INCURABLE PATIENTS BILL [H.L.]

HL Deb 12 February 1976 vol 368 cc226-301

4.49 p.m.

Debate resumed.

Lord WELLS-PESTELL

My Lords, we all listened with close interest and attention to what my noble friend Lady Wootton had to say in support of her Bill. I shall not pay tribute to her sincerity that has already been done— because I doubt whether there are many, if any, Members of your Lordships' House who are held in higher respect than is my noble friend. We know from past experience that she holds her views very sincerely.

The declared main purpose of the Bill, as I understand it, is to protect incurable patients from avoidable suffering and to strengthen their rights. The principle behind the Bill—that the disposal of his life is, in the extreme circumstances specified, a matter for the patient alone—is something on which an individual's own conscience must decide. Your Lordships will no doubt think hard and carefully on this crucial matter. However, leaving aside the essential decision, we still have to look at the practical consequences of the Bill and it is to those that I propose to address my remarks.

The Bill needs to answer four questions. First, does the right to which it refers need strengthening? Secondly, could such extended rights be adequately codified? Thirdly, might not such legislation impose new and unwelcome pressures on the very people it is designed to protect? Fourthly, are the problems of ethics and implementation which might face the caring professions most involved, acceptable?

The view of the Government is that, as it stands, the Bill does not fully meet these points, as I will endeavour to make clear as I proceed. In addition, there are practical considerations that make it undesirable for the Bill to be enacted in its present form even if its basic proposals were to be accepted. As these questions are intertwined in each aspect of the Bill, I feel that I can best explain myself by examining the Bill clause by clause.

The first clause provides that an incurable patient shall be entitled to receive whatever drugs will give him full relief of pain and physical distress, including being rendered unconscious if no other treatment is effective, even if he has refused intensive care or any other life sustaining treatment. My noble friend Lady Wootton of Abinger dealt with this very carefully but I believe that such a provision is unnecessary as it does no more than reflect what I and many other people believe to be existing good medical practice. I expect it has been included in the Bill in an attempt to remove the anxieties some doctors feel about drastic measures to relieve pain when these may shorten life. If that is so, it may well prove counter-productive, because in attempting to clarify the law one risks unintentionally restricting the doctor's clinical freedom by drawing clear lines between what is not legal as well as what is. In fact I do not think that at present a doctor would be prevented from doing all that the clause seeks to empower. The crucial fact here is that any conscious, sane patient is, at the present time, entitled to refuse any item of treatment to which he objects. Doctors, too, already have a professional duty laid upon them to try to control pain as best they can. I think it is also fair to say that this is accepted as a proper course of action even in those cases where such measures may hasten death.

Clause 1 makes a specific reference to providing a right to be rendered unconscious in the pursuit of pain relief. Given the clinician's duty to which I have just referred, the production of unconsciousness or not seems irrelevant, even if this state could be satisfactorily defined. The difficulty which there would inevitably be in defining unconsciousness to the satisfaction of all highlights a problem which this Bill repeatedly presents, perhaps inevitably, given its emotive subject-matter —the problem of defining terms in a generally acceptable way.

Taking only this clause, how can such words as "intolerable" and "distressing" be objectively interpreted? What is intolerable for one person may be only distasteful or irritating to another. Moreover, the Bill makes no provision for restricting such terms to physical suffering, so presumably mental suffering would qualify for relief also. Both these examples point to the conclusion that the only arbiter is to be the patient himself, however unbalanced, depressed or simply mistaken he may be in judging his own condition.

These represent only two of a number of such difficulties. Although it is not my intention to catalogue them all, I should like to point out one more because it is the word which stands at the centre of the Bill, the word "incurable". Could there be general agreement on what constitutes an incurable condition? Surely, there is now an almost endless series of cases in that grey area between curability and incurability, a grey area that is continually shifting as medical knowledge improves. To take a quite straightforward example of the difficulty, in the case of an incurable and ultimately fatal disease where substantial remission is possible, is the patient to be regarded as incurable for the purposes of the Bill?

I should like to refer to two other points that I feel would cause problems, before passing to the later provisions of the Bill. First, Clause 1(2) refers to the patient's attendant physician, implying only one person being involved, and that he has overall charge of the patient. I am aware that my noble friend Lady Wootton of Abinger, during the course of her opening, said that it might well be necessary to have two. In fact in hospital care and supervision will generally be shared among several doctors, and a number of nurses, too. If the Bill were to progress, account would have to be taken of such a problem, by specifying a clearly indentifiable physician or physicians.

