Assisted Dying Bill [HL]

Lord Aberdare Excerpts

2nd reading
Friday 22nd October 2021 Lords Chamber

[Lord Aberdare (CB)]

My Lords, I support the Bill, above all as a matter of choice. I congratulate my noble friend Lady Meacher on introducing it.

If I was in the situation covered by the Bill, with little time left, no worthwhile quality of life and nothing to look forward to beyond intolerable pain and misery, both for myself and my family, I would want the option of seeking help to die, even though I might not take it. Merely having this choice would make it less likely that I would use it. I hope I never find myself in this position, but I have been greatly moved by the harrowing experiences of so many who have, including close members of my family, and of course by many of the stories we have heard from noble Lords today, including recently from the noble Lords, Lord O’Donnell and Lord Butler, and the noble Baroness, Lady Meyer.

For me, the question then is whether the Bill might have undesirable consequences. It applies only when someone has an incurable condition, is dying, wants to be helped to die and has the mental capacity to make that decision. My view of our medical and judicial services is not so jaundiced as to believe that two doctors and a High Court judge could easily be misled in assessing this. The Bill’s safeguards seem comprehensive, transparent and robust, and would create a situation in some respects less likely to result in suicides and other premature deaths than exists today. Of course, they would need full scrutiny and review as the Bill goes through and afterwards.

Like other noble Lords, I have had several hundred emails and letters on both sides of the argument—from doctors, both for and against, from people with disabilities, both for and against, and from people of faith, both for and against. I believe that everyone in our society should have the right to make intensely personal decisions such as this themselves, of course with input from those they love or trust. I add that not wishing to be a burden to one’s loved ones in one’s dying days seems to me a perfectly respectable consideration for a dying person to take into account.

Having thought deeply about the issue, considered carefully everything I have read and heard, not least today, spoken to doctors and others about their views and, finally, consulted my conscience, as many of the letters I received enjoined me to do, I can only conclude that the merits of the Bill, limited as it is, sufficiently outweigh the arguments against it for it to deserve to proceed, preferably with government assistance, as urged by the noble Baroness, Lady Mallalieu, and, of course, with full scrutiny and amendment.

Few minds will be changed today, but I ask opponents of the Bill to consider whether it is right to deny the wishes of a clear, consistent and growing majority of people who have expressed their views on this issue. The experience of other countries that have already moved in this direction is reassuring, and I hope we shall take the first step today towards following them. To quote just one of the letters I have received, “It really is time we did something to help all those terminally ill to make their own choices.”

Social Action, Responsibility and Heroism Bill

Lord Aberdare Excerpts

Tuesday 18th November 2014 Lords Chamber

[Lord Aberdare (CB)]

My Lords, I will speak to my Amendment 11 as well as to Amendments 8, 10, 12 and 14 in this group. I remind your Lordships of my interests as a trustee of St John Cymru Wales and as a vice-president of the First Aid All-Party Parliamentary Group.

As I indicated at Second Reading, the leading first aid organisations including St John Ambulance and the British Red Cross welcome the Bill in principle. Anything that serves to reduce or overcome people’s reluctance to step forward to provide assistance in emergency situations has to be good news. It can, as we have heard, be argued what actual difference the Bill makes to the law as it stands. However, if there is a perception that it removes the likelihood of people being sued after trying to give life-saving assistance in an emergency, and if people believe that the Bill gives them some extra protection, that in itself is worth having.

My concern is that Clause 4 as it stands is not seen by the leading first aid organisations as giving that reassurance. We know from the research I quoted at Second Reading that the people most likely to help in an emergency are those who have actually received first aid training. So these potential life-savers go along to their first aid courses, where they are taught to:

“Protect yourself and any casualties from danger—never put yourself at risk”.

I quote from the standard First Aid Manual. During their training, they may well ask, “If I take action to provide first-aid assistance in an emergency, can I be confident that I will not subsequently be sued if something goes wrong?”. To which the answer from the first aid training body would have to be, “As long as you act without regard to your own safety or other interests, you should have protection under this law; but we recommend that you should consider your own safety before acting, in which case this law would not seem to help you”. I suggest this would be more than a little confusing and unlikely to provide the reassurance which the Minister has emphasised several times is the object of this Bill.

I thank the Minister for copying me on his letter to the noble Lord, Lord Beecham, and I welcome his confirmation in that letter of the Government’s desire to encourage first aid and his recognition of the concerns of St John Ambulance and others. He also states that the Government will, quite rightly, work with voluntary organisations and other bodies during implementation phases to ensure that the Bill’s contents are brought to the attention of all those with whom they engage. In that case it would seem rather important that those bodies should themselves see the wording of the Bill as helpful to their own concerns.

