Assisted Dying Bill [HL]

Baroness Murphy Excerpts

2nd reading
Friday 22nd October 2021 Lords Chamber

[Baroness Murphy (CB)]

My Lords, I give my wholehearted support to the Bill proposed by the noble Baroness, Lady Meacher—and I have supported all the other such Bills that have come to this Parliament in the last 15 or 17 years.

Listening to the debate, I sometimes think that we are very parochial about this issue. We must look more closely at the international evidence. I hear some deliberate misreading of the international evidence, and it is important that we pay attention to it. Recently, somebody said that this would interrupt the trust between doctors and patients. All the evidence from Europe is that doctors in the Netherlands are trusted the most.

I want to mention two other common arguments that have been repeatedly mentioned today. The first is that frail older people will be coerced into killing themselves by wicked relatives or others aiming to inherit—referred to by the noble Lord, Lord Tebbit, as the “vultures”. Heavens, as a medical psychiatrist working with older people, I have come across these vultures quite regularly, but they are very easy to spot. Studies of patients who seek an assisted death in other legislations that use this particular approach, such as Oregon, Washington state and others, have demonstrated that those who seek an assisted death are not the frail and very aged with cognitive impairments that make them vulnerable to undue influence; they are far more likely to be college educated, financially secure and articulate people who have always valued personal autonomy. They have a mean age of 74, which I think is quite young, and, in the most studied jurisdictions, a very high percentage, 90% in Oregon, are already receiving palliative care or hospice at home care. Assisted dying is a very small part of good palliative care and end-of-life care in those jurisdictions; it is not an either/or.

My experience of being an expert witness in a large number of testamentary capacity cases—although, of course, sometimes the patient is dead already when I come to the case and sometimes the patient is going to die quite soon—is that undue influence and these subtle pressures never occur in patients who have the mental capacity to the high degree that is demanded by this legislation. There are usually tell-tale signs from a relative’s behaviour over the months and years before the death that the patient has been habitually exploited. Susceptible people usually have early dementia, a learning disability or, very rarely, an unusual lifelong dependence on another person. The American Bar Association showed that this was true recently.

I am going slightly over time here, and I am sorry, but the other matter arises from a recent demonstration by the University of British Columbia’s department of family medicine that people who seek an assisted death and those who are terminally ill who do not seek an assisted death both have the same rate of feeling that they do not wish to be a burden. That is an issue that is understandable and is distributed across the whole population; there is no difference between the two groups.

I urge noble Lords to look more closely at the evidence and to act accordingly to try to introduce a Bill from which so many people would benefit at the end of their lives—less than 1% but, nevertheless, an important tiny percentage of people who are nearing the end of life—to have the kindly death that they wish for themselves.

Assisted Dying Bill [HL]

Baroness Murphy Excerpts

Friday 18th July 2014 Lords Chamber

[Baroness Murphy (CB)]

My Lords, I am afraid that the noble Lord, Lord Gordon, will be disappointed that I am one of those members of the medical profession who would be proud to be associated with the Bill. I certainly would not desist from becoming an expert under a code of practice to administer medication to those who had requested it, if the Bill was passed. Many members of the medical profession feel, as I do, that at the moment the provisions are fudged, the system does not work and it depends on regular, 24-hour hypocrisy to deliver the care that we are currently obliged to pretend that we give.

Last time we debated this topic in the House, I rather lost my temper—egged on, I have to say, by the noble Baroness, Lady Boothroyd—so I have promised myself that I will not do so this time. However, one of the things that trouble me about debates in this House is that we go endlessly for emotional anecdote, talking about our experience, or talking about other jurisdictions as if we have looked at the evidence. I have sat here as a simple medical scientist—I was a practising psychiatrist and academic for 30 years, working with elderly people in the most deprived community in south-east London—and I have to tell noble Lords that I do not recognise any of the fears from evidence.

And there is evidence. Only one jurisdiction in the world has adopted the legislation that we are proposing here today: Oregon, which has now had it for 17 years. There are not only the annual reports on Oregon, which have very clear statistics on the issues we are talking about, on depression, and so on, but there is also—I will also refute what the right reverend Prelate the Bishop of Bristol recently said—a lot of independent research evidence from people outside the direct system who have gone to look at it and have done serious research. I am concerned about serious research evidence, not the anecdotes. There has been talk about the risk or fear about the doctor-patient relationship, but the country in the world that has the best trust in its doctors is the Netherlands. That is research evidence.