The second point I wish to make refers to the misuse of drugs legislation, whose control is based on the clinical discretion of the doctors attending the patient and the entitlement to receive drugs provided by Clause 1(1). The relationship of the Bill to this legislation would need to be clarified in order to avoid conflicts, for there would certainly be cases where overriding the physician's discretion to prescribe drugs could lead to serious abuses.

I am rather unclear about the purpose of the second clause. The provision of Clause 2(1), that an incurable patient who takes his own life shall be deemed to have died by misadventure would do no more than perpetrate a legal fiction. This point was raised by the noble Earl, Lord Cork and Orrery, but, if I may say so, I am putting the point of view of the Government. Presumably the only reason why self-deliverance in these circumstances should be treated differently from any other suicide would be to exculpate the person who supplied the drugs or abetted the suicide. If this is so, it could involve exposing the seriously ill to intolerable pressures from those who might be better off without them. The whole vexed question istied up with the Suicide Act of 1961 across which this Bill cuts, directly but inexactly. Section 2(1) of that Act makes a person who aids, abets, counsels or procures the suicide of another, or an attempt by another to commit suicide, liable on conviction to up to 14 years' imprisonment.

It may be argued that if a patient chooses to take his own life it is not unlawful and therefore others should not interfere. However, there are legal, ethical and humanitarian reasons for not accepting this. On the legal count, it has been held that in certain circumstances health authorities are liable to very substantial damages when potential suicides have succeeded in only sustaining permanent injury. On an ethical count, some doctors and nurses would undoubtedly have conscientious objection to this provision. But even more worrying, to punish a doctor for attempting to preserve life seems to be totally unacceptable and against all the ethics of medicine.

The humanitarian problem lies in the fact that a suicide does not always take place in total isolation. Even the most thoroughgoing supporter of the principle of this Bill would have to accept that from time to time there would be violent attempts at self-deliverance. If doctors and nurses were debarred by law from intervening, considerable distress would be caused both to them and to any patient spectators, not to mention the possibly mutilated unsuccessful suicide. At present, a doctor or nurse faced with such a case could intervene and subsequently seek to ensure that treatment concentrated on establishing peace of mind rather than prolonging life.

I have two other more mundane difficulties concerning Clause 2 as it is at present phrased. First, the declaration that, "any interference …shall be unlawful", does not create a criminal offence for enforcement purposes and there is no provision elsewhere in the Bill making it so. Secondly, for the provisions of the clause to operate, it would be necessary for the relatives, nurses and doctors involved to know both of the patient's wish and of the patient's incurable status under the Bill. Detailed administrative arrangements would have to be evolved to cater for this, if it could be done. The final clause of the Bill is presumably intended to make it easier for doctors to discontinue treatment, since to treat a person against their declared wish could be an assault.

My Lords, I accept that the problems posed by the brain-damaged patient who is maintained by mechanical means are very real. There are questions to beexamined and answered and this is an area at which the medical profession must look—and are doing so—long and hard. The chief medical officer of the Department of Health and Social Security has asked the Royal Colleges to examine the concept of brain death and I hope that it will prove possible to issue meaningful advice. I feel that such advisory measures are more appropriate and, indeed, more helpful than legislation. Otherwise my objections to this clause are largely repetitions of those I mentioned earlier.

On the question of definition, what does degeneration, for example, signify? Is the process of ageing itself not a sort of degeneration? On the question of the signed statement, the Bill does not indicate what should happen in cases where a statement was known to have been made previously but could not be found at the crucial time. I am also rather puzzled about what would happen if a patient changed his mind, and the means by which the statement should be brought to the attention of the doctors involved. Would there be a central register, or perhaps a card carried by the patient? It could be argued that these are matters of detail.

Baroness WOOTTON of ABINGER

My Lords, if the noble Lord, Lord Wells-Pestell, will allow me to interrupt him for a moment, I think the points he is now raising are covered under Clause 3(3), which allows the appointment of someone like an executor under a will, whose business it is to call attention to the declaration.

Lord WELLS-PESTELL

My Lords, I shall accept that from my noble friend Lady Wootton of Abinger, but, as she will appreciate, there are difficulties in relation to the production of it and the possibility that the declaration could not be produced at the appropriate time. At any rate I think everyone would agree that it would be essential not to place any onus on a doctor to find out if such a statement existed, before instituting lifesaving treatment. Finally, as with the self-deliverance clause, there is the disquieting problem of external pressure possibly being put upon people to sign a statement which, left to themselves they would not have signed.

