Assisted Dying for the Terminally Ill Bill [HL]

My Lords, as speaker No. 90, I should like to follow the noble Lord, Lord McColl, with a few messages from the Government, which may be a little more complex than his messages. I am grateful to the noble Lord, Lord Joffe, for devoting his birthday to introducing this revised Bill and for setting out the intentions of the Bill so clearly. It provides us with a further opportunity to consider this important and sensitive subject. There is no doubting the commitment of the noble Lord, Lord Joffe, to this issue, nor the compassion that drives him. Nor is there any doubt that others are equally committed to opposing this legislation. I should like to pay tribute to the moving personal experiences of several noble Lords and their willingness to share those experiences with us. I am particularly indebted to my noble friend Lady Symons for her moving speech. This remains an emotive and profound subject, which continues to elicit strong and often opposing views. Sadly, as I know from my own postbag, it can produce intemperate and offensive expressions of those views, which, I have to say, were greatest from those who were opposed to the Bill. As noble Lords have mentioned, your Lordships debated this matter in detail last October when there was considerable balance in the number of Peers who would and would not oppose the Bill. The noble Lord, Lord Joffe, told us that he would revise the Bill’s provisions in the light of the points raised. On behalf of the Government, I want to make it clear that, as in October, they are listening carefully to the debate on this complex ethical issue. We consider that it is right that Parliament should lead on this debate and should provide the forum where all shades of opinion can be heard. Therefore, in accordance with the conventions of this House, the Government will not seek to block this Bill being given a Second Reading. There has been much discussion of what would and would not be allowed under this Bill were it to become law. I want to take a moment to remind us of the situation today. It is important that the legal position is clearly understood. Let us be absolutely clear: euthanasia—which is commonly understood to be the intentional taking of life, albeit at the patient’s request or for a merciful motive—and assisted suicide are unlawful. Anyone alleged to have taken active steps to end another’s life would be open to a charge of murder or manslaughter. Anyone alleged to have assisted a person’s suicide would be open to penalties of up to 14 years’ imprisonment under the Suicide Act 1961. This Bill introduced by the noble Lord, Lord Joffe, proposes that in certain restricted circumstances doctors should be able to assist a competent patient to end his or her own life. This is the issue that your Lordships are being asked to consider and that I am reflecting on today as a Government Minister. I remind your Lordships that we are not dealing with matters around withholding or withdrawing treatment or a person’s right to refuse treatment, even if that refusal may result in his or her death. These are also important issues but they have nothing to do with the assistance to die that the Bill seeks to introduce. These issues should not be confused. I also want to make it clear that there is no connection with the Mental Capacity Act. The Assisted Dying for the Terminally Ill Bill specifically relates only to competent adults. The Mental Capacity Act, on the other hand, deals with people who lack capacity to make decisions. There is no connection at all between the two. The Mental Capacity Act also has nothing to do with euthanasia or assisted suicide. Section 62 of that Act makes it quite clear that it does not change the law on murder, manslaughter and assisted suicide. I am also aware of the increase in public debate on this issue. Noble Lords have mentioned the work of particular groups: for example, the setting up of the umbrella organisation Care NOT Killing to campaign against the Bill and the work of the renamed Dignity in Dying, which supports the Bill. We have all observed that there has also been a notable increase in correspondence. And we have heard about the recent changes in the stance taken by a number of professional bodies, and how those have been arrived at. The noble Lord, Lord Carlile, and others mentioned the recent statement from the Royal College of Physicians on its members’ views. As I understand it, the college sought the views of 16,400 plus fellows and members. It had a response of 5,111, which I calculate is a response rate of around 30 per cent Seventy-three per cent of this group felt that a change in the law is not needed. Does that mean that this or any poll carried out in the same way speaks for all doctors or just for those with strong views on the issue one way or the other? It certainly does not seem to me to support the conclusion that it shows that a majority of doctors oppose the Bill. There has been some flourishing of figures in the debate relating to support for and opposition to the Bill. Let me remind the House that the Select Committee, so ably chaired by the noble and learned Lord, Lord Mackay of Clashfern, stated:"““It is evident that there is a great deal of sympathy at least for the concept of euthanasia, and it seems likely that the level of sympathy has grown in recent years””." The committee cited the evidence for its conclusion. I am sure we all listened attentively to the noble Lord, Lord Moser, as he helped the House to pick its way through the reliability of survey information on public opinion. He drew on his knowledge and great expertise in the area. I am also aware that since the Select Committee published its report, in August 2005 the Daily Telegraph published the results of a survey which showed that 87 per cent of people thought that those who are terminally ill should have the right to decide when they want to die and to ask for medical assistance to help them. However, it is worth reflecting that the survey evidence also suggests that the views of politicians are moving in the opposite direction. In 1995, 70 per cent of MPs surveyed opposed voluntary euthanasia; by 2004 that opposition had increased to 79 per cent This debate has highlighted the strong and often opposing and conflicting views that people have on this issue. I recognise that we have to ask ourselves how to weigh the views of particular groups. There is no easy way to resolve these conflicts and dilemmas. Views differ between professionals, members of the public, and Members of your Lordships’ House and the other place. However, one thing is clear: we must continue to listen to the views of the public and of patients, as well as those of interest groups. The Government have a strong public involvement agenda and are fully committed to increasing patient choice. Let me be clear that this extension includes areas such as palliative