Assisted Dying Bill [HL]

Lord Alton of Liverpool Excerpts

Friday 16th January 2015 Lords Chamber

[The Lord Bishop of Chester]

My Lords, briefly, the debate is now running into the sand a little and I hope that we can move on. I have great sympathy here for the noble Lord, Lord Dobbs. The word “suicide” could be applied to a member of the French resistance who, knowing that he was going to be captured and thinking that he would not be able to resist the Gestapo, took own life—an action I would completely understand—but it could also be applied to a suicide bomber. The word is so multivalent that once we start discussing it, we get into this interminable process. I suggest that we have now heard the arguments and should move on.

[Lord Alton of Liverpool (CB)]

My Lords, I will be brief because I did hear what the right reverend Prelate the Bishop of Chester has just said. I understand that the House will want to move to a conclusion but I was very struck by the remarks made a few moments ago by the noble Lord, Lord Dobbs, about suicide. I would like to return to that point in a moment. However, I support my noble friend Lady O’Neill for three reasons: the first is because of language, the second because of law and the third because of practice.

On the question of language, the noble Lord, Lord Dobbs, being a well known and very accomplished writer, will be familiar with the influential dystopian novel 1984 by George Orwell, who said in it that,

“if thought corrupts language, language can also corrupt thought … It’s a beautiful thing, the destruction of words”.

The words that we use to describe our actions are crucial. There are so many other examples in law of euphemism, the word used earlier by the noble Lord, Lord Brennan, where we have distorted language to disguise the realities of what we are doing. I do not accuse the noble and learned Lord, Lord Falconer, of doing that in his Bill but it is quite clear on page 4, line 11, where Clause 6(2) states:

“In the Suicide Act 1961, after section 2B (course of conduct), insert—”.

So the law will be changed. It is not the Dying Act but the Suicide Act that we are seeking to change.

There is language and law, but there is practice as well. The noble Lord, Lord Dobbs, talked about suicide. At an earlier stage, I mentioned that my father was one of five brothers who served in the Second World War. His eldest brother lost his hearing and became deeply depressed. He was very ill at the end of the war and took his own life. I agree with what the noble Lord said about the stigmatisation, particularly of mental health, and the suicides which can follow from it. We must be acutely aware of that.

In 2000, the World Health Organization issued new guidelines about suicide. It said:

“Suicide is perhaps the most tragic way of ending one’s life ... Every effort should be made to avoid overstatement”.

Interestingly, given the media coverage of these events, it also said:

“Front page headlines are never the ideal location for suicide reports … Suicide should not be depicted as a method of coping with personal problems … Instead, the emphasis should be on mourning the person’s death”.

This House wisely published a Select Committee report on these questions. It stated:

“Dying is not only a personal or individual affair. The death of a person affects the lives of others, often in ways and to an extent which cannot be foreseen”.

The ending or taking of a life is not a trivial question. We must say what we mean. The language must be clear and we must be aware of what the practice will involve. As I have said in this House before, I wish that we placed as much emphasis on helping those who wish to live by providing assisted living as on assisted dying, especially those who are vulnerable and feel at risk as a result of this legislation.

[Lord Popat (Con)]

My Lords, may we have the privilege of listening to the noble Baroness, Lady Grey-Thompson?

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[Lord Carlile of Berriew]

My noble friend, for whom I have the utmost admiration and with whom I have worked on many issues, I am afraid misses the point of what I am saying. I know the work that the noble Lord, Lord Alton, who was referred to, has done on mesothelioma. I absolutely applaud that work and I will give way to him in just a second when I have finished this paragraph. What I have in mind is that in a situation like that there will be not only the specialist who may be treating an issue that has arisen recently but a general practitioner who has had that patient on their books for a considerable time, who will have records that they can look at which give them that knowledge, and who will have seen the patient in the past. What I am seeking is exactly the combination between a licensed medical practitioner—I accept that they should be licensed—who has had some experience of dealing with the patient and a specialist who may be treating the symptoms of the particular illness.

