Assisted Dying Bill [HL]

Lord Bishop of Oxford Excerpts

Friday 16th January 2015 Lords Chamber

I will make just one last comment. Cardinal Newman, in his great debates with Charles Kingsley, said that truth was not what left the mouth but what was heard in the ear—that we can tell the truth in the sense that we can defend that what we said was absolutely correct but we can say it in a way that we know will be heard differently from the way in which we have expressed it. When we discuss a Bill of this kind, we have to be very careful to remember that absolutely essential definition: truth is what the hearer hears. I think “suicide” is what the hearer needs to hear, and all sides of the House should accept that. “Assisted dying” is not what the hearer needs to hear because that will mean something quite different.

[Lord Harries of Pentregarth (CB)]

My Lords, I have put my name down to Amendments 129, 130, 132 and 152 in this group, which are all concerned to achieve the same purpose as the amendment moved by the noble Baroness, Lady O’Neill—clarity and honesty.

The point has already been made that this is an amendment to the Suicide Act and therefore consistency alone demands that we use a word such as “suicide” rather than “dying”. Before the Bill started to be discussed, if you asked the average person what the phrase “assisted dying” meant, I think most people would say that it would be to try to help a person who is dying be comfortable and out of pain, and that they had somebody with them to accompany them in this process, this journey out of this world. That is what “assisting” them would be. It would be totally different from taking active steps to end their life. I am rather surprised by the conviction with which the supporters of the Bill are opposing what we are asking for, which is simply clarity, honesty and a doing-away of the cloak of these euphemisms—it occurs not just in the case of the word “suicide” but, as we will discuss later, in the use of the term “medicine” instead of “lethal drugs”. Let us go for clarity and honesty. Even supporters of the Bill should approve of that.

[The Lord Bishop of Carlisle]

My Lords, I speak in support of the comments made by the noble Lords, Lord Cormack, Lord Winston and Lord Deben. As the noble and right reverend Lord, Lord Harries, has just made clear, the Bill seeks to amend Section 2 of the Suicide Act 1961. This should be made explicit throughout the Bill: it will allow doctors to assist in the suicide of a terminally ill patient. Regardless of a person’s state of health, if they deliberately end their own life, they are committing suicide rather than simply hastening the process of dying. Anyone else involved in this act is assisting a suicide.

In making this as clear as possible, the amendments in this grouping, some of which have my name attached to them, are seeking to be constructive. As has been mentioned, some strident voices in society claim that this is a euthanasia Bill; it is clearly not. But outside this place, there is some confusion about what the Bill is seeking to legalise, which must be dispelled. First, doctors must understand exactly what the Bill will require of them. Secondly, the terminally ill, who might seek to take advantage of provisions within the Bill, must understand that ultimately they will be required to take their own lives. Finally, society must understand the change to the law that Parliament is considering.

The amendments encourage us to move beyond mere slogans. They introduce an element of clarity which is a prerequisite for proper scrutiny. They also bring sharply into focus what the Bill seeks to do and what it does not.

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[Lord Harries of Pentregarth]

My Lords, I have added my name in support of the amendment of the noble Lord, Lord Carlile, but I also support the other amendments in this group. I do not intend to go over the reasons already stated so fluently by both noble Lords; I just want to emphasise the point of this whole range of amendments, which is quite simply to make this Bill much safer. If it is eventually passed, with these amendments people will have much more confidence in it than they have as it stands at present.

As we know, a great number of doctors—probably the majority—are opposed to any Bill such as this and therefore we are bound to get a situation where people who are sympathetic to what is proposed will look round for a doctor who shares their point of view. Clearly, we need to avoid that. Therefore, instead of just one doctor, we need two doctors, as the amendment says. One of the doctors needs to know the patient very well and needs to be not just registered if retired but, as the noble Baroness, Lady Finlay, said, currently licensed. These kinds of safeguards will ensure that the Bill, if eventually passed, has the confidence of the public.

