Assisted Dying Bill [HL]

Lord MacKenzie of Culkein Excerpts

Friday 18th July 2014 Lords Chamber

[Lord MacKenzie of Culkein (Lab)]

My Lords, I am sorry that I am unable to support the Bill in the name of my noble and learned friend, although I know that it has been introduced from the very best of motives. I speak as a nurse who has been on the nursing register for some 39 years. It is some time since I practised, but I have spent a good deal of my working lifetime representing nurses and nursing. Of course, nursing has changed in that time; social attitudes have evolved since my first entry into nursing as a student nurse. But I am clear about this: what has not changed is the ethical basis and ethos of nursing.

I have always understood the central tenet of nursing to be duty of care—about promoting and maintaining health, preventing and/or treating illness and injury and helping patients to recover and, where that is not possible, giving the best quality of life until death. I do not believe that giving the best quality of life until death can include the nurse delivering and assisting the patient to ingest a lethal lytic cocktail on the authorisation of an attending physician.

Doctors are busy people with time at a premium. It is nurses who are with patients for 24 hours out of 24, so it likely to be the nurse who would be, in the words of the Bill, the “assisting health professional” duly authorised to carry out the function of actually assisting the death of the patient by preparing these lethal drugs. I hesitate to use the word “medicine”, which is in the Bill, because medicine, if my Latin is any good, is something to do with healing and not death. The nurse would prepare the medical device, load the syringe driver or, as the Bill says, assist the patient to ingest.

The Bill tries to give safeguards by saying that the final act of self-administration lies with the patient. How will a patient with motor neurone disease who cannot swallow and cannot move their arms because they are paralysed carry out that final act? They will not. They are excluded from the Bill. So the compassion, which we all share, is selective. It does not apply to all people with serious, progressive neurological conditions, for example.

I do not want nurses to be in a position where in the course of their normal duties a patient might say—it could be said as a joke, but it might be said seriously out of concern by a vulnerable patient—“I hope, nurse, you’re not one of these who assist dying”, or perhaps in the more vernacular, “I hope you’re not one of these who bumps people off”.

Many in the medical profession say, rightly, that assisted dying facilitated by a physician will fundamentally alter the patient/doctor relationship. In my opinion, that applies in exactly the same way to the nursing profession. I see any legislation based on the Bill as leading inexorably, maybe a long time in the future, to assisted suicide as a right rather than an exception. We have heard about slippery slopes. I am sure that the noble Lord, Lord Steel of Aikwood, when introducing the Abortion Bill in 1967, said many of the same things that have been said today. Now we see how society has evolved and that position has changed.

If that happens in this country to the public perception of assisted dying, it could follow that there will be seen to be a duty on nurses and doctors to be involved. That is not something that I want any part in facilitating, conscience clauses notwithstanding. This is an enormously difficult area, but there are too many unresolved issues at the heart of the Bill, not the least of which, as it is presently drafted, is that it would lead to nurses being in serious contravention of the Nursing and Midwifery Council code.

Given the intervention of the Supreme Court, there is a powerful argument, despite what my noble and learned friend has said, for a royal commission to take a long, hard look at this issue before it returns to Parliament. For those reasons, not the least of which is the potential for serious damage to the ethics and ethos of nursing and the public trust of nurses, I regret that I cannot support the Bill.

Public Bodies Bill [HL]

Lord MacKenzie of Culkein Excerpts

Monday 7th March 2011 Lords Chamber

[Lord Greenway]

My Lords, I admire the tenacity of the noble Lord, Lord Berkeley, on this matter which, as the Minister well knows, we have discussed on a number of occasions. I declare a non-pecuniary interest as an elder brother of Trinity House and I will address my remarks mainly to Trinity House. Despite what the noble Lord, Lord Berkeley, said, I do not think that it would be within the powers of any Government of this country to enact something relating to a body set up in Dublin in the Republic of Ireland. Therefore, any thought of doing things with regard to Ireland must be out of order.

The noble Lord’s other main concern relates to the payment of light dues and particularly to the efficiency of the general lighthouse authorities. The previous Administration commissioned a report by Atkins, which looked into further efficiencies that could be made in addition to those that have already been made over a number of years, certainly in the case of Trinity House. Its recommendations were accepted and are being implemented through the new general lighthouse authority joint strategic board, which was set up by the Atkins review. In parallel, the Shipping Minister asked the GLAs to consider how they might achieve an additional reduction in expenditure, averaging 25 per cent over the period ahead, which Trinity House will deliver in full through a six-year programme. This programme has also been accepted by the Minister.

