Assisted Dying (No. 2) Bill

John Pugh Excerpts

Friday 11th September 2015 Commons Chamber

[Rob Marris]

No, I will not for the moment. I must make some progress.

I respect the views held by people who are strongly opposed to my Bill. I share their motives for wanting a better society and to ensure that we have a law that protects people. On the tube this morning, I stood next to a man in a hoodie on which it said, “Understand difference”, which I thought was quite appropriate. This debate is not about opinion poll numbers; it is about a matter of conscience, ethics and the kind of society in which we live. We need such a debate, and Parliament should not only debate this issue today when 85 hon. Members wish to speak but scrutinise the Bill in Committee in detail, and it should come back to the House for further scrutiny.

[John Pugh (Southport) (LD)]

Will the hon. Gentleman clarify something that has been bothering me? He has called this Bill the Assisted Dying Bill but there is not a person in this room who would not assist the dying. In the interest of clarity, why did he not call it the assisted suicide Bill?

[Rob Marris]

It is quite simple: it was called the Assisted Dying Bill in the House of Lords. I refer hon. Members to the Bill’s long title, which is often overlooked:

“A Bill to enable competent adults who are terminally ill to choose to be provided with medically supervised assistance to end their own life.”

I think that is pretty clear.

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[John Pugh]

Will the hon. and learned Gentleman give way?

[Keir Starmer]

I would prefer it if the House allowed me just to lay out the history so that everybody can understand it. I will of course try to take on board all the points that are being made.

I took it to be the compassionate act of a loved one, and using the exercise that the DPP had, decided not to prosecute.

A courageous woman with multiple sclerosis, Debbie Purdy, was in the process of bringing a case against the DPP in our courts. It started as a case against my predecessor, but became a case against me, and it was reaching the final stages. She noticed the reasons that I had given, and she argued before the House of Lords judicial committee that the DPP should be required to set out in guidance the approach that was being taken, and would be taken, to assisted suicide.

[John Pugh]

Will the hon. and learned Gentleman give way?

[Keir Starmer]

For the reasons I have given, I genuinely think it may be more helpful for the House if I just completed the exercise. I am deliberately trying not to put my views into this chronology so that people can simply see it for what it is, whatever view they take.

Debbie Purdy persuaded the committee that I should be required to produce guidelines. In the last judgment of the House of Lords judicial committee before it became the Supreme Court on the other side of Parliament Square, it ordered that I should do so. I was, of course, at that stage deeply aware of the views that were held on all sides, and I decided that a very wide public consultation was necessary so that the guidelines would be as fully informed as they possibly could be. I decided also to issue interim guidelines so that people could see the words on the page of the guidelines before the consultation exercise started, and so that it would be a meaningful consultation rather than one where views would be expressed in the abstract but without a real, detailed eye on what I was proposing.

The interim guidelines were underpinned by two principles. The first was that the criminal law should rarely, if ever, be used against those who compassionately assist loved ones to die at their request, so long as that person had reached a voluntary, clear, settled and informed decision to end their life. The second was that very strong safeguards are needed to protect those who might be pressurised in any number of subtle ways. Those who encourage the death of the vulnerable should feel the full force of the law.

The response to that consultation exercise was huge. Most criminal justice consultation exercises have responses numbered in the low hundreds; the response to my consultation exercise was nearly 5,000, and that is treating all the heads of faiths as one respondee when, in truth, they were responding on behalf of very many within their communities. It was probably the widest consultation on this particular area of our law ever conducted. It included, as one would expect, members of the public, doctors, other healthcare professionals, representatives of all faith groups, judges, public servants, Members of this House and Members of the House of Lords. In the course of that exercise, I personally met many who were most concerned about the guidelines.

There was overwhelming support for the interim guidelines that I had published and the two principles that underpinned them: compassionate assistance to those who are clear they want to end their lives, yes; pressurising the vulnerable, no. Accordingly, when I issued the final guidance that is still in force, I adopted the same two underpinning principles. They have now been used for five years. I personally oversaw about 80 cases, looking at the details in each of the files, and made decisions in 79 of those cases that no prosecution should be brought, and there was no clamour to change the guidelines.

Throughout the process, I thought long and hard about the position of doctors and health professionals, and whether their acts of assistance should come within the guidelines, in favour of prosecution or against. I took the view then, and I still hold the view now, that if the DPP indicated that doctors or medical professionals were unlikely to be prosecuted for assisting, that would undermine the intention of Parliament when it passed the Suicide Act 1961. I took the view that Parliament was not prepared to go that far when it passed that Act, and that the DPP should not, by the back door, as it were, indicate in the guidance that doctors and health professionals would be unlikely to be prosecuted if they assisted. Therefore, in the guidelines, when they were first drafted and as they are now, a factor making it more likely that someone will be prosecuted is that they are a doctor or a health professional assisting someone.

That particular issue came to a head in the Tony Nicklinson case, which went to the Supreme Court recently. Tony Nicklinson, as many people in this House will know, suffered a series of strokes and became completely paralysed save that he could move his head and eyes. Because of his paralysed state, he could not carry out his wish to end his life without assistance. He applied to the High Court for an order—a declaration—that he be permitted a doctor to assist him in his death. When he lost his case in the High Court at the first stage, Mr Nicklinson embarked on the difficult and painful course of self-starvation, refusing nutrition, fluids and medical treatment. His case proceeded to the Supreme Court, as everybody here knows, and in June 2012 the majority held that there was an incompatibility between our current position and fundamental human rights, but because of the margin of appreciation they should not themselves make a declaration to that effect but leave it to Parliament to further consider the issue, and today is that opportunity.

