Health: End of Life

Earl of Arran Excerpts

Thursday 12th December 2013 Lords Chamber

[The Earl of Arran (Con)]

My Lords, last week I spoke of my experience as yet another member of your Lordships’ Select Committee on the Assisted Dying for the Terminally Ill Bill. I travelled to Oregon, as did the noble Baroness, Lady Hayman, and the noble Lord, Lord Taverne, in 2004 to see how the Death with Dignity Act works in practice, it having been enacted there 10 years before. I wish to talk further briefly on Oregon simply because we think that the Act works well.

We often hear from opponents that there has been a meteoric, inexorable rise in the number of people who have an assisted death in Oregon. Quite aside from the fact that a modest rise should be expected in a new system such as this—proving, surely, that the system is working well—we are still looking at a very small number of cases each year. There have been fewer than 80 cases each year, representing less than a quarter of 1% of all deaths in that state. In this country, as has already been said, that would amount to approximately 1,000 to 1,200 people.

What better proof can there be of the law’s effectiveness than the continued support of Oregonians themselves? They voted to retain the Act by 60% to 40%, and polling consistently confirms that between 75% and 80% of Oregonians continue to support the Death with Dignity Act.

I can suggest several reasons why that support remains so high. First, as I have already said, assisted dying is not running rampant across Oregon. It is used by a small number of people who suffer from intractable distress. However, while assisted dying is not used widely in Oregon, it offers reassurance—again, as has already been said—to a great many people. Forty per cent of those who request medication that would allow them to have an assisted death and meet the safeguards to access the medication do not use it and die naturally. Only around 1% or 2% of those who begin the discussion with their doctor about assisted dying actually go on to take life-ending medication.

The Act offers reassurance to dying people that they may avoid unnecessary suffering; it offers reassurance to healthcare professionals that they may discuss openly and frankly with their patients the whole range of choices at the end of life; and it offers reassurance to family members that they need not face the impossible moral dilemma of breaking the law and helping a loved one to die, as is the case in this country. The fears raised by those who are opposed to a change in the law have simply not materialised. There are no documented cases of abuse in Oregon. Vulnerable people are not disproportionately affected by the Death with Dignity Act. There have been no public calls to extend the Act to cover those who are not terminally ill or do not have mental capacity, proving that the alleged slippery slope does not exist. Indeed, assisted dying is now law in the states of Washington, Denver and Montana.

As I said last week, palliative care continues to play a vital role alongside assisted dying in Oregon, showing that they are not mutually exclusive. Of course, we must offer excellent palliative care for all, but we must also acknowledge that some people who are dying, even with the very best palliative care, will suffer at the end of life. For this small but significant minority of people, our current law is not working. As so often happens, it tends to be society as a whole that eventually brings about the great humanitarian reforms. Witness, first, the Sexual Offences Act 1967 on homosexual reform, which incidentally was introduced by my father in your Lordships’ House; and, secondly, the Abortion Act 1967 and further such legislation in 1990. Ultimately, it is the will of the people that pushes open the barriers and Parliament has to act. Both of those reforms involved the possibility of death. This Act deals directly with death and it is critical therefore that we get it right. Against a background of a growing majority of public support, I believe that we have got it right.

We have been arguing among ourselves for a long time—too long—about this reform. Now, dithering is done and Parliament must act soon—and very soon. Finally, none of us here today asked to come into this world. Should we therefore not have a choice to say how we might wish to depart from it?