Health: End of Life

Baroness Warnock Excerpts

Thursday 12th December 2013 Lords Chamber

[Baroness Warnock (CB)]

My Lords, I congratulate the noble Lord, Lord Dubs, on introducing this debate, which is timely on two counts. First, we have a chance to think about the demise of the Liverpool care pathway, which was obviously well intentioned but had flaws. We have not yet had a chance to consider in detail what should be put in its place, if anything. Secondly, as this debate has shown, it is a kind of run-up to the debate that will take place later next year on the Bill proposed by the noble and learned Lord, Lord Falconer. I do not want to say anything more about that Bill except that I agree very strongly with the view that the present state of the law is unsafe and intolerable and cannot be supported.

I go on to one issue that seems something of a scandal—the case of patients who are dying who may actually be, or may be perceived to be, incompetent to make decisions about their treatment. I cannot think of anything more humiliating than to say that I wanted to die and that my life was no longer worth living only to be told that I was suffering from depression. Well, I would be suffering from depression in the ordinary sense of the word—but I could be told that I was suffering from clinical depression and could be cured by medication. My lawful refusal of medication might even be disregarded in those circumstances, because I should be deemed not competent to make it.

I regard it as a scandal that so very few people draw up advance directives or put in place a lasting power of attorney. Since the passing of the Mental Capacity Act 2005, this is something that is worth doing and which preserves choice, even in the case of the person being incompetent. One difficulty that has already been mentioned is the difficulty of access to an advance directive, even if it has been made. This is very serious. I have a friend who was involved in trying to devise a bracelet that people could wear to say that they had made an advance directive and how it could be accessed by people in the ambulance service. She was refused hospital help in devising this bracelet because the authorities said that they would be liable to prosecution as assisting suicide if they were known to have helped to devise this bracelet. That seems bizarre, because it would be a help if, as one can carry a donor card, one could also carry some kind of indication that an advance directive existed.

A worse difficulty is that so few people know about what their rights actually are under mental capacity law, and that many even do not know that there are such things as advance directives or that a power of attorney can be given. The culprits here are general practitioners, who should have a duty to have in their surgery accessible information about advance directives, in the way that they have dozens of leaflets about diabetes, asthma and other kinds of ills that people may suffer. This seems to be something that would be very easy to do—and then people, whatever their age or state of health, who came to the surgery, would have access to the means of making an advance directive. The means could be made simpler; the doctor could sign the pro forma that could be supplied in the surgery. People could, almost as a matter of routine, ensure that they had such a thing in place if they feared that their treatment at the end of life would be not what they would want and not what would be best for their own interests and the interests of society.

This is a very important change that ought to be made, and which could be made, if only the medical profession was not so very much afraid of death. This is a terrible indictment, really. Even at my age, I frequently talk to my GP, who I know well, about death—and he to me. But that is very rare. On the whole, doctors need, most of all, to change their attitude to death, because their professional and compassionate duty is not always to save life but to relieve the suffering of their patients. I think that this is a change that we can make.