Let me briefly cite some examples, provided by the British Red Cross and St John Ambulance, of how Clause 4 might affect the actions of a potential life-saver. First, I shall give two examples of heroic actions for which Clause 4 as it stands would seem to offer no reassurance at all. If a person has fallen off a ladder and is lying unconscious on their back, a responder might be afraid of moving them because of the risk of causing damage to their back or neck. Leaving them on their back could cause them to die from a blocked airway, often described as swallowing one’s tongue, so the heroic act would be to move them on to their side in the recovery position, with an open airway, even if this might cause other injury. Similarly, a responder may be concerned about causing injury through giving CPR—particularly if it might subsequently turn out to have been unnecessary because the person’s heart had not actually stopped. CPR requires quite forceful pressure on a casualty’s chest, which may result in injury such as broken ribs. Again, inaction could have much more severe, possibly fatal, consequences than unnecessary action. I cannot see that the wording of Clause 4 offers any reassurance at all in these instances.

I will look at situations more specifically covered by the wording of Clause 4. If someone has been electrocuted and a first aider rushes into action without considering whether the power source is still live and the casualty still in contact with it, he or she might well be acting heroically, but is likely to make the situation worse, with two casualties instead of one. We often hear of people plunging into cold or fast-flowing water to try to rescue someone in difficulties, only to end up drowning themselves, or suffering a cardiac arrest from the shock of sudden immersion in cold water, when they may have been able to help more effectively from the shore. Yet this is the sort of rash and unreasonable action that the wording of Clause 4 might seem to envisage, if not encourage.

There are a number of options before noble Lords to improve this part of the Bill and ensure it sends a clear, positive and unambiguous message to potential life-savers and, of course, to those who train them. Amendment 10 from the noble Lord, Lord Pannick, simply removes the unsatisfactory wording from the end of Clause 4. Amendments 8, 12 and 14 from the noble Earl, Lord Attlee, improve on this by replacing these words with the phrase “and without acting perversely”, which is defined in terms of how a reasonable person would act in the circumstances. My own Amendment 11—which needless to say is the one I recommend to your Lordships—replaces the same words with the phrase,

“and was acting reasonably and with a public-spirited intention”.

Any of these three options would improve the Bill; better still, of course, would be for the Government themselves to come up at a later stage with a form of words to define the sort of behaviour that is both heroic and consistent with good first aid practice, in order to give real reassurance to potential life-savers that they are unlikely to be successfully prosecuted if they act in a way that is reasonable and public-spirited, as well as heroic.

[Lord Hope of Craighead]

My Lords, I am in the happy position of not having my name to any of the amendments and therefore can offer such thoughts as might be useful as to which of them is to be preferred. I support a lot of what the noble Lord, Lord Aberdare, has said about the wording as it stands at the end of Clause 4 but I prefer the simplicity of the amendment from the noble Lord, Lord Pannick. The more you qualify the proposition that ends with,

“to assist an individual in danger”,

the more you open up the possibility of argument. The simpler the message, the better. The message is well conveyed by stopping at “danger” without introducing these complications and therefore I support the amendment from the noble Lord, Lord Pannick.

Social Action, Responsibility and Heroism Bill

Lord Aberdare Excerpts

Tuesday 4th November 2014 Lords Chamber

[Lord Aberdare (CB)]

My Lords, I start by declaring my interests as a trustee of St John Cymru Wales and as vice-chair of the First Aid All-Party Parliamentary Group. No doubt like some other noble Lords, I have received a briefing from St John Ambulance, which is of course the counterpart in England of St John Cymru Wales. There has been much discussion about the purpose of this Bill and what difference it will actually make. During the debate on the Queen’s Speech in June, I welcomed the announcement of the Bill, which I felt could help to achieve the laudable aim of persuading more people to volunteer or to provide emergency first aid assistance when needed without worrying about possible legal consequences of doing so. Having now seen the text of the Bill, and read and listened to the debates on it, I am not so sure.

The principal purpose of the Bill, since it is not at all clear to me whether or how it will actually change the existing legal position, seems to be the often-touted idea of sending a signal, both to the courts and to the rest of us, including potential volunteers and providers of emergency first aid help. However, if you are going to send a signal with any effect, it needs to be clear and unambiguous. It would also be helpful for the signal not to conflict with other signals that people expected to follow it are likely to receive. This Bill seems to fall short on those criteria, in at least two respects.

First, the Bill seeks to address an apparent concern that bystanders sometimes do not try to help in emergency situations because of fear that they may subsequently be sued for their actions. St John Ambulance commissioned research from ICM in August—which the Minister mentioned—to find out what factors might deter people from giving such help and whether this Bill would help to overcome them. The findings show that the key factor determining the likelihood of someone taking action in an emergency is having been on a first aid course. Some 55% of people with advanced first aid training would help, even with a life-threatening injury; while 55% of those with no first aid knowledge would not give first aid at all, even for a minor injury. The main inhibitor is that people lack the skills and confidence to know what to do and fear, possibly with some justification, that they may make the situation worse. Some 63% mentioned that concern as opposed to the 34% mentioned by the Minister concerned about possible legal repercussions. A rather small majority said that this Bill would make them more likely to administer first aid. Some 18% answered “more likely”, against 14% “less likely”, giving a positive balance of just 4%. One clear conclusion of this research is that the best approach to increasing the number of people willing to give emergency first aid—surely better than this Bill—would be to ensure that more people receive first aid training. One obvious way of doing that, which your Lordships have heard me mention before, would be to make such training mandatory in schools.

