Assisted Dying for the Terminally Ill Bill [HL]

My Lords, as an enormously privileged member of the Select Committee, I am immensely grateful for the time that we have spent in considering how to meet the wishes of some terminally ill adults who are suffering unbearably. Like all those in today’s debate who are supportive of the Bill, I would of course prefer that their wishes could be met in some other way. But, as the committee unanimously noted, these people are,"““determined individuals whose suffering derives more from the fact of their terminal illness than from its symptoms and who are unlikely to be deflected from their wish to end their lives by more or better palliative care””." While taking evidence we visited the state of Oregon in the USA. I, among others, was most impressed with the way that the Oregon Death with Dignity Act 1997 compassionately responds to the request to die with assistance. As noble Lords may be aware, the Bill introduced by the noble Lord, Lord Joffe, is closely modelled on that Act, which a majority of my fellow committee members have confirmed that they support. There has been considerable confusion in this country about how the Act is working there. Perhaps I may briefly remind your Lordships of some of our experiences there. We held 10 evidence sessions in Oregon, in nine of which witnesses largely agreed that the Act was working well and without abuse. Representatives of the Oregon Hospice Association, the Oregon Medical Association, the Oregon Board of Medical Examiners, the Oregon State Board of Nurses and Oregon’s equivalent of the Department of Health, among others, all expressed satisfaction with the Act. One set of witnesses, however, comprising a small group of doctors belonging to Physicians for Compassionate Care—PCC—tried to persuade us otherwise. However, the evidence that we received from the Oregon Medical Association strongly suggested that these individuals oppose the Act primarily because of their deeply held religious beliefs. This group’s view of the Act was in stark contrast to the other nine groups. This group told us that Oregon’s end-of-life care is of poor quality and has deteriorated since the Act was passed. Indeed, that message has been widely repeated. But some of your Lordships will have attended or read the notes of last month’s presentation from Ann Jackson, CEO of the Oregon Hospice Association, at which she confirmed that the quality of end-of-life care in Oregon has improved and has not been compromised since the passing of the Act. Oregon is a leader in this area and was last year named the best place to die in America. The number of people dying in hospice care has doubled since the Act was passed, and every Oregonian now has access to hospice care, even those in the most remote areas. One member of this group, Dr Kenneth Stevens, has suggested that Oregonian doctors now take less care of their terminally ill patients because they have the easy option of offering an assisted death instead. There is absolutely no evidence to substantiate that claim. In contrast, independent research has found that since the Act was passed, 70 per cent to 80 per cent of doctors have sought to improve their knowledge and skills in the care of the dying. So, Oregon legislation has had no adverse effect on hospice care; nor have the dire consequences that were predicted by groups such as PCC prevailed. Unfortunately, such predictions are now being made in this country. Out of the 240,000 deaths in Oregon, 246 people have used the Act in the eight years since its passing; not—I repeat, not—the thousands that were anticipated by the Act’s critics. The annual Oregon state reports show that, contrary to the predictions, these individuals are not very elderly; not disabled; not uneducated; not motivated by financial concerns, inadequate pain control or psychiatric illness; not uneducated and not disproportionately members of ethnic minorities. In Oregon, we heard again and again that these individuals valued being in control and making their own decisions and could not tolerate the way in which illness had robbed them of their dignity. They were motivated by a desire to remain in control of their lives and avoid this loss of dignity and autonomy. Most importantly, more than 90 per cent of them were enrolled in hospice care at the time that they received their prescription: so dying Oregonians do not have to choose between palliative care and assisted dying. I do not support these proposals blindly. Like others, I weigh the positive benefits to the great many terminally ill adults who would be reassured by these proposals and the small but significant number who would use them against the possibility of abuse. There is compelling evidence that the Oregon Act works well. In addition to this, the noble Lord, Lord Joffe, has included even more safeguards than existed in the Oregon legislation. Whatever happens today, I make one prediction. Like homosexual reform—which Bill, incidentally, was introduced by my father and took four attempts to get through your Lordships’ House—and the abortion Bill, and despite the similar controversy over this Bill and what the Churches and some doctors may say, eventually the clamour from society as a whole for legislation such as this will prevail, and, in doing so, society will be giving some relief to those suffering from intractable distress.