Assisted Dying

Debate between Baroness Jay of Paddington and Baroness Buscombe

Monday 6th March 2017 Lords Chamber

[Baroness Jay of Paddington]

To ask Her Majesty’s Government what assessment they have made of recent legislation on assisted dying in North America; and whether those laws provide an appropriate basis for legislation in England and Wales.

[Baroness Buscombe (Con)]

My Lords, I remind all Back-Bench speakers that they are time limited to one minute—and we have to be strict about that.

[Baroness Jay of Paddington (Lab)]

My Lords, I am grateful for the opportunity to raise this Question for Short Debate today. This House has a very distinguished record of authoritative, informed and wise debate about the very complicated and difficult issue of assisted dying. However, since 2015, when my noble and learned friend Lord Falconer’s Bill made considerable progress in this House but was then dropped at the time of the general election, and following a Bill in the House of Commons that failed, there has been very little opportunity to reopen the question of changing our law. I must say that the number of speakers this evening suggests that interest has not declined, and I apologise for the very short time that has been given to the debate.

While the UK Parliament may have been inactive in the recent past, the international picture has changed significantly. This is particularly true in North America, where Canada and several important jurisdictions in the United States have passed, and indeed implemented, laws to enable assisted dying. Overall, these new laws bear a striking similarity in their provisions and safeguards to those proposed in the Falconer Bill.

I have just spent a few weeks in the United States, including in Washington DC, where, as noble Lords are well aware, the political atmosphere is febrile and deeply divided. Nevertheless, on 18 February, the capital city of the United States became the latest place to bring an assisted dying law quietly into effect, without, as far as I know, even a single presidential tweet. It is too early to judge how that will work in practice, but what surprised me was the calm acceptance which greeted its introduction. The same has been true in California, the most populous and diverse state in the union, where legislation was passed in 2015. Colorado followed suit in 2016, after a referendum in which 65% of the population supported the law change.

Canada’s Parliament also acted last year, with Canada becoming the first Commonwealth country to legalise assisted dying. The Canadian decision came after a constitutional ruling from its Supreme Court. There are some lessons in that experience for the British situation, and my noble and learned friend Lord Falconer will address those.

It is very important to note that all the lawmakers in the USA have closely followed the state of Oregon’s original Death with Dignity Act, which was introduced as long ago as 1997. The citizens of Oregon now have two decades of experience of the Act, and the most recent report shows, once again, the stability that has always characterised its practice of assisted dying. In total, 1,127 Oregonians have made this choice in the past 20 years, amounting to less than 0.19% of all deaths over the same period. Interestingly, in 2016, the number of assisted deaths fell slightly, from 135 in the previous year to 133. The original tightly drawn eligibility criteria have not been challenged or extended beyond the terminally ill, and there have not been proven cases of abuse. The argument that changing the law leads always to a slippery slope of rising numbers and looser guidelines has been shown to be wrong.

Interestingly, Oregon’s hospice movement, which in the 1990s was opposed to a change in the law, now acts to support end-of-life options. Palliative care there is very highly rated, as indeed it is in this country, but unlike in Britain there is no suggestion that palliative care may always be an alternative to an assisted death. More than 90% of the state of Oregon’s citizens who choose to end their lives are already enrolled in the hospice system and the vast majority of them die at home in comfort. That same kind of experience is reflected in the newer statistics from other states where monitoring is now in place.

This is a gentle and compassionate approach to dying which is working effectively and safely for the minority who make the choice. I emphasise again that all the American laws are very similar to those proposed in the Falconer Bill, although my noble and learned friend’s proposals contain even more stringent safeguards, partly of course as a result of amendment in this House. Surely the expanding transatlantic experience should act as a positive guide to future legislation in this country.

Of course it would be wrong to suggest that although death with dignity is now an accepted choice for many North Americans, there was not fierce controversy when it was first mooted. However, what I find surprising is that some of the types of opposition which have so far seemed insurmountable in this country have not prevented change there. Let us take, for instance, the question of religious faith and belief. Americans are known to be more religious and certainly more observant than the British. Surveys suggest that almost three times as many citizens in that country attend a religious service about once a week, and yet within religious practice and faith there does not seem to have been the intransigent opposition to the concept of assisted dying either by faith leaders or their flocks that we have often heard here.

I was impressed by the statements of Governor Jerry Brown of California when he signed that state’s End of Life Option Act. Noble Lords may remember that Jerry Brown, who was indeed a Jesuit seminarian in his youth, said that he did not know what he would do personally if faced with a terminal illness but:

“I am certain, however, that it would be a comfort to be able to consider the options afforded by this bill. And I wouldn’t deny that right to others”.


I am delighted that the noble and right reverend Lord, Lord Carey, is speaking in the debate, and I hope that others of our faith leaders will be able to follow what I would regard as the more open approach shown both by the noble and right reverend Lord and people such as Governor Jerry Brown.

Another source of rather adamant opposition to change in this country has been some of the professional organisations representing doctors. Obviously doctors must play a vital role in the safe practice of any assisted dying legislation. Again, the North American experience is instructive. In California and Canada the medical associations, which were initially concerned, have now adopted appropriate positions of neutrality to the new laws. This pragmatism has therefore usefully meant that they, doctors and other health professionals can be actively involved in both shaping good practice and guiding the development of safeguards for everyone involved.

While all this has been happening on the other side of the Atlantic, the situation here remains frozen, and today’s Parliament really does seem to be out of step with the overwhelming majority of the British public who, when they are surveyed, always support change. The evidence suggests that more and more people here are now assuming control over the end of their lives by taking the law into their own hands. In 2016, a record number of 47 Britons—those who could afford both financially and physically to do so—travelled to the Swiss organisation Dignitas for assisted deaths. A recent freedom of information request to local authorities revealed that each year more than 300 terminally ill people die by suicide, sadly often taking their lives alone so that they do not involve or incriminate anyone else.

It is now more than 20 years since I first became involved in this issue as a member of a Select Committee of this House. I said earlier that noble Lords have taken a leading role in the assisted dying debate, and perhaps unusually we have been widely commended for our thorough and proper approach. Now, in 2017, the North American experience shows that laws which closely resemble Bills that have been introduced in this House before can operate safely and successfully. I hope that the Government will make a positive assessment of these developments and reflect seriously on how they might be relevant to this country. I also hope that the business managers of the House will make it possible to have a more lengthy consideration of the current issues.

I am grateful to all those who are taking part in this debate, although as I say, I regret the shortness of time to speak. I am sure that noble Lords will continue to play a central part in developing legislation to reform our own laws.