Coroners and Justice Bill

In opposing the amendment, I speak as a doctor, a retired neurologist, and someone who in my professional life spent a great deal of my time looking after people with progressive neurological diseases and many individuals who were terminally ill. I must also remind the Committee that in 1992 and 1993 I had the privilege of chairing your Lordships’ ad hoc Select Committee on Medical Ethics, which spent a full 12 months in detailed inquiry into issues relating to whether it would be appropriate to legalise physician-assisted suicide and voluntary euthanasia. I do not intend to go into details about that inquiry, except to say that we considered with great care submissions from many different quarters, including those who favoured the question of legalising assisted suicide. I fully appreciate that three members of the committee, which I was privileged to chair, have subsequently changed their minds. I know that they have supported the Falconer amendment, but I do not, for reasons that I should like to explain. In that inquiry looking at the issue of people who were terminally ill from progressive and fatal diseases, we recognised that there was a principle that had been applied in many cases in the past by the medical profession and accepted by the legal profession—the principle of double effect. What double effect meant was that if, in order to relieve pain, distress and suffering it was necessary for doctors to give such doses of medication as may have the secondary consequence of shortening life, this was acceptable in law and in medical ethics, but the intention must not be to kill. Since that time, I wholly appreciate that a number of philosophers and doctors have regarded that principle as being hypocritical. Some have said that it is a fudge; nevertheless I still believe that it served the medical profession well over many years. I recognise what the noble and learned Lord, Lord Falconer, said about his opinion to the effect that, at the moment, the law on this issue is being abused. I remind him that one of the issues that arose out of that inquiry—incidentally, our report was accepted by this House—related to an amendment, which had been tabled earlier on this Bill, about the law relating to the offence of murder. The Home Office reported to us 23 cases where a family member had administered a fatal dose of medication to an individual with terminal illness because of their belief that they were assisting that person and that their motives were merciful. In all but one of those 23 cases the law was, in a sense, not accepted because each one should have been accused of murder. However, in every case but one, the offence was changed to one of attempted murder or manslaughter, because everyone knew that the motive was merciful and that, in consequence, no jury would ever be likely to convict. It was for that reason that we recommended a change in the mandatory life sentence, but that is another issue entirely. However, the law was, in our opinion and at that time, being abused and not accepted. I turn to the issue of assisted suicide. Ludwig Minelli, who runs Switzerland’s suicide facility for overseas visitors, is something of a fanatic. He has made no secret of his view that suicide is a marvellous opportunity for a human being and that he regards safeguards as unnecessary. I believe that Parliament would be abdicating its responsibility for the safety of British citizens abroad if it were to pass this amendment. Look at the cases that have gone to Dignitas in Switzerland. They include individuals with cauda equina syndrome—weakness in the lower limbs—individuals with inclusion body myositis, and a whole series of people who have been put to death in that so-called clinic, which is not really a clinic, when there was no evidence that they were suffering from a terminal illness. I turn to the point that the noble and learned Lord raised on safeguards and the issue of getting two medical practitioners to confirm that these individuals were of sound mind and could make this declaration. We all remember what happened to the Abortion Act as regards the requirement that two doctors should confirm that the individual was suffering from a disorder such that the continuation of the pregnancy should not be allowed. What about the qualifications of these doctors? Any regulation or law of that kind must surely prescribe in detail the nature of the medical people who would be called upon to certify these cases as being appropriate to travel abroad in company with a loved one. Another issue came out of our report 17 years ago—I appreciate that in many respects the opinion of some Members of this House have changed and that the attitude of some members of the public may have changed. However, one of our major recommendations was that the facilities for palliative care for people in terminal illness should be vastly improved. Palliative care has changed out of all recognition. As a consequence of the law legalising euthanasia in the Netherlands, where we visited and saw that more than 1,000 people a year were being put to death by euthanasia when they were not capable of giving or withholding consent—the consent was given by others—there has been a decline in palliative care. In this country it has been extended considerably. Palliative care is provided not just by hospices but by doctors who are fully trained in general practice to administer palliative care. I believe that the situation is such that everyone in a terminal illness can be entitled to and can receive a quality of medical care to help them to die well. I end with a quote from one of the papers I have received: ""If I were asked whether I would prefer to receive high quality palliative care in a terminal illness and would be enabled in the UK to die well, or whether I would rather go to Switzerland to be killed, I have no doubt which choice I would make"."