There is also the very difficult question of diagnosis. I am a member of the review body of the noble Baroness, Lady Neuberger—the Liverpool care pathway. It has certainly been brought home to us that diagnosing a person’s death is a very inexact science, and indeed we are calling for more research on this.

Perhaps, on this very subject, the Committee will allow a brief moment of levity in relation to the remarks of the noble Lord, Lord Winston, on the Lockerbie bomber. He had three months to live but, as someone said, it was three months in Scotland—with due apologies to all Scottish noble Lords here. I apologise for levity on what is a very serious matter. However, I very much hope that the supporters of the Bill will accept the majority of the amendments in this group, as they will undoubtedly give the general public more confidence in it.

[Lord Cormack]

My Lords, if we are to have this Bill, it is very important, as the noble and right reverend Lord said, that there should be confidence in it. I just want to address a few brief remarks to the amendment of my noble friend Lord Carlile of Berriew, to which the noble and right reverend Lord is also a signatory.

I remember as a young Member of Parliament in Staffordshire talking to a rural general practitioner who had been there for many years. He made the point to me—I have quoted it before—that a doctor can only truly know his patient if he knows him in his home as well as in the surgery. I know that things have changed a lot since then but I treasure my relationship with my general practitioner—it is one of the most important relationships that I have. I like to feel that I can talk uninhibitedly to him, and indeed I can.

It is very important that we avoid falling into a trap. Because of the widespread reluctance among the medical profession to support the Bill, we could fall into the trap of certain doctors being available for hire. That is the last thing that the noble and learned Lord, Lord Falconer, would want. I have never at any stage doubted for a single second his utter sincerity and his honourable motives. That should be taken as read throughout the House, and I believe that it is. However, where a large number of medical practitioners feel, for the best reasons of conscience, that they cannot sign up to this Bill, there will be a danger—I put it no higher than that but one has seen it in the field of abortion—that some doctors will in effect be for hire. That has to be guarded against and one of the best ways of doing so is to ensure that there is an amendment similar to that moved by my noble friend. I hope that, when he comes to respond, the noble and learned Lord, Lord Falconer, will accept that.

I have grave reservations about this Bill. I do not want the Bill but I understand why many do. Therefore, if it, or a Bill like it in the next Parliament, is to go on to the statute book, the safeguards must be real, comprehensive and absolute. If a doctor is to sign a document, that should happen only after lengthy conversations with the patient concerned—after a real discussion. I would like to feel that during that discussion the doctor, whatever his or her personal views, can play devil’s advocate and point out all aspects of this ultimate decision that the patient is on the verge of making. However, that can happen only if there is a real knowledge of the patient and a proper relationship between the doctor and the patient. Six months is a short enough time. I have been registered with my general practitioner for over 30 years. Many noble Lords will have had similar long relationships and others will have had shorter ones. But before you talk to a doctor you feel the need to know him, and he or she needs to know you. The amendment moved by my noble friend is modest but it helps to provide a safeguard which, if a Bill such as this is to go on to the statute book, we would all like to feel is in place.

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[Lord Berkeley of Knighton (CB)]

My Lords, unlike the noble Lord, Lord Cormack, I have always welcomed and embraced the Bill, or certainly one very like it. One of the great qualities of your Lordships’ House is that, especially on an occasion like this, we listen to the arguments and are prepared to mould what we are trying to achieve. When I listened to Amendment 13 from the noble Lord, Lord Carlile, and especially Amendment 13A from the noble Baroness, Lady Finlay, I felt that they were reasonable. However, I have now heard the noble Baroness, Lady Brinton, and the noble Lord, Lord Warner, very eloquently saying why they are very worried about this issue so I am still slightly up in the air about it, although I think, with regard to Amendment 13A, that it is essential that these are “licensed” medical practitioners. The noble and learned Lord, Lord Falconer, is trying as hard as he can to go with the House and to take on things like this.