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[Madam Deputy Speaker (Mrs Eleanor Laing)]

Order. I am grateful for the advice of my hon. Friend. I would not have taken advice from any other Member of this House, as I am quite capable of judging how long a Member is taking. My hon. Friend is in the unique position of being able to offer me advice and I am taking it. The hon. and learned Member for Holborn and St Pancras (Keir Starmer), who currently has the floor—

[John Pugh]

rose—

[Madam Deputy Speaker]

Order. The hon. and learned Gentleman is in a unique position of being able to give information to this House on this extremely difficult issue. I have therefore allowed considerable leeway for him and I am sure the House will agree with that. At the same time, I am also sure that he will soon conclude his remarks.

[John Pugh]

Further to that point of order, Madam Deputy Speaker. The cases the hon. and learned Gentleman is talking about at length are not covered by this Bill. They are not terminally ill cases.

[Madam Deputy Speaker]

Order. That is not a point of order. We are not wasting time this morning on points of order. There are many people who wish to speak.

--- Later in debate ---

[John Pugh (Southport) (LD)]

I am unpersuaded by the promoter of the Bill. I agonise over this issue, because death and the manner of our death should trouble us all. I do not entirely trust my own instincts on this, so I took the trouble of going to my local hospice, Queenscourt hospice, to hear from staff there what their advice was on this Bill. After all, they see death on a regular basis—daily, hourly, weekly. They oppose this Bill strongly, emphatically and definitely, and endorse the stance I shall be taking.

The thing we must recognise is that we all have a terminal disease called life. None of us get out of here alive, and some of us are nearer the door than others. It is hard to imagine how we would feel if the exact timing or manner of our death became more clear. We must admit that there are, perhaps rarely, bad deaths and troubling deaths, although, as anyone in medical practice will tell us, they are decreasing and are far less in evidence than they used to be. But the weakness of the Bill is that it provides no real solutions to the issues that concern most people and it creates a raft of other problems we do not currently have.

It is a misnomer to refer to the Bill as proposing assisted dying. Dying is legally assisted in a range of ways every day—physically, emotionally and spiritually, and specifically by the hospice movement. The Bill is about assisted suicide. My intervention on the hon. Member for Wolverhampton South West (Rob Marris) was not trivial, because the language is crucial here. If we are to understand the moral facts and look reality in the face, we have to call things by their proper name. I am reminded of the Americans in Vietnam referring to dead civilians as “collateral damage”. We are talking about assisted suicide, and there is no essential right for people to demand of the state that it assists them with their suicide. In fact, it is the policy of Governments to reduce the number of suicides, and normally it is our moral duty to discourage suicide.

[Lucy Allan (Telford) (Con)]

Does the hon. Gentleman agree that anyone who has any knowledge of suicide sees it as a desperate and tragic act, committed by somebody in extreme emotional distress? It is usually committed alone, leaving families and loved ones devastated. The desire of a dying person for a peaceful death is so different from what I have just described, and anyone who has any knowledge of suicide would share that view. I believe the hon. Gentleman’s argument to be null and void on that point about suicide.

[John Pugh]

The default position is to discourage people from committing suicide, because suicide is most frequently the action of desperate people who are not getting the help they require. I believe that is acknowledged by the sponsors of the Bill, because they are suggesting that assisted suicide should take place only in special, carefully defined circumstances. Their Bill would put in place a series of provisions, which we have all read, to explain how we can be sure that these conditions actually apply. They are talking about this being a relatively limited exception and it is seemingly tightly drawn.

Let me make some huge, bold assumptions that I would not naturally make. Let me assume that these provisions, although not so far fully defined, would work perfectly, without abuse or uncertainty, and that this Bill is all that its sponsors want or are contriving. Therefore, this will not be like what happens in Switzerland, Belgium or Holland, and people will still have to go to Switzerland if they feel that their life is intolerable, unless they are likely to die anyway within six months. People may also still die undignified and unfortunate deaths, regardless of their prior wishes, if they cannot display current mental capacity. Those would be the consequences of the Bill. Paradoxically, the more likely it is that someone’s end would be undignified, the less likely it is that they will be judged to have the capacity to comply with the legislation. In reality, what this Bill permits is for a strictly limited number of people to have their suicides assisted, regardless of whether their anticipated end is painless or pain-free, dignified or not. That is what the proposals actually amount to.

[Tom Tugendhat (Tonbridge and Malling) (Con)]

Does the hon. Gentleman also recognise that except for in its exclusion, the Bill does not contain any recognition of the patient’s family? Therefore, this Bill would do exactly what we are seeking not to do: it would force the individual to be on their own and the family to be excluded.

[John Pugh]

It is fair to say that regardless of what people may expect of this Bill—we saw some mistakes in the contribution made by the hon. and learned Member for Holborn and St Pancras (Keir Starmer)—what it will do is not what most of the supporters of the Bill expect it to do. What it will do is generate certain very obvious risks, which have been well highlighted by other Members and so I will not go over them again. The risks are simply that the elderly and infirm will be pressured, doctors’ motives will be questioned or confused, palliative care will be progressed less and suicide will be seen as a solution more, and life will be treated more casually—more as a disposable commodity. The social consequences are, to say the least, incalculable; we cannot be certain about them. But even if there is just one poor old soul—and, strangely enough, it is usually the old who die—who, under pressure, seeks a quick dispatch, it does matter. The hon. Member for Wolverhampton South West could not rule out that possibility, and clearly recognised that that could be a consequence.

In conclusion, this week started for most of us with the haunting picture of a single child drowned on a beach. It was just one life and it affected the whole country. The consequence that can be drawn is that, as a civilisation, we cannot be casual about life without becoming a different sort of civilisation.

[Several hon. Members]

rose—