My Lords, with the leave of the Committee and with the agreement of my noble and learned friend Lord Mackay, I shall speak to Amendment 10 under the new regulation that we have. With that amendment, I would probably include Amendments 52, 164 and 170. When I left Cumbria, Amendment 70 was included in that grouping but it was moved while I was on the train. Before speaking further, I should perhaps declare an interest since, as I told your Lordships at Second Reading, I was co-founder of St Mary’s Hospice in Cumbria more than 20 years ago and, although I retired some two years ago as chairman of the trustees, I maintain my involvement as the patron. I have no professional qualifications in the field of palliative care, but my close association with a hospice over a good many years has done much to crystallise my thoughts on the matters under discussion in your Lordships’ House today. We have heard many deeply moving personal experiences, and of course I have my own, but nothing has moved me so much as witnessing not only the physical and mental relief of patients of the hospice but the sense of pure joy that the hospice movement sometimes brings through acceptance and the general level of care.
I feel sure that it is a view shared by both sides of this debate that anyone who is provided with assistance to end his or her life must understand clearly what he or she is doing; that much is surely beyond argument. However, as with many other aspects of the noble and learned Lord’s Bill, there is a significant gap between saying what should happen and putting in place provisions to ensure that it does. It is to fill such a lacuna in the Bill that I am proposing these amendments. Many of the arguments have been covered by my noble friend Lord Howard.
For a fully informed decision, the Bill as it stands requires simply that a person seeking assistance with suicide must be,
“fully informed of the palliative, hospice and other care which is available”.
But what does that mean? It means no more than that the doctor assessing the request must explain to the applicant for assisted suicide what the various end-of-life care options are. Such a doctor may well know little of what modern palliative care has to offer. It is a medical speciality that is making huge advances year by year, and it is unlikely that even a good doctor, with limited experience of end-of-life care, will be able to be sufficiently acquainted with the subject.
There is also a world of difference when making a decision between being told about something and having had first-hand experience of it. I offer this quote from the report of the Select Committee which, under the chairmanship of my noble and learned friend Lord Mackay, 10 years ago examined the Assisted
Dying for the Terminally Ill Bill of the noble Lord, Lord Joffe. The committee’s report recorded evidence from Help the Hospices, as it was then called, as follows:
“Experience of ... pain control is radically different from the promise of pain control, and cessation of pain almost unimaginable if symptom control has been poor. On this view, patients seeking assistance to die without having experienced good symptom control could not be deemed fully informed”.
Specialist palliative care embraces the holistic care of the individual and those around them, considering not only their physical or medical symptoms, such as pain, vomiting or breathlessness, but also their spiritual, social and psychological needs. When distressing physical symptoms overwhelm a patient, they cannot see beyond the pain, the breathlessness, the anxiety or the vomiting. Effective symptom management enables a person to re-emerge and function once more, and to make informed choices regarding their future. Without such experience, my contention would be that the applicant’s capacity to make informed choices is seriously impaired.
The chief executive and the medical director of the hospice of which I have the privilege of being patron do not, as far as I am aware, take a position either for or against the Bill. However, they agree with this amendment and have this to say:
“We see every day how very limited is the understanding and knowledge of Palliative care services among both patients and professionals. Most people resort to these services only when they have a need of them”.
This view of course contradicts that expressed earlier by the noble Baroness, Lady Murphy, earlier in the debate.
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There is still in some quarters a residual perception of a hospice as a sort of enhanced care home licensed to drug patients to the point of insensibility. Even in your Lordships’ House, I make no apology for repeating the very important fact that here in Britain, many people, including the noble Baroness, Lady Finlay, are pioneering a highly specialist care model which I would guess is world-beating—a point also made by my noble friend Lord Howard—and it continues to forge ahead. Progress is made daily in such areas as the enhancing the effectiveness of morphine through the use of co-analgesics, nerve blocks and new drugs. I could go on. Palliative medicine aims to combine sound medical science and exceptional attention to symptom control with the art of giving people support, hope and the ability to plan their future with their illness.
This is the background against which I propose that if a person seeking assistance with suicide has not previously had a consultation with a specialist in palliative care, he or she should be referred for such a consultation. This will ensure, apart from anything else, that the person seeking assistance with suicide will hear about end-of-life care options from the experts in that area of medicine rather than from the attending doctor. The attending doctor referred to in the Bill is very unlikely to be such an expert, given that 90% of palliative care practitioners are opposed to physician-assisted suicide. An important element of such a consultation is to give the patient an opportunity to
hear how modern pain relief and symptom control work. There is a considerable mythology surrounding this subject, with many people believing that increased dosages of pain relief put a patient’s life at risk and that terminal illness therefore means increasing pain. This is simply not the case in modern palliative medicine. While it is not possible to give an absolute guarantee of pain relief in every case, proper palliative care can in most cases reduce, if not eliminate, the pain of terminal illness without any risk to the patient’s life. A terminally ill person contemplating suicide needs to hear this, and to hear it from an expert in this field of care.
A palliative care referral will also give the applicant an opportunity, if he or she wishes, after discussing end-of-life care options with a specialist, to request a course of palliative treatment to ascertain whether that, rather than suicide, would meet his or her needs. Some may well say, after experiencing such treatment, that they still wish to proceed with assisted suicide. So be it, but if even just a handful change their minds, the exercise will not have been in vain.
I recognise that this is another step in the assessment process and that some will argue that it adds to the burden of ending one’s life, but it is crucial that any such decision is fully informed. Even in Belgium, whose euthanasia law has raised serious concerns, there is provision for hospitals to insist on such a palliative care filter, as it is known. In fact, where Belgium is concerned, noble Lords might care to note that well over 90% of requests for euthanasia in that country vanish when applicants experience the palliative care that they need.
I recognise also that specialist palliative care is not evenly available to everyone in this country, but I feel, given the gravity of what is being proposed here, that it is incumbent on us to ensure that a fully informed decision means something more than just a chat in the consulting room of a doctor who, as likely as not, lacks an appropriate level of expertise in end-of-life care. This amendment in its own right has the potential to bring relief to many who face physical and mental anguish, but it goes further: it provides a vital safeguard that certainly needs to be a feature of the Bill.