Health: End of Life

Baroness Murphy Excerpts

Thursday 12th December 2013 Lords Chamber

[Baroness Murphy (CB)]

My Lords, there are policy priorities for the end of life and there are legislative priorities. They are very far apart, but intimately connected. I have no doubt that the policy priority must be to improve the experience of dying in hospital, as that is, at the moment, where most people die.

End-of-life care requires honest conversations between doctors, nurses, patients and families. The antecedents of a bad death are exactly the same as those that engender generally poor care in hospital wards. I admire the report published by the noble Baroness, Lady Neuberger, and her colleagues which looked at how to replace the Liverpool Care Pathway with individual care plans, but I fear it will not make a jot of difference until the culture of medicine and nursing is transformed.

However, this policy priority is not the legislative priority, and compassion dictates that we find a safer way in legislation to help all dying people, just as in Oregon state the death with dignity law stimulated the public’s understanding of death and dying and increased the provision of good palliative care. I believe that focusing our legislation on the tiny few who want to make their own choice of time of death will not only help the few but will help to create an understanding of the broader needs of dying people.

Let us imagine for a minute that the Falconer Bill has already been enacted. In the average clinical commissioning group area, we are talking about five or fewer people a year who would make the request and fit the criteria. That figure is derived directly from Oregon state. The noble Lord, Lord Alton, is right in saying that the numbers have gone up slightly in Oregon, but there is no statistically significant increase. It has remained at that tiny figure over the past 15 years, and it looks as if in Washington state, which is double the size of Oregon, it will be the same. There are four years of experience there. Five people annually are enough for a small team of expert doctors to administer a code of practice that would be devised by the professions and laid before Parliament.

I want to concentrate on just one safeguard because the others are fairly easy to address. It is about what the noble Lord, Lord Tebbit, in a debate in Grand Committee so memorably referred to recently as “the vultures”—relatives who cannot wait to get their hands on an inheritance—and those who might exert subtle pressures on people to kill themselves. This has already been mentioned by the noble Lord, Lord Hylton, and has been mentioned in the past by the noble Lord, Lord Tombs, and the noble Baronesses, Lady O’Neill, Lady Campbell and Lady Grey-Thompson. I spent many years as an academic psychiatrist doing much testamentary capacity expert witness work and, believe me, I know that the vultures are circling overhead. It is crucial that we can spot where there are profound or subtle pressures on individuals. But given that all those seeking an assisted death will have full mental capacity, how susceptible are they really? We do not need to guess or to create false scares. A research review has recently been published by the American Bar Association Commission on Law and Ageing. Almost all those who are subject to undue influence or subtle pressures are indeed suffering from lack of mental capacity, as you would expect. They are very aged, frail and have dementia. They are habitually exploited. The very few who are subject to undue influence when they have full capacity are in those very curious situations, which are fairly easy to detect, where one individual is very dependent on another. We saw that recently in the case where a group of people were subject to imprisonment. I would refer to it as emotional imprisonment. They are very rare cases indeed. We can take account of them. A humane society that really cares for individuals should be able to meet the wishes of that tiny few who want to say where and how they die, with whom they die and also when.