[Lord Alton of Liverpool]

The noble Lord has entirely answered the remark of the noble Lord, Lord Avebury, about mesothelioma. It is indeed predicted that some 60,000 more British people will die of that terrible disease over the next 20 to 30 years. However, the point is that they have general practitioners who care for them, and of course they have specialists who they then go to see as well. In many ways, it reinforces the noble Lord’s point—that having two doctors to examine a patient and be with them—to go through the gateway, as he put it earlier—is the right thing to do, as expressed in the amendment.

[Lord Carlile of Berriew]

I am grateful to the noble Lord, Lord Alton. I see that I have spoken for 12 minutes and want to bring my remarks to a close.

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[Baroness Campbell of Surbiton]

My Lords, the answer to the noble Lord’s question is that they fear that they will take advantage of this legislation when they are at their lowest with no choice. The noble Lord, Lord Low, will understand as much as I do about terminal situations where you do not have choices. These people have said that they do not want this Bill because they know that they might take advantage of it.

[Lord Alton of Liverpool]

Before my noble friend completes her remarks, has she had a chance to read the briefing that was sent to Members of your Lordships’ House only yesterday by the disabled people’s charity Scope, which says—this reinforces the point she has just made—that in the US state of Washington, where assisted dying is legal,

“61% of those requesting to end their lives did so because they felt a burden on friends, family or care-givers”?

Scope says in its briefing to your Lordships in support of the amendments we are considering:

“The definition in the Bill of ‘reasonably expected to die within six months’ would capture many disabled people”.

[Baroness Campbell of Surbiton]

I think that was a question to me from the noble Lord, Lord Alton. The answer is, yes, I did know about Scope’s role. In fact, Scope approached me to ask me to emphasise issues around prognosis in the debate today.

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[Lord McColl of Dulwich]

My Lords, I would not dream of trying to rebut anything that the noble Lord said.

[Lord Alton of Liverpool]

My Lords, I support what the noble Lord, Lord McColl, said. He is one of the foremost medical authorities in your Lordships’ House. We know that many of the royal colleges and the British Medical Association, speaking for 153,000 doctors, say that it is not possible to legislate safely—which is the point that the noble Lord, Lord Cormack, made.

However, I recall that when my late father was dying and I went to spend time with him during the last part of his life, the doctor told me that I should make long-term provision for long-term care. After he left the room it was the nurse, who was the wife of one of the policemen who worked in the Houses of Parliament at that time, when I was in another place, who said to me, “David, you don’t need to make long-term provision. In my view, your father will be dead before the end of this weekend”. Needless to say, it was the nurse rather than the doctor who got it right.

Many noble Lords will have read the briefing from the Royal College of Nursing, which arrived only today. It says:

“Terminal illnesses are often extremely unpredictable with periods of improvement and deterioration. This can make it extremely difficult to pinpoint when someone might die … we remain concerned that diagnosing that a patient is expected to die within six months could result in inaccurate judgements through no fault of the medical practitioner”.

That is the point that that noble Lord, Lord Warner, has just made. It could lead to litigation against doctors and nurses if we do not put in far better safeguards than the Bill provides at present.

[Lord McColl of Dulwich]

I thank the noble Lord for that intervention. I have been in practice for very many years and I still am. One of the things that always struck me was how wrong I was about trying to predict when a patient would die. I well remember a typical case of a lady who was only 28. She had inoperable cancer of her throat. She was in great distress, with pain and distressed breathing. I saw my job as a doctor to relieve all her symptoms, whatever the cost. I said to her, “If you like, I can put a needle into your vein and titrate you with heroin”. Heroin is a marvellous drug. You have to dilute it in a large volume and not use the small volumes in the ampoule, because if a gun goes off you might suddenly give them too much too quickly. I titrated her and asked her to tell me when all the symptoms had gone. Eventually she said, “Yes, that’s fine”. It was a huge dose of heroin. I had no problem about giving it. The strange thing was, not only did it not kill her, it gave her a new lease of life. It is unrelieved pain that is the killer.