Returning to respecting individuals’ choice, I have heard it said here today that we must set that aside because of the profound effect on others. However, we already accept people’s decision to reject life-saving treatments if they have the mental capacity, regardless of any effects their subsequent deaths may have on those they leave behind, and we are happy to allow doctors to assess mental capacity for that purpose. I have heard other noble Lords say how difficult it is, and no doubt in the future others will say the same. The fact of the matter is that the Mental Capacity Act and the Mental Health Act and a lot of other legislation regarding mental health patients are totally predicated on doctors’ ability to assess capacity, and they do so every day of the week. Therefore let us have none of that.

On the code of practice, no legislation on health and social care puts on the face of the Bill the detail of how the Act is to be implemented. We always ask for the professions, and of course the Department of Health involves the professions and the independent professional bodies in trying to deliver a code of practice that is acceptable to the professions which have to deliver the care. It will be the same in this Bill as in any other. I say that having spent a good part of my life on codes of practice for the mental health legislation.

I will make my last point on the issue of depression. The right reverend Prelate the Bishop of Bristol said that 60% had symptoms of depression. That is not true. One in six has some symptoms of depression. People who are terminally ill have symptoms of depression. However, that does not mean that they have a clinical depressive illness which can be treated, and there are ways of excluding that. Again, noble Lords will hear differently, and I ask them please to read the research evidence. We should make our decisions on evidence that exists today, not on supposition.

Assisted Suicide

Baroness Murphy Excerpts

Wednesday 5th March 2014 Lords Chamber

[Baroness Murphy (CB)]

My Lords, I give my full support to the introductory speech from the noble Baroness, Lady Jay. However, I am abandoning the rest of my speech because I am so cross at what I have heard today, which I know to be totally false and I am tired of listening to it.

First, I say to the noble Baroness, Lady Campbell of Surbiton, that services for terminally ill people have got substantially better over the past five years. There is greater understanding and more talk about the issues surrounding death in hospital. The economic circumstances of this country have not led to greater disadvantage for people who are terminally ill; paradoxically, it has led to an improvement.

I should also like to tell the noble Baronesses, Lady Campbell and Lady Grey-Thompson, that it is impossible to conflate the problems of people who are terminally ill, are already dying and are about to die with those of people who have a chronic long-term disability and are not dying. We must distinguish between these two groups. That is crucial because they are completely and utterly different.

I should also like to say to my two medical colleagues behind me, the noble Baronesses, Lady Finlay and Lady Hollins, that, if their patients do not talk about dying or the wish to die when they are terminally ill, I just do not think they are listening very well.

[Baroness Finlay of Llandaff]

My Lords—

[Baroness Murphy]

I am sorry; I have only two minutes. Of course people talk about this. They do not sit there quietly. I read the BMA guidelines again today to make sure that I was up to speed—being a member of the BMA, I would, wouldn’t I?—and I can tell your Lordships that they make it very clear that you must not discuss any of these issues. I believe that the BMA circulated this guidance to everybody today and not just to doctors. Incidentally, we know that the BMA has never asked its members about this—I have never been asked by anybody in the BMA. Of course, it is led by people who are violently opposed to any new policy, so that is hardly surprising.

My time is up but I must express my anger today. I am for the proposals put forward by the noble Baroness, Lady Jay.

Divorce

Baroness Murphy Excerpts

Monday 18th October 2010 Lords Chamber

[Baroness Murphy]

My Lords, I am no lawyer, and I really do not know much about divorce law, but I have been through a divorce, which has led me to observe what happens in the courts. It was a long time ago, before the case of White v White in 2000, but it led me to think about how the law treats marriages and what we might do about it. I have a great deal of sympathy with the ideas expressed by the noble Baroness, Lady Deech, on how we might move forwards.

On “Desert Island Discs” recently, Kirsty Young asked Fay Weldon how she felt when her husband of 30 years left, and she said,

“I thought I would go mad”.

That captured for me the exact sense of disorientation, disbelief, anguish and despair that I felt when it happened to me—an infinitely greater loss than bereavement, it seemed to me, since you lose your entire notion of who you have been for 50 years. The rather disdainful approach that I had previously taken in a secure marriage, as I thought it, to people whose marriages had collapsed naturally disappeared very quickly. If I can talk about this subject now with equanimity, it is because it all happened more than 13 years ago and I have had the good fortune to marry again.