Any change to the existing governance arrangements of the GLAs would bring significant risks and costs. For this reason, I suggest that the amendments are unnecessary.

[Lord MacKenzie of Culkein]

My Lords, I also pay tribute to my noble friend Lord Berkeley for raising this matter again. As the noble Lord, Lord Greenway, said, my noble friend is tenacious. However, I am sorry to say that I disagree with the points that he has made. We debated this matter extensively on 21 January and I want to reiterate a couple of points from that debate. The WS Atkins report went into considerable detail on the general lighthouse authorities. The British and Irish Governments have dealt pretty comprehensively with the so-called Irish question and the new strategic board has been set up which will drive further reductions in costs. At the end of the day, the shipping companies pay these costs.

Last Saturday I picked up a lovely little book about the Bell Rock lighthouse, comprising a series of articles written by an assistant lightkeeper in about 1904. The foreword to the book describes how the lighthouse authorities in the UK work. One of the interesting points was that, despite repeated reductions in costs around the turn of that century, the shipping companies were demanding that they should not pay light dues and that the lighthouse authorities be funded out of imperial taxation. Nothing has changed in 110 years.

I do not know many, if any, organisations that could have cut their costs and increased efficiency in the way that the lighthouse authorities have. There have been massive cuts in personnel, huge advances in technology, and that is the way forward. If technology moves forward and becomes affordable, I have no doubt that there will be further reductions in light dues. For the present, however, I see no useful purpose in pressing these amendments. I am pleased to note that the noble Lord, Lord Berkeley, has said that they are probing amendments.

[Lord Taylor of Holbeach]

My Lords, this has been a useful debate—I am sure that the noble Lord, Lord Berkeley, believes that to be the case—and I thank all noble Lords for their contributions. This is a probing amendment and I accept that in my response. I understand the noble Lord’s purpose, because he has proposed for some time that the general lighthouse authorities that serve the coast of the United Kingdom and Ireland should be merged into one body. Indeed, mention was made by the noble Lord, Lord Davies of Oldham, of the Bill that the noble Lord, Lord Berkeley, has presented to the House. I also thank the noble Lord, Lord MacKenzie of Culkein, for his contribution that shows that a lot of progress is being made in this area. It is an opportunity for the use of technology that the authorities have taken advantage of. I also thank the noble Lord, Lord Greenway, for his involvement with those bodies, particularly Trinity House. I hope that my noble friend Lord Newton of Braintree will accept that these are probing amendments. I respond in that spirit.

I should explain to noble Lords that the Commissioners of Irish Lights has functions in relation to Northern Ireland and to the Republic of Ireland. Moreover, it is a body established in Dublin under Irish law. In case people fantasise about people earning enormous salaries, no staff member earns €1 million in the employment of that body. It is not for the UK Parliament to purport to abolish or otherwise this body or its functions in relation to the Republic of Ireland.

A recent independent study by the consultants Atkins, to which reference has been made—it was a comprehensive review—addressed the provision of marine aids to navigation and concluded that the present arrangements, whilst complex, achieve the basic objective of ensuring the safety of the mariner and provide high-quality, comprehensive and integrated maritime aids to navigation all around the British Isles. Notably, Atkins recommended some changes to the governance of the general lighthouse authorities through the creation of a joint strategic board. Since last year, with the Shipping Minister’s endorsement, the joint strategic board has worked closely with the Department for Transport and the three general lighthouse authorities to identify further efficiency measures to drive down running costs.

The general lighthouse authorities are no strangers to minimising their costs, as the noble Lord, Lord MacKenzie, said, by adopting new technology, estate rationalisation, joint operational initiatives and the generation of income from their commercial activities. These organisations have ensured that the level of light dues that pay for their work is 40 per cent lower in real terms than in 1993. Indeed, Atkins concluded that the general lighthouse authorities have a strong track record in identifying and realising efficiencies and cost reductions within their operation and support functions. These directly benefit ship owners through reduced burdens on the general lighthouse fund and the real-terms level of light dues.

I know that the noble Lord, Lord Berkeley, has pursued this issue with terrier-like commitment, but I hope that I have been able to provide some clarity on the recent progress that we have made in this area of policy.

I am afraid that I am not in a position to answer the question on the Freedom of Information Act and its application to the various authorities, but I shall try to do so and will write to the noble Lord with that information. With that in mind, and in view of the general lighthouse authorities’ excellent reputation for delivery, I hope that the noble Lord will feel able to withdraw his amendment.