My point, and I shall make it extremely briefly, is about the six months’ terminal illness. I think that this is right, and I shall tell the House why. I have had lots of letters, as have many noble Lords, and there is something that they nearly all say. I had one this morning from someone who is 80, saying, “I don’t have a terminal disease but I do want to feel that I would have the option, if I became really ill, to talk this over with my doctor and work out a way of assuaging great pain and causing distress through that pain to my family. It might just be that I would talk to my doctor about having opiates that might repress the respiratory system”. Is that assisted suicide? I do not know. I certainly think that it is an option; frankly, very few doctors that I know deny that it has happened in their lives. They have treated people, especially in country practices where, as the noble Lord, Lord Carlile, has illustrated, they have known the patient for many years, even decades, and they ease them out of this life into the next one. It seems to me that this is the luxury that most human beings want to be afforded. I think that that is what the noble and learned Lord is trying to achieve, and on that basis I very strongly support him.

[Lord Harries of Pentregarth]

Would the noble Lord like to clarify what he means by that very ambiguous phrase about doctors easing patients out of this life? Does he mean the administration of pain-killing drugs, which might have the side-effect of slightly shortening life, or does he mean doctors deliberately administering an overdose in order to kill a person? Perhaps he could clarify what he means because he is making quite a bald claim about doctors’ practice.

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[Baroness Hayman (CB)]

My Lords, reference has been made to the GMC, and therefore I should perhaps draw attention to my interest as a member of that body, although I, of course, speak today purely personally and not on behalf of the GMC.

I want to address two issues relating to doctors. First, I support Amendment 15 on changing from a registered to a licensed medical practitioner, which is an important safeguard and correction.

However, I have severe concerns about Amendment 13. The right reverend Prelate said that he thought it would make the Bill safer for patients. I have to disagree. I think it would make the Bill impractical and restrictive. The reasons for that are partly the reasons outlined by the noble Baroness, Lady Brinton. People who are desperately ill who receive a diagnosis one or two years before their death very often think about moving. They sometimes move to be near relatives or into a care home, but moves even half a mile up the hill, as I learnt recently, can mean the severing of a long-term relationship with a GP practice. It is impractical and unfair to ask people who have moved in these circumstances to rule themselves out of access to the provisions of this legislation.

It is also impractical in terms of doctors themselves. We were taken back to the days of Dr Finlay in many ways by the speeches of the noble Lords, Lord Carlile and Lord Cormack. Very few people these days have a decades-long relationship with a single general practitioner. I am very nervous, because my legal education ended in 1969, of taking on the noble Lord, Lord Carlile, but he spoke about the realities of multiple partners in general practices in the National Health Service today. Certainly, my experience in my new practice is that you will be seen by any one of a number of partners there. However, the amendment says very specifically that the person must have been registered with one of the two doctors,

“for medical care for at least six months immediately prior”,

not at the practice but with that specific doctor. That is very difficult for people to comply with.

Equally, like patients, doctors also move. They move to different parts of the country, and they retire. You can imagine many circumstances in which reading and applying those specific provisions would simply rule out for patients the ability to access this legislation. For that reason I oppose this amendment.

[Lord Harries of Pentregarth]

Would the noble Baroness be willing to accept a different kind of amendment which took into account the situations she mentioned? Of course, she is quite right that people might move from their general practice into a care home, but it seems that it would be very easy to devise an amendment which took account of that. There would have to be perhaps two or more general practitioners who agree over a period of time.

[Baroness Hayman]

I am grateful to my noble and right reverend friend. The difficulty is trying to put this in the Bill, to deal with all the different circumstances that will arise with individuals or with practitioners. I would be much more comfortable with that, because I think we are all on the same page with regard to not wanting someone who has had absolutely no contact with their doctor, because of all the issues which we know arise. However, I would much rather that those sorts of issues were dealt with in guidance, both from the GMC and the Secretary of State. It would then be much more possible to make sure that there would be equality of access for patients.