Health: End of Life

Lord Beecham Excerpts

Thursday 12th December 2013 Lords Chamber

[Lord Beecham (Lab)]

My Lords, as the noble Baroness has just reminded us, this debate encompasses two issues. The first is one that has clearly attracted unanimous approval throughout the House: the need to provide care and support for the dying at the end of life and to honour their choice, particularly in relation, for example, to whether they die at home, in hospital or in hospice—matters referred to by the noble Baroness, Lady Murphy. There is clearly agreement that this objective should be fulfilled, and there are ways in which matters can be taken forward from the current position. Compassion in Dying, for example, has recommended that progress be made in dealing with advance decisions, and simplifying the procedure for living wills and lasting powers of attorney. The noble Baroness, Lady Meacher, referred to establishing a register that, again, Compassion in Dying has referred to. There is the issue of training for professionals and much else. I hope that the Government will look at these matters.

One matter came to my attention yesterday by virtue of an article by Jackie Ashley in the Guardian pointing out that whereas people can get leave from work for various reasons, there is no provision in law for leave for carers of those who are terminally ill. Perhaps the Government could look at that. I am of course not asking the Minister for a response today but it is something that I invite her and colleagues in other relevant departments—BIS and so on—to look at. It could well make a significant contribution.

The second area with which we are concerned is assisted dying. On this we have had a very balanced debate. I have been keeping a scorecard of those who have spoken in favour and against, and it roughly balances out across your Lordships’ House. I must also say that the debate has been in the highest traditions of this House in terms of thoughtfulness and sensitivity. There are clear issues here—ethical, moral, religious and practical—that need to be addressed. It is not a party issue. There is no official opposition line, and I suspect that there is no official government line. I speak from a personal standpoint.

However, it is perhaps necessary briefly to rebut three points that have been made by some speakers. The noble Baroness, Lady Morris, said that under the proposals of my noble and learned friend’s Bill doctors would be required to take the life of patients. That is not the case. The Bill specifically deals with self-administered drugs that could end life. The noble Lord, Lord Alton, spoke of the “emasculation” of the hospice system. I see no evidence of that at all. As I shall say later, I have knowledge of the working of the hospice system and I do not think that anyone who might support my noble and learned friend Lord Falconer’s Bill or some version of it would for a moment wish to diminish the effective role of an important part of our health provision. There was a suggestion by the noble Lord, Lord Hylton, that among the major religions Buddhism was clear in its maxim that one should do no harm. That, of course, is also the substance of the Hippocratic oath. However, the question is: what constitutes harm? Is it confined only to causing death? Can it not also be allowing or facilitating the prolongation of suffering? Therefore, the situation is perhaps more nuanced.

My own position is informed by my personal experience. My wife died five weeks after I was introduced into your Lordships’ House, having suffered from bowel cancer for two years, with secondaries in the liver and lung. It was always a treatable but not curable condition. She was the daughter and sister of doctors. She nursed her mother, who died of cancer, in our home. She was a health visitor, a nurse and a Relate counsellor. From the outset of her illness, she was very clear that, should she suffer considerable pain, she would wish to be helped to end her life. She received wonderful treatment from the National Health Service in Newcastle and from the hospice in which she spent her last few days. Fortunately, she never experienced quite the degree of pain that would have led her to invoke the remedy, which in any event would not have been available to her.

She lived very fully in those two years. She made a television programme about bowel cancer; she made a DVD about stoma, having undergone a cystostomy; and, with friends, she produced a book about living with cancer. Therefore, she was very conscious of the condition and anxious that people should learn from her experience. However, I know that she would have wished me to express support for the choice that in the end she did not have to make. I suppose that I had the dubious privilege—nevertheless, I felt it to be a privilege—of being with her when she died in the hospice. She had been sedated and was out of pain for those last few days. Of course, not everybody has that opportunity, and there are those who would clearly wish to have the chance to end what can be a very painful experience.

I have friends who are undergoing precisely these difficulties now. I have a particular friend who has also suffered from cancer, and it is a recurrent condition. Having, again, been treated very well in hospital and in a hospice, she is now having home care and there is great gratitude for that but, frankly, it is a very painful condition—more painful than my wife endured. It is one which my friend wishes could end swiftly, rather than see her pain prolonged, even though she is having wonderful care, with full medical back-up, at home with her family. I have other friends who have undergone very difficult experiences, and there will be many in your Lordships’ House who can testify to that.

So we have some difficult choices to make. We are not asked to make choices today; we are debating and discussing how policy might evolve in both the areas that have been the subject of this debate. I take the point made earlier that, if you have the means, it is possible to avoid that debate. You can go to Switzerland, as some people have done, and leave the stage, as it were, there under the system that currently prevails. However, a minority of people can take that course and there will not be many, although there will be some, who would prefer the alternative, which my noble and learned friend’s Bill would secure. Of course there are issues of safeguarding and of avoiding people being persuaded to take that course of action, and it would be essential to embody that in any legislation, should we reach that position.

There are clearly many who would adopt the approach that Dylan Thomas advised in a memorable poem:

“Do not go gentle into that good night …

Rage, rage against the dying of the light”.

For those who do not want to go gentle, whether they want to rage or not, of course we must offer every conceivable support to allow them to do that. However, others would take a different line of poetry. They might take the line from Keats and wish:

“To cease upon the midnight with no pain”.

In my view and the view of some of your Lordships, that is a decision which should also be respected, supported and facilitated, but with the very clear proviso that there must be proper safeguards and that nobody should be required to go against their conscience—for example, as a medical practitioner—to administer what would be required to produce that ceasing upon the midnight with no pain.