Lord Winston
Main Page: Lord Winston (Labour - Life peer)
Lord Stevens of Birmingham (CB)
My Lords, I speak specifically against Amendment 771, which would require the Secretary of State to establish an assisted dying help service as part of the National Health Service. I believe that that is a conceptually misplaced proposition in that, if we cast our minds back to last Friday, it was completely evident that the sponsor of the Bill does not intend that only in cases of unbearable pain or suffering would a person be eligible for the assisted dying service. Instead, concerns about your finances or being a burden on your family would be defined as legitimate bases for making the choice to opt for an assisted death.
It is not the proper function of a national health service to deal with financial burdens or pressures on people’s families in that way: that is a category mistake. Indeed, the founding charter for the NHS, the National Health Service Act 1946, is quite clear, and all successive health Acts have laid out the purpose of the NHS, which is
“to promote the establishment … of a comprehensive health service designed to secure improvement in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness”.
Assisted dying does not fall within the scope of that purpose. In fact, I think that must be evident indeed to the drafters of the Bill, because somewhat camouflaged at Clause 41(4) is the suggestion that, by regulations, that founding charter for the National Health Service could be amended to include assisted dying. They reference the fact that change is probably required to the most recent iteration, the 2006 Act, to bring that about. I do not think it can be said legitimately that this is a part of the purpose of the National Health Service, and it is unnecessary in practice, organisationally.
Just because doctors, like lawyers and social workers, are proposed to be involved in this, it does not mean it is inherently part of the National Health Service. Doctors do DWP assessments, but that does not mean the National Health Service runs the benefits system. Doctors are involved in driving licence assessments, but that does not mean the National Health Service runs the DVLA. Doctors are involved in the criminal justice system as forensic medical examiners, but that does not mean the NHS needs to run the court system.
Lord Winston (Lab)
Does the noble Lord agree that removing life support is not part of the health service?
Lord Stevens of Birmingham (CB)
As the noble Lord will well know, the ethical principle of the doctrine of double effect is in place there. There is no doctrine of double effect associated with assisted dying; it is a completely different ethical principle. In fact, part of the reason why it would be dangerous to include assisted dying in the National Health Service is because it risks undermining the very trust that people have in their clinicians.
It increases the risk of what you might call self-coercion in the name of altruism. People thinking that they are reducing not only the burden on their families but on the NHS from an earlier death is a genuine risk. We saw that, frankly, during Covid, when the slogan, “Protect the NHS”, was used. A number of us were opposed to that, fearing it would put people off coming forward for needed care, which is precisely what happened. The idea that an NHS-branded assisted dying service might, at least in people’s minds, come to be associated with helping to protect the NHS by virtue of choosing an earlier death blurs the lines, which we should be careful to avoid.
Fundamentally, it is unwise to include assisted dying in the National Health Service because it blurs the distinction between palliative care and what is proposed in the Bill. As we have just heard from the noble Lords, Lord Harper and Lord Deben, many of us have concerns that the choice on offer will not be a genuine choice if palliative care is not available, and I am afraid the Government have been less than forthcoming as to what they envisage palliative care services looking like over the coming years.
Two months ago, I asked the Government a very straightforward Written Question: can they tell us whether the palliative care and end-of-life care modern service framework, which they are going to publish, will quantify the incremental funding needed to make sure that everybody who would benefit from specialist palliative care would get it? I did not get an Answer to that straightforward Question before this House debated the palliative care elements of the Bill. This week, I received a two-sentence response—it was not an Answer —which said:
“The Government is developing a Palliative Care and End of Life Care Modern Service Framework for England. I refer the Noble Lord to the Written Ministerial Statement … on 24 November”.
That was the Answer to the Question: will the Government’s framework specify the funding gap, identify funding to meet it, and ensure that people have access to care? On that basis, we are entitled to conclude that they probably do not intend to move in that direction. Therefore, the concerns about having an assisted dying service as part of the National Health Service, when palliative care needs go unaddressed, are all the more acute.
For those three reasons—the fact that the proposal is conceptually misjudged, organisationally unnecessary and inherently risky—I oppose the proposition that assisted dying should be part of the NHS.
Lord Mackinlay of Richborough (Con)
I apologise to the Committee for not being fully engaged today. I have appointments elsewhere, and my father’s funeral was yesterday. I remember during the Covid period Ministers stood behind a sign reading “Stay home, protect the NHS, save lives”. My real concern now with the thought of a navigator that has only one direction is that will it be—I know it sounds rather flippant—“Save the NHS, choose a navigator, choose death”? That seems to be the chilling direction that the concept of a navigator and one choice only seems to be directing us towards.
