just 0.2% of deaths in the state followed a prescribed lethal dose. This is a benefit for a very few, at the cost of a very big moral change. What is more, it may not even be necessary. In his judgment on the Nicklinson case, Lord Sumption argued that the law is considerably more humane and flexible than many of those who argue for reform appear to recognise.
Too many campaigners dismiss it, but better end-of-life care can help. Reshaping the moral landscape is no alternative to cherishing life and the living
Daily Telegraph editorial:
An unhealthy Bill
The Bill to legalise assisted dying turns the ethics of the medical profession upside down
Today, the House of Lords debates a Bill to legalise assisted dying in the case of the mentally capable with less than six months to live. Its supporters are doubtless well motivated, but their proposal represents a path better not taken.
The proponents of assisted dying are keen to cast it as a civil rights issue, as though this is a freedom unjustly denied. Yet the idea that this is a great progressive cause is undermined by the nature of the opposition to it, which includes disability activists and doctors, who argue that it would put the vulnerable at risk. In reality, the issue at stake is whether doctors should be allowed to assist in someone’s death. Such a reform would turn the ethics of the medical profession upside down, creating a legal framework wide open to accident or abuse.
The problems with the Bill are many. Few doctors would be willing to make a prognosis about life chances, given the possible consequences; and such prognoses often turn out to be wrong. Even if patients are mentally competent, will they always be totally free from external pressure? The terminally ill may conclude that they are a burden to those around them and feel compelled to choose death. It is also argued that assisted dying will be permitted only in limited circumstances – but in the Benelux countries, these have widened to the point where euthanasia has essentially become normalised.
Even if the Bill is thrown out, it remains important to continue the debate over one of the most personal matters that politics can touch upon. In today’s Telegraph, Lord Lloyd-Webber tells us of the productive years that his terminally ill mother might have lost had such a law been passed, and of his own struggle with the issue. The more assisted dying is discussed, the more its risks will become apparent.
Some contributors to the House of Lords debate said that because we put down dogs that are in pain we should do the same to humans. it’s worth noting that last year, according to the Dogs Trust, 10,000 dogs were destroyed – put down because they had been abandoned or were unwanted, not because they were sick. How long will it be before we apply the same attitudes to unwanted or abandoned human beings?