I sought out the very best divorce lawyer I could, as did my husband. He was a businessman, and our affairs were very complicated with businesses and homes abroad as well as here. I was the joint owner of some of them and not others, so noble Lords can imagine that it was a very difficult matter to tease out the ownership of these various possessions. But we were both very determined from the outset that we would remain close friends and stay close to each other’s families. Did the lawyers help? They were the very best, nicest people and were even personal friends with each other, but several weeks down the line the adversarial system had us both with barristers lined up and cocked at the ready, ready for the courts to proceed. We were both getting more desperate, not less. We had a chat about it and said that we thought we could probably do a better job ourselves, so we went off to the pub and went line by line down all our assets and decided how to divvy them up. Some of the assets, of course, had more financial value but less emotional value, while others had more emotional value and less financial value. We simply went back and sent a joint letter to both our solicitors saying, “Please get on with that—that is it, please”. We were not very popular with our solicitors, but I know that any more fighting would have destroyed our future relationship. Having dealt with the separation agreement to our mutual satisfaction, we could then start to deal with the rest.

I realise that many couples will not be able to negotiate in this way. Often one spouse is much stronger than another and sometimes there are few feelings left for the other person. Anger turns to revulsion very quickly. People will behave badly if they can get away with it, and men and women are equally to blame for bad behaviour. Yet I believe that if we had had a skilled mediator in place, we could have solved many of these difficulties from the outset. I particularly liked the introduction in 2003 of the collaborative legal practice arrangements, where people sit down with their lawyers, outside of court, and do it together in a low-key way, still having joint conversations and avoiding the expensive court battles. It seems to me that people ought to go through that first, as a sort of obligatory phase.

Where children are involved, it seems to me that an adversarial court situation is, frankly, bonkers. It is expensive, detrimental to the health of children and leaves scars between the parents that are unlikely ever to heal, meaning that children, in effect, often lose one parent entirely. Frankly, I do not see why legal aid should be available to allow unhappy people to continue mutual squabbling over the possession of their children—and how often have we seen that?

The noble Baroness, Lady Meacher, and I share an office with the noble Baroness, Lady Howarth, who is the chair of CAFCASS. The horrific stories that she tells of the sort of things that children are subjected to in courts while being fought over makes your hair stand on end. As one American lawyer said, the parents declare war and then draft the children. Disputes should be settled out of court through mediation and dispute resolution by non-adversarial professionals. We have an edifice of family courts whose raison d'être we should question. I understand that 95 per cent of divorces in the US are now completed through mediation and/or legal collaboration. Surely, we should aim for that here.

However, what about the very wealthy and the underlying principles? It seems to me that the basic premise of White v White in 2000 is right. The law on the needs basis had not kept up with changes in society. In most cases, the courts were trying to satisfy the needs of both parties with limited resources. The noble and learned Lord, Lord Nicholls of Birkenhead, emphasised that there could no longer be gender discrimination when determining the allocation of ancillary relief. He said,

“If, in their different spheres, each contributed equally to the family, then in principle it matters not which of them earned the money and built up the assets. There should be no bias in favour of the money-earner or the child-carer”.

The House of Lords also recognised that, by being at home and looking after young children, a wife may lose forever the opportunity to acquire and develop her own money-earning qualifications and skills. To a great degree, that is still so. The noble and learned Lord, Lord Nicholls, also said that the judge,

“would always be well advised to check his tentative views against the yardstick of equality of division”,

and that it seemed to him that equality should not be departed from, apart from with good reason. All of that seems absolutely right.

What do we do about foolish men with large fortunes who get hitched to gold-diggers, then find themselves divorced a few years later? My heart does not bleed for them very much; no, men and women will always be fools in love and there is surely scope within the principles of White v White for adjustments to be made. As Simon Cowell—he is the one on the other side when the rest of us are watching “Strictly Come Dancing”—recently said:

“Marriage is an outdated contract … I don't believe in marriage, certainly not in this business”—

I suppose that he means show business. He said:

“The truth is that you get married and in a year or two they clean you out”,

so he is wisely remaining single for now. He is engaged instead, which seems to be an end point rather than a plan to do anything else in the future.

I am rather ambivalent. I am very attracted to the right reverend Prelate’s view that once you marry someone, you are forming a partnership more than a temporary arrangement. You are making a life and committing yourself to that person. On the other hand, we must recognise that there is a force to be had in saying that in the modern era, having some sort of premarital arrangements or commitment would probably be more sensible. So the answer is for us all to have prenuptial agreements when we embark on the journey, however wealthy or impoverished we start out. Making them legal would at least be a partial step towards the sort of reform that the noble Baroness, Lady Deech, is advocating.

