Assisted Dying Bill [HL]

Baroness Meacher Excerpts

2nd reading
Friday 22nd October 2021 Lords Chamber

Moved by

[Baroness Meacher]

That the Bill be now read a second time.

Relevant document: 9th Report from the Delegated Powers Committee

[Baroness Meacher (CB)]

My Lords, I declare my interest as the unpaid chair of Dignity in Dying. My Bill has three informal co-sponsors: the noble Baroness, Lady Davidson of Lundin Links, who will make her maiden speech today; the noble and learned Lord, Lord Falconer of Thoroton; and the noble Baroness, Lady Brinton. I thank them for their support. Indeed, I thank every noble Lord in the Chamber.

Today, in England and Wales, assisted dying is prohibited by the Suicide Act 1961. Anyone who assists a person to end their life is liable to prosecution and imprisonment for up to 14 years. It turns compassionate friends and family into criminals and causes thousands of dying people to attempt to take their own lives alone in order to safeguard their relatives.

How many of us fear that we may be one of the unlucky small minority—I emphasise “small minority” —of people who suffer a traumatic dying process in which our precious palliative care services cannot relieve our suffering and cannot enable us to have a dignified death? Some 52% of the population report that they have witnessed a loved one suffer unbearably at the end of their life. Assisted dying will reduce those fears of dying so that we can live better. Then, when we are given a terminal diagnosis, the legal right to an assisted death will give us and our families great comfort and reassurance, knowing that we will have a choice and some control over how long we can tolerate our suffering.

The benefits of the Bill to dying people and their families will be huge, yet this is a truly modest Bill based on tried-and-tested laws from overseas. It is an overwhelmingly popular Bill in society. We know that 84% of the population at large support assisted dying, including 80% of people who declare themselves religious and 86% of disabled people. That is not surprising, because the sole aim of this Bill is to reduce unnecessary and unbearable suffering.

What do I mean by intolerable or unbearable suffering? There are forms of suffering that even the best palliative care cannot alleviate. A small but significant minority of dying people will experience intolerable symptoms. Let me give some examples. One is constant nausea and vomiting, night and day, which, because of an allergy to antiemetics, cannot be alleviated by palliative care services. Another is fungating wounds from a cancer protruding through the skin, perhaps in the cheek; I have a friend who suffered that recently. Such wounds exude pungent and deeply unpleasant odours described by doctors as “ward-clearing” because all the other patients have to leave due to the odour. However, the dying person can never leave, can they? That is, unless they are given the opportunity to take their own life.

Motor neurone disease is totally different but, day by day, week by week, it eventually deprives the person of every possibility of moving a muscle anywhere in their body. Some of those people will end up unable to speak, to swallow, to eat or to drink. How many of us want to go through that? Should we not have the right to avoid the very end of all that suffering? Often the loved ones of these people go through years and years of nightmares and panic attacks, thinking back and remembering the pain and suffering that their nearest and dearest went through. This Bill could end that suffering.

What can the dying person do under the current law to avoid such suffering? The options are grim. We can starve ourselves to death—a horrible way to die. We can refuse treatment, with more uncertainty about how much suffering that will cause. We can take our own lives—thousands of people try to do that every year and nine-tenths of them fail with the most appalling consequences. We can poison ourselves with stored up pills and alcohol, alone, to protect our loved ones. I had an aunt who had terminal liver cancer. The tumour was the size of a football. In the middle of the night, all alone, she took all her pills and whisky and the next morning her husband, who knew nothing about it, found her dead. That death left an indelible mark on me and probably explains why I am here today. The law leads dying people who desperately want medical assistance to die to travel to another country, long before they are ready to die. Imagine going to take your life before you really feel that that is what you want to do.

Now I will tell you something that you will find a little surprising. Our colleague, the noble Lord, Lord Field of Birkenhead, who is dying, asked me to read out a short statement:

“I’ve just spent a period in a hospice and am not well enough to participate in today’s debate. If I had been I’d have spoken strongly in favour of the Second Reading. I changed my mind on assisted dying when an MP friend was dying of cancer and wanted to die early before the full horror effects set in, but was denied this opportunity … A major argument against the Bill is unfounded. It is thought by some the culture would change and that people will be pressurised into ending their lives. The number of assisted deaths in the US and Australia remains very low—under 1%—and a former Supreme Court judge in Victoria has concluded about pressure from relatives that ‘it just hasn’t been an issue’. I hope the House will today vote for the Assisted Dying Bill.”


Why are we bringing another Assisted Dying Bill before Parliament? Those who oppose this Bill will remind us that over six years ago such a Bill was defeated overwhelmingly in the House of Commons, but a great deal has changed since then. We have seen a radical shift in the views of doctors. In 2019, the Royal College of Physicians ended its opposition to assisted dying. Last month, the BMA did the same thing following a survey that showed that 50% of its members supported assisted dying and 39% were against. My belief is that, about 10 years ago, maybe 5% of doctors supported assisted dying. The change has been extraordinary. I had a meeting with the Royal College of Surgeons the other day. It is considering reviewing its position. If it does, all the royal colleges will have moved from opposition to neutrality.

In this same period, seven more US states have legalised assisted dying. Now 11 US states have it, as well as five states in Australia. New Zealand is introducing assisted dying; it will be available for people from next month. All those jurisdictions have an Act of Parliament very similar to the Bill that we are discussing today. Other countries have broader models of assisted dying. Canada and Spain are among the latest countries to legalise euthanasia in the past few years, in which a doctor administers a lethal medication. Italy will have a referendum next year. When a country has a referendum, it will introduce a law, because this is an incredibly popular measure. Debates are under way in Portugal, Austria, Germany and Ireland. Perhaps most important is the likelihood that within a few years the Scottish Parliament will legalise assisted dying—there is a majority for it in the Parliament. My challenge to our Prime Minister is: “Boris, do you really want to be upstaged by Scotland on this issue, an issue of such historic proportions?”