Secondly, the reference in Clause 4 to acting,

“without regard to the person’s own safety or other interests”,

runs directly counter to accepted first aid practice, as set out in the standard First Aid Manual developed jointly by St John Ambulance, the British Red Cross Society and St Andrew’s First Aid. This clearly states:

“Protect yourself and any casualties from danger—never put yourself at risk”.

What signal is this clause trying to send? Does it seek to encourage people to pile into emergency situations without any thought of the risks and dangers to themselves, which might indeed be viewed as heroic, but possibly in many instances also dangerous and foolhardy? Or should it encourage them to assess the risks and then take appropriate action, without of course feeling constrained by lack of skills or fear of legal consequences? Surely it is the latter.

One of the ways in which people are likely to hear about the provisions of this Bill and their effect in providing protection from prosecution when people act in a socially responsible or heroic way is through the process of receiving first aid training, but with the Bill as it stands the organisations providing such training would be forced to point out that it might remove such protection from people who act responsibly by taking account of their own safety before acting, as they are taught to do as part of their first aid training. That seems quite contrary to what the noble Earl, Lord Attlee, wants to happen in first aid training. Is that the message we want to send? I have considerable doubts about whether this Bill will anyway achieve the useful outcomes to which it is supposedly directed, but it certainly will not do so unless Clause 4 is amended to remove the phrase relating to personal safety and, ideally, replace it with a form of words that would emphasise the value and importance of responsible citizens learning first aid from as early an age as possible, as a means to being effective rather than counterproductive heroes.

Like other noble Lords, I am not convinced of the appropriateness of the nuclear option of denying the Bill a Second Reading, but if it goes into Committee I hope the Minister will make every effort to address the concerns that have been expressed today, particularly in relation to Clause 4.

Assisted Dying Bill [HL]

Lord Aberdare Excerpts

Friday 18th July 2014 Lords Chamber

[Lord Aberdare (CB)]

My Lords, I support this Bill. The primary reason is purely personal and I can speak only on a personal basis. I would certainly wish to have the option provided by this Bill if I ever find myself in the quite limited situation that it addresses, although I fervently hope that that will never be the case. I believe that I am responsible for my own life and how I live it, including the right to end it if I find it no longer bearable.

My mother and mother-in-law both had long-drawn-out deaths, which in the case of my mother-in-law was accompanied by great suffering. In the end, both took the only way out that they could by starving themselves to death. Neither would have benefited from this limited Bill, but their experience has been crucial in forming my views. So have the stories I have heard of so many others who have endured deaths of almost unimaginable pain and misery for themselves and their families because they have not had it in their power to end it and cannot legally call on others to help them. I think particularly of an article that Prue Leith wrote in the Telegraph some time ago about the death of her brother.

A key question for me is whether the safeguards in the Bill are strong enough to protect vulnerable, elderly, sick or disabled people, or those who may be open to some form of coercion to persuade them to die. To be eligible for an assisted death, a person must have a prognosis of six months or less of remaining life. They must be mentally competent, have a “clear and settled intention” to die, have made their decision voluntarily without external pressure, be well informed about alternative options and be given time to reconsider their decision, which can be revoked at any time. All those requirements must be certified by two doctors acting independently. One of the merits of the Bill is that these judgments have to be made before the death can take place, rather than any suspicious circumstances having to be investigated afterwards.

In my judgment, the proposed safeguards seem to provide an adequate basis to ensure that the Bill can be used only in the limited circumstances for which it is designed. No doubt they will be thoroughly tested and I hope improved in Committee, which I welcome. No one can have listened to many of the powerful, deeply felt and well informed speeches today on both sides of the issue without seriously re-examining and retesting their own views. Similar arrangements to those in the Bill have worked well in Oregon for 17 years. The number of assisted deaths, at 0.2% of all deaths, is not out of line with what one might expect as reasonable. Research shows that the law is working safely. Other states are beginning to follow Oregon’s lead.

We have been clearly told by the Supreme Court that the present law is not working and that parliamentary guidance is needed. This Bill gives people in the very last stages of life the option of making a voluntary decision to shorten the process of dying that they feel they can no longer bear. Above all, the Bill seeks to offset the appalling cruelty of forcing people and their families quite unnecessarily to endure an agonising final period of life in the face of their often desperate pleas to help them to end their suffering. It is surely time to listen to those pleas.