care and end-of-life care. We have actively sought and will continue to seek the views of the public, people who use those services and, indeed, those who work in the area. That helps to illustrate why it is so important to have an open and wide debate on an issue such as this. There is no simple answer and I reiterate the important role the Government believe that Parliament has in providing a forum for considering issues of this nature, in particular the wisdom and experience that your Lordships’ House brings to this difficult area. I do not propose to comment in detail on the provisions of the Bill. Other noble Lords have raised many points on which the noble Lord, Lord Joffe, may wish to reflect. My understanding is that he is very willing to contemplate amendment. However, I want to remind the House that taking a neutral position on the Bill is not the same as doing nothing. The Government are of course concerned with the fitness for purpose of any legislation proposed, and it is in this context that I mention a few issues in respect of the Bill’s provisions. First, the Bill proposes to protect a physician from criminal liability if he or she assists a qualifying patient to die or attempts to do so in accordance with the requirements of the Bill. But it makes no mention of protection from civil liability. Secondly, there is a lack of clarity about how the protection from legal liability relates to different members of the healthcare team, and noble Lords will know that healthcare is essentially now, in many cases, a team effort. Thirdly, there is a lack of clarity about the extent to which there would be any duty on physicians and others to assist a patient’s death, even if the qualifying conditions are fulfilled. Finally, some of the terms used in the Bill, in our view, have a very wide—and sometimes subjective—set of definitions. Again let me be clear that I make no detailed suggestions about how these points might be addressed. A number of noble Lords have raised issues about the obligations that the Bill would place on the health professionals involved. The Government recognise that these have to be addressed fully in legislation of this kind. Whatever the outcome of the Bill, the Government agree that it is important that no one should be compelled to assist someone to die. Others have mentioned the details of the Bill’s conscience clause. We would see an important role for the relevant professional bodies in considering whether the Bill should place any duties on healthcare professionals, with a conscientious addition. I agree fully with the important place of palliative care in this debate, which has been highlighted by many noble Lords. I, too, pay tribute to all the staff who work in this area and provide such a splendid service to patients in this country. All patients should have access to good symptom control and to appropriate support and counselling. However, I fully acknowledge that, historically, hospice services have been developed in an ad hoc way and that specialist palliative care services have largely been restricted to the care of people with cancer. Those with other conditions have largely been cared for by generalist staff such as GPs, district nurses and hospital staff in non-palliative care wards. As a government we are committed to addressing these discrepancies in access to care and we have made good progress in recent years. A key strand of this activity has been to provide training in the principles of palliative care to generalist staff. This was the focus of our £6 million district nurse programme, in which more than 12,000 nurses and a further 3,000 allied health professionals participated. It is also part of our current £12 million end-of-life care programme. We have also taken action to increase the availability of specialist palliative care and support through the investment of an extra £50 million a year. This represents an increase in NHS funding for specialist palliative care of about 40 per cent over 2000 levels. This investment has so far funded a range of activity, including the provision of an additional 44 palliative medicine consultants and 172 clinical nurse specialists. A key aspect of palliative care, and one which is central to the discussion here today, is the management of pain. A survey of cancer patients’ experiences of pain management undertaken by the National Audit Office in 2004 showed good progress since 2000, with five out of six cancer patients believing that hospital staff had done all they could at all times to relieve pain, while over nine out of 10 felt that they were given enough medication or other help to deal with pain after leaving hospital. Clearly we want this position to keep improving as we continue to implement our commitments. Let me reassure the House—I think some doubt has been expressed on this during today’s debate—we have made clear in our general election manifesto that we are committed to improving palliative care provision so that all people, regardless of their age or condition, are able to choose where they live and die. To deliver this, we have set out a programme of action on end-of-life care in our recent White Paper Our Health, Our Care, Our Say, and we are developing those services in consultation with key stakeholders. Whatever the outcome of the Bill, we will continue to extend palliative care. I do not accept the argument that we and the NHS will be deflected from this path by the passage of the Bill, as some have suggested today. That is simply not the case. I gently say to the noble Lord, Lord Elton, that how we invest in our healthcare now is a bit different from when he was a Minister. We should put his experience in this area in perspective. We will continue to develop palliative care and build on the excellent work being done by the Marie Curie Delivering Choice programme, a key focus of which is better co-ordination of services and communication between providers. Noble Lords have rightly paid tribute to this country’s leading position in palliative care. We want to make it even better; we want to build on the work that we have done and we will continue to do that as rapidly as possible. In conclusion, I thank noble Lords for the quality of today’s debate. It reinforces the importance of open and continuing debate in considering such difficult ethical issues. Once again, important principles have been discussed with passion and reason in a heartfelt way but, I hope, to a constructive outcome. Many points about the provisions of the Bill have been raised and no doubt the noble Lord, Lord Joffe, has much to think about. I repeat, finally, what I said earlier: the Government will not seek to block the Bill’s Second Reading, in accordance with the usual conventions. As I said on a previous occasion, I hope that I have achieved a sufficient degree of inscrutability consistent with the Government’s position of neutrality on this issue.