Health: End of Life
Debate between Lord Ahmad of Wimbledon and Lord Joffe
Lord Joffe (Lab)
My Lords, I, too, join the welcome of the noble Lord, Lord Alton, to the right reverend Prelate the Bishop of Sheffield, and I look forward to his contribution to the important issues that this House considers.
The starting point for the debate must surely be the law on personal choice in England and Wales. The law has been considered in a large number of cases and was admirably summarised by the noble and learned Baroness, Lady Butler-Sloss, in her judgment in 2002 in the case of Ms B v an NHS Hospital. In it she endorsed the 1993 judgment of Lord Donaldson of Lymington in Re T (Adult) when he held that,
“the patient’s right of choice exists whether the reasons for making that choice are rational, irrational, unknown or even non-existent”.
Likewise, Robins, Judge of Appeal, in the case of Malette v Shulman, held that:
“The right to determine what shall be done with one’s own body is a fundamental right in our society. The concepts inherent in this right are the bedrock upon which the principles of self-determination and individual autonomy are based”.
It is against this law that we should be considering the various options for patient choice at the end of life. These include the following options. Option 1, palliative care: where it is available it is the preferred option for the overwhelming majority of patients. However, despite the excellence of UK palliative care it is not the solution for a small but significant minority of patients—a point accepted with a measure of reluctance even by palliative care professionals.
Option 2, refusal of further life-saving medical treatment: all patients have this right to bring their suffering to an end.
Option 3: patients have the right to starve themselves to death by refusing either food or water. This takes great courage, self-determination and suffering because weeks can pass before the patient withers away.
Option 4, terminal sedation: the patient is so heavily sedated that he or she remains unconscious for all or most of the time until they die. However, it is not certain that patients can insist upon this option.
Option 5, a request by patient for removal of life-saving equipment: based on the case of Ms B, doctors are obliged in law to accept an instruction from mentally competent patients to remove them from the equipment so that they can end their suffering.
Option 6, the double effect option: the doctor at the request of a patient can prescribe potentially lethal medication to control the patient’s pain which could end the patient’s life.
Option 7, the Director of Public Prosecutions option: provided that the patient has mental capacity he or she can be assisted to die by any person except a doctor if the assistance was given on the grounds of compassion.
Option 8, assisted dying: this is not yet an option but one wonders why not in the light of all the options open which are dependent on choice. This should be a compassionate option but it is currently not available because our law prohibits it. This is why the noble and learned Lord, Lord Falconer, has introduced the Assisted Dying Bill to change the law so that mentally competent patients who choose that option can end their suffering through ending their lives.
The only limitations upon patients making choices on their own lives is that they should have mental capacity and should not, when selecting their option, put vulnerable members of society at risk. In the case of assisted dying, this risk would be prevented by an array of safeguards introduced in the Bill of the noble and learned Lord, Lord Falconer.
In congratulating the noble Lord, Lord Dubs, on introducing this debate and agreeing with his unqualified support for the Bill of the noble and learned Lord, Lord Falconer, I ask the opponents of that Bill one question, which so far they have never answered: what option do they propose for the suffering of terminally ill patients for whom palliative care is not the solution and who make an informed decision to end their suffering by ending their lives? Surely that option cannot be that they continue to suffer terribly until they eventually die.
Lord Ahmad of Wimbledon (Con)
My Lords, before the next noble Lord rises to his feet, I remind all noble Lords that this is a time-limited debate. That means that when the clock shows “4”, they should look to conclude their remarks.