Terminally Ill Adults (End of Life) Bill Debate
Full Debate: Read Full DebateBaroness Fraser of Craigmaddie
Main Page: Baroness Fraser of Craigmaddie (Conservative - Life peer)Department Debates - View all Baroness Fraser of Craigmaddie's debates with the Ministry of Justice
(1 day, 7 hours ago)
Lords ChamberMy Lords, I have two amendments in this group. We have heard a lot of comments about the real world and what is actually going on now, today, out there in healthcare. It will be very interesting to hear how the noble and learned Lord, Lord Falconer, responds to all the criticisms and to the way the inherent dangers in Clause 5 have been highlighted.
My Amendment 201 concerns children. A little boy with advanced malignancies said to me, “I'm going to die when my goldfish dies”. He went on to talk through what he wanted when he was dying and how he would play football in heaven with another boy who had died recently. Not long after, his goldfish was found floating. My strenuous attempts to resuscitate his goldfish failed, and he gently died soon after.
That was some years ago. Today, children live off the internet, not just off what they hear from other children. They know about the debate on this Bill—some raise it in “Learn with the Lord” sessions. If a child is asking questions about this, they must be able to express their fears if they are already ill. They often speak with remarkable frankness. Children’s awareness is phenomenal. They deserve gentle, honest planning of their care that also explains why they are ineligible for assisted suicide. Hence my wording, but the wording of the noble Lord, Lord Rook, provides much clearer guidelines for clinicians involved, to allow them to listen but in no way to hint that the child will be eligible.
Assisted suicide is not a medical treatment. It falls outside McCulloch and Montgomery rulings, hence my Amendment 159. As has been said, if a doctor raises assisted death unprompted, the implication is that this is something you should consider—a tacit implication that this might be your best option. Addressing the comments by the noble Baroness, Lady Hayman, it is a doctor’s duty of care to sensitively explore with open questions and careful listening, to discuss whatever the person wishes to discuss at their initiation. That is patient autonomy and control. Mencap, the Association for Palliative Medicine and the Royal College of Psychiatrists have all warned how patients’ trust gives doctors a dangerous ability to steer decisions if the suggestion comes from the doctor.
Listening with undivided attention is crucial in gentle, honest communication in the face of patients’ anguish. Patients hang on to our every word, so suggesting it as an option signposts them in that direction. It abandons suicide prevention duties under the Mental Health Act and the state’s duty under Article 2 of the European Convention on Human Rights. The amendments overall have a common theme of making the autonomy of the patient paramount in these discussions, their being able to raise assisted death in their own time, at their own pace and at their instigation. I hope these amendments will be taken heed of.
My Lords, I thank my noble friends Lord Jackson and Lady Monckton—whose speech was quite spectacular—for raising the example of DNRs. It is very good example when we are talking about who can raise assisted dying in preliminary discussions.
I want to give a very brief illustration. When my father was in hospital, five different medical professionals came into his room and took us, his family, aside, to get him signed up to a DNR. He did not really want that. It might have philosophically been the right medical thing to do, but he was not in the right place. He did not want to be asked, and certainly not five times by five different medical professionals. It left a rather bitter taste in our mouths, because when we were able quietly, as a family, to have that discussion with him, he did have a DNR. We were fortunate to have that time, rather than him having something put at the end of his bed with the Sainsbury’s bag.
This group of amendments is really important. They are all similar, saying that we need some guidance on who can raise the discussion and under what circumstances. If we really believe that patient autonomy is important, then something should come from this group of amendments and be in the Bill.
My Lords, briefly, Clause 6 standing part has been opposed by my noble friend Lord Moylan because of other aspects of amendments he has tabled. I very much support Clause 6 staying in the Bill: it was the one amendment on Report in the Commons where there was a significant majority in favour. In particular, I found it astonishing that anyone could even consider raising this with a child: it disappointed me that the sponsor of the Bill in the Commons voted against that amendment, but I am relieved it got through. It is also worth pointing out to the Committee that there is slightly different wording between Clause 6 and Clause 5(1), which my noble friend Lord Moylan’s Amendment 152 addresses by making sure “other health professional” is included, not just “medical practitioner”.
I have also seen multiple times what my noble friend Lady Fraser has just referred to. It is very irritating, especially when somebody is being taken home to die, if, against their wishes, DNR had been put in place by medical practitioners and then had to be rescinded. It is somewhat frustrating in that regard.
My noble friend Lord Goodman was succinct; I think that is partly the training of a journalist, or it might have been two years of quiet contemplation when he considered his vocation in an abbey on the Isle of Wight.
I want to briefly raise one point: the noble Baroness, Lady Blackstone, referred to the BMA. I am conscious that it is a trade union for doctors and does a lot of work on their behalf, but it is not a clinical body. However, the BMA pointed out its concerns that, without it, there would be uncertainty and legal risks for doctors. The BMA went into more detail on that in its evidence. In contrast, the Medical Defence Union’s written evidence to the Commons Select Committee—by the way, the MDU is an organisation that specialises in providing indemnity and other legal issues regarding doctors—came up with a different thing. It said:
“The MDU is concerned that the legislation, as … drafted … leaves doctors who do raise it at greater risk of a complaint”,
and then subsequent legal things.
So, as has also been pointed out, at what point would this ever be raised? I support more generally the approach and understand that, if a doctor is asked about this, of course that should be open to a response, unless they do not wish to do so, and part of Clause 5 covers that. But, overall, that initiation should not be in the hands of the medical practitioner, and we will come on later in further clauses to debate the recording of such discussions.