My final point is about the no-fault divorce system. It must be sort of right; we cannot expect the courts to weigh up all the various causes and hurts between individuals. Rather than a no-fault divorce, though, I would like to see the notion that it is everyone’s fault—in other words, that the two people have somehow contributed to this failure overall, and that ought to be recognised when people are going before mediation and the collaborative legal system.

My solution for the moment is a universally legally binding prenuptial agreement, but I still rather like the idea that we have to take on the notion that when we marry, we do so for life.

Drugs and Crime

Baroness Murphy Excerpts

Tuesday 15th June 2010 Lords Chamber

[Baroness Murphy]

My Lords, I add my voice to those of others in thanking the noble Baroness, Lady Meacher, for her untiring efforts to change UN drugs policy. The UN thinks that she can change the world, and I have to tell your Lordships that, after many years’ experience, it is wholly right.

The past 10 years has seen some modest reduction in harms. I pay tribute to the work of the National Treatment Agency in getting so many more people into treatment and care, but there is no doubt that our current emphasis on the criminalisation policy, which we have pursued here and abroad with minimal accompanying strategies on prevention and care, has been unhelpful. At the moment, we spend less than 7 per cent of the drugs budget on healthcare and less than 0.5 per cent on research into effective prevention and treatment strategies. There are no formal figures on how much is spent on education. Those figures alone must make us pause and rethink in the way that the noble Baroness advocated today.

I return briefly to the differences between decriminalisation and legalisation, which are seriously different strategies. Around the world, we know now, especially from studies in the United States, in different states' policies, and in Australia, that eliminating criminal penalties for possession of small quantities of drugs has no effect on the prevalence of drug use. That is true for marijuana and it is probably true for hard drugs as well, although I have to say that only Spain and Italy among major industrialised countries have tried it, and they do not collect outcome statistics that are in any way meaningful, so there is a serious problem there.

I love the story of the American academic researcher MacCoun, who works at Berkeley in California. He asked his undergraduate students whether they would be in favour of California removing penalties for possession of small amounts of marijuana. About two-thirds said yes, and the rest were opposed. Almost none knew that it had occurred 25 years ago.

Decriminalisation is not the same as legalisation, which allows some form of regulated sales or distribution, and of which there is only one contemporary example: the well known Dutch model of de facto legalisation which began in 1976. There is no instance of legal commercial access to cocaine or heroin in a modern, industrialised nation. Switzerland has probably come nearer than most and has concentrated significantly on improving health and reducing criminality among participants in its heroin prescription programme but, again, more rigorous research is needed.

Nevertheless, we can blame prohibition for much of the crime and violence around the illicit drug markets, for a large fraction of drug overdoses and drug-related illnesses and for corruption and the violation of civil liberties. However, other harms are due to the drugs themselves and the influence they have on the user’s health and behaviour. Legalisation would eliminate the harms caused by prohibition, but it would not eliminate the harms caused by drug use. Thus, there is a trade off. If average harm went down under legalisation without an increase in use, we would clearly be better off than we are today, but if legalisation produced a significantly large increase in total use, total drug harm would go up, even if each incident of use became somewhat safer. Total harm can rise, even if average harm goes down. It is true to say that at present there is no firm basis for projecting the relative magnitudes of these effects.

What we need to do is perhaps to have some decriminalisation, but to refocus on the prevention and treatment strategy. President Obama’s adviser, Thomas McClellan, has given many talks in this country and has described very well the new prevention strategy focusing predominantly on school and adolescent education, the re-engagement of parents, constant police monitoring and the involvement of all community organisations that come across young people. They are all pushing a specific message. I should remind noble Lords that drug addiction and misuse start between the ages of 10 and 21. Practically no one becomes an addict after that point. It is therefore very clear where we can focus our prevention strategies.

Overcoming addiction is very difficult. We know that compulsory coercion in the criminal justice system and compulsory treatment do not work. However, there are good forms of coercion. People need to take an active part in the choices that they make. That is part of the NHS commitment to all patients. They need to make active choices, and there are good forms of negotiation and coercion that can get people happily into treatment as a voluntary act. We should use coercion in the good sense of negotiating with individuals and asking what we can do to help them in their lives to make it sensible for them to come in and stick with the treatment. It is a long, hard graft and covers all the other issues that the noble Lord, Lord Adebowale, so eloquently described, but it is well worth it for the good outcomes that we can achieve.