Lord Winston (Lab)
I feel tempted to try to answer that very quickly. I too will be leaving the Committee before we get to a vote on this or at least some decision from the Minister about what the Minister is going to say. I have to say that this discussion about the cost of treatment is not a reasonable one. The noble Lord, Lord Stevens, did not discuss this in his speech, but I think the speech of the noble Lord, Lord Birt, is overwhelmingly important because it is about the notion of our sensitivity in this situation.
There are many people who go to the health service who do not get treatment. It is not always a treatment. For years, I was pioneering in vitro fertilisation, which was not successful for a very long time. We got 16 babies worldwide in the first four years. There are now millions of happy families as a result, many of them in this House some of the time. The people in this House who opposed in vitro fertilisation—believe me, there were many of them—would probably have refused to accept assisted dying too. The fact of the matter is that the health service develops. It is not static. It changes depending on what the need is. In vitro fertilisation, instead of being an orphan subject, is now a major treatment funded by the health service. Unfortunately, it should be more funded, but we are getting a lot of success doing it in the way we are, and we will increase that.
It is also fair to point out that there are medical treatments developing all the time in the health service, which are not funded at the time when they are developed. Take cancer treatments, which are extremely expensive, very often with the most expensive drugs. Of course, we have to deal with the internal market in the health service, but we persuade the people who understand the need for healthcare, are faced with patients and have to treat them in the best way—
Lord Winston (Lab)
I will not give way. I will answer at the end. I have almost finished what I have to say.
The fact of the matter is that this is not a true argument. There are many examples. In my practice, probably about 60% of the time when people came to my clinic, and it was always true even when IVF was successful, I refused them treatment. I refused to treat them, not because there was no money or we could not afford to treat them, but because I thought the treatment would increase their distress because it was so unlikely to be helpful.
When that happens to people, it is a kind of death within them, but they have the great advantage that they can mourn that death and overcome it by doing other things. Unfortunately, in this situation, when people are dying in the way they are, often horribly, there is something that we need to try to do purely out of compassion.
Lord Markham (Con)
To build on that, I will put the financial numbers into context. The impact assessment has it down as £28 million; I believe that is 0.000175% of the NHS budget. It is right and proper that we decide how NHS resources are spent and in which direction, as the noble Lord, Lord Winston, said. We make those decisions all the time—for example, whether we put more funding into cancer or other services. It is entirely appropriate.
One of the key phrases was, “It is our NHS”, and what do we know about assisted dying? That 70% of the public support it. Given that, surely it is entirely right that resources are spent in that way.
Lord Moore of Etchingham (Non-Afl)
The point that is being missed was made by the noble Lord, Lord Stevens, and it is the problem with what the noble Lord, Lord Winston, was saying. Can the noble Lord respond to it? We are talking about what the aim of this is, but it is not a health aim. The noble Lord, Lord Winston, spoke of better treatment for cancer and in vitro fertilisation. Are the noble Lords arguing that death is a health aim?
Lord in Waiting/Government Whip (Lord Lemos) (Lab)
I apologise to my noble friend. The guidance of the House is that you cannot intervene on an intervention.
Baroness Finlay of Llandaff (CB)
It might be helpful to add that, in normal procedure, you would explain to a patient what the complications may be but also what you will do. This Bill does not say what you will do. That is why I pointed out that somebody who is very drowsy and beginning to wake from a huge dose of lethal drugs would not be able to self-administer a further dose. This Bill is very clear that the practitioner does not administer the fatal dose; it must be done by the person themselves. Therefore, we have a bit of a gap here, because the doctor can tell them what might happen, but it does not seem that the doctor can tell them what they will do in the event of it happening and how it would be managed.
Lord Winston (Lab)
Before the noble Baroness sits down, what about the patient who says, “I’m not interested in the complications; I just want the injection as soon as possible”? At what stage is that allowable under medical practice? I have refused information from a doctor myself in the past. People have that autonomy, do they not?
Baroness Finlay of Llandaff (CB)
Of course patients are welcome to refuse. I am slightly worried by the noble Lord’s phrase “I just want the injection”. The Bill is very clear: this is about self-administration. The doctor has to discuss with the patient how they are going to inject themselves with the lethal dose of drugs, whether they will do it with different syringes, if there is a mixture in the syringe and the complications of trying to do that. In asking the question, the noble Lord has just illustrated the nub of the problem.