This Bill is an attempt to drag our assisted dying legislation out of the 1960s and into the present day. It is not a euthanasia Bill; it would read very differently if it were. What are the main provisions of the Bill? It would give terminally ill, mentally competent people over the age of 18 the right to choose the manner and timing of their death. To be eligible for an assisted death, two independent doctors would have to confirm that the person requesting assistance had a life expectancy of no more than six months. Prognoses are a little unreliable but, in the countries that have this law, people take the medicine only in the last week to two weeks of life and, at that point, the prognosis is much more certain. People must have mental capacity and have reached a clear and settled decision to have an assisted death without pressure or coercion from any person. If at any stage there were doubts over their capacity, either doctor could refer the person to a specialist. The patient’s nearest relatives would be interviewed to check their motivation. Having seen this evidence, the entire process would need to be approved by a judge of the family division of the High Court.

How does this Bill relate to palliative care? All of us who support the Bill—and I mean all of us—are passionate about achieving the best possible palliative care across the country. While we are unable, in this Bill, to include additional financial provision for palliative care, we urge the Government to follow the example of Victoria, in Australia, and elsewhere, where the legalisation for assisted dying has been accompanied by a significant investment in palliative care services. The principles of patient choice are rightly paramount in modern medicine but are drastically curtailed when it comes to the end of life. Patient choice means nothing for the dying unless it includes the patient’s right to decide when they can take no more suffering.

The right to an assisted death, where and when the patient chooses, surrounded by loved ones, is an essential and complementary part of high-quality palliative care. The Oregon Hospice & Palliative Care Association was against assisted dying before legislation was introduced there. Today, it is very much in favour. Why? Because it has improved palliative care; now, their doctors and nurses can have honest, expansive conversations about the wishes and fears of dying people. Palliative care has improved in Oregon over those 22 years, and it would do the same here.

I will touch on the report of the Delegated Powers and Regulatory Reform Committee, of which I am a member, although I should say that I did not attend the meeting to discuss this Bill. The report raises valid points about having the affirmative rather than negative procedure, and I will be talking to doctors and lawyers about some adjustments to the Bill to reflect those recommendations.

In my closing remarks, I will briefly scotch some arguments that are likely to be heard today. Might there be a slippery slope, our opponents suggest—I have just had that debate with a doctor on BBC television news. No, there would not be. Our opponents know that not a single jurisdiction in the world that has legalised assisted dying for people who are terminally ill and mentally competent has expanded it beyond those strict criteria, except Canada. The reform there was led by a Supreme Court judgment that, if somebody is not terminally ill but is suffering unbearably, it is contrary to their human rights to be denied an assisted death. The Parliament decided to have a narrow Bill initially, not dissimilar to ours, and, if that worked, to extend the scope of that Bill. Canada is a very exceptional case because of that. The reform was led by a Supreme Court judgment and the Parliament was a bit nervous about doing it, so people today should not refer to Canada as an example of a slippery slope. The laws in Belgium, the Netherlands, Switzerland, Canada, Spain, Colombia and elsewhere may be raised today. I hope they will not be, as they have always been more broadly based. References to those laws are irrelevant to our debate.

We will also hear much today about vulnerable people, which is absolutely right, but there are no legal safeguards for dying people who decide to end their lives early, whether by starving or, on occasion, shooting themselves. We propose a rigorously safeguarded system that would end these barbarous deaths and protect vulnerable people.

Some say that pain can always be controlled; cancer specialists know better. Some have written to me referring to the terrible suffering of terminally ill cancer patients from physical pain—a small minority, but each and every one of them is important, nevertheless. The Association of Cancer Physicians, in its excellent and balanced book End of Life Choices for Cancer Patients—it is careful not to come down on one side or the other—concludes that

“we do not see the comprehensive provision of high quality palliative care and the introduction of assisted dying as alternatives in competition with each other.”

In other words, they work well together when they exist together. The current law is unsafe and results in untold suffering. No civilised society should tolerate such a law. I beg to move.

--- Later in debate ---

[Baroness Meacher (CB)]

My Lords, I thank every single one of your Lordships who has spoken here today. I want to say a special thank you to the Minister. I should think he was pretty depressed when he found out that he had to reply to an extremely lengthy debate on a Friday, but I thank him for his courtesy and comments; they are most welcome. I also thank the noble Baroness, Lady Davidson of Lundin Links, for her formidable maiden speech. I tell you, my maiden speech was nothing like as good as that; it was really quite superb.

We have heard many moving and powerful speeches. Of course, I could respond to lots of the comments made by people on the other side of the argument. It would not be difficult but it would certainly take time. I am absolutely sure that your Lordships do not want me to do that this afternoon—am I right?

[Noble Lords]

Hear, hear.

[Baroness Meacher (CB)]

I do want to respond to the noble Lord, Lord Carlile, because I can do it quickly. The High Court has been consulted. He said that it had not; I think it is important to put that right.

This has been a remarkably courteous debate, despite the incredible depth of feeling, including my own, on the issues on both sides of the House. I know how strongly people feel about this issue. I am grateful for the courteousness with which everybody—I think I can say that—has expressed their opinions.

All I want to do is say thank you again to noble Lords.