The problems to which I have referred are far from being exhaustive, but your Lordships may find them sufficient to show that the Bill as it stands is largely unnecessary, in certain respects undesirable and in some respects unworkable. I know that my noble friend Lady Wootton has specifically disclaimed any association of the Bill with euthanasia. She mentioned it quite properly. It was also mentioned by the noble Earl, Lord Cork and Orrery, and I know there are a number of your Lordships who are thinking of the Bill in those terms. Certainly, it has been referred to in those terms by people outside your Lordships' House.

Nevertheless, I think I ought to be perfectly frank and tell your Lordships of a correspondence which passed between my right honourable friend the Prime Minister and the late Cardinal Heenan. On 7th August of last year, in reply to a letter from the late Cardinal Heenan in which the letter referred to the possibility of legislation for the killing of old and incurable folk, my right honourable friend the Prime Minister wrote these words: Such a policy of euthanasia would be wholly abhorrent and there is absolutely no possibility of this Government—or I believe of any Government—ever giving it support". My Lords, I have tried this afternoon to demonstrate that legislation is unnecessary—I know that my noble friend Lady Wootton of Abinger will not accept that—and, if enacted, might cause as many problems as it solves. In addition to the obvious shortcomings in the drafting of the Bill, the Government have carefully considered this matter, and have given careful consideration, also, to the principles involved. They have come to the conclusion that they cannot support this Bill.

5.7 p.m.

Baroness YOUNG

My Lords, we have all listened with profound interest to the explanation of her Bill by the noble Baroness, Lady Wootton of Abinger, and to its Amendment explained by my noble friend Lord Cork and Orrery. I should like to begin by saying that I have great sympathy with the intentions of this Bill, for it is, I believe, a Bill to relieve suffering—and who can be against that principle? Indeed, no one who has watched someone suffering in the last stages of an illness or, indeed, at the last stages of old age, can be unaware of the great pain and suffering both by those who suffer directly and those who suffer because they are watching the suffering of someone they love and feel powerless to do very much at all. We all want to die with dignity and in peace, and it is something that we want for others.

This debate obliges us as well to consider the great issues of life and death, and to talk about death. We cannot often do this, for we have developed a series of euphemisms for death nowadays, talking only about terminal illness. Indeed, as a generation we are as reluctant to talk about death as the Victorians were to talk about sex. Yet death is a fundamental fact of life. Thinking people want the opportunity to talk about this fundamental principle, to think through their beliefs, and to decide whether the fundamental principles which have governed our lives for centuries should be altered in the light of present-day conditions, or, if they still hold good, why they still hold good. This Bill gives us this opportunity, and for this reason, too, I believe we should be grateful to the noble Baroness, Lady Wootton, for bringing it to your Lordships' House.

On my part, I feel some diffidence at speaking at all, as I am neither a doctor, a lawyer nor a theologian. In the society of today, with its very rapid changes in the practice of medicine, the techniques for the relief of pain, and the definition of death itself, it is necessary for each individual to think through his own belief. I should like to make it clear that the views I express today are entirely my own. In view of the large number of speakers, I shall deliberately keep my remarks very short, although the more I study the Bill the more I believe there is to say about it. I hope the noble Baroness, Lady Wootton, will realise that it is time, not care and thought, which is preventing my saying as much as I would like.

Turning to the Bill, in particular to Clause 1, it would seem to me—and it so seemed, I think, to the noble Lord, Lord Wells-Pestell; I was most interested to hear what he had to say—that, on the best advice I can get, Clause 1 is an attempt to legislate for good medical practice. The question to be asked is: Will this legislation, and in particular Clause 1, help to relieve suffering? Of course, no patient ought to suffer unnecessarily, but it would seem to me that what is needed is far greater medical skill spread among far more doctors and nurses, more pain units—that is units specialising in the treatment of pain—and more qualified staff.

A community physician with whom I discussed this Bill gave me what he believed to be a quite typical example of what might happen with a person who was suffering. The specialist had offered a certain amount of a pain-relieving drug to be given at intervals, and this was done. In the middle of the night the patient suffered more, and the nurse on duty looked at the instructions and carried out to the letter what the specialist had advised. It might well be that the patient ought to have had more, but would Clause 1 make this possible? After all, the nurse on duty could only do what she was asked to do by the specialist. The answer to that, surely, is more training, both for the doctor and for the nurse, and better specialist care in hospitals. I believe it to be true —and I shall be most interested to hear what the doctors have to say when they speak on this Bill—that if the best help was available to all, almost all suffering could be relieved. At present any patient is entitled to drugs in sufficient quantity to keep pain under control. The tragedy must be that this is not always what happens to patients. Nevertheless, the question needs to be asked: Would Clause 1 make this possible? I find it difficult to believe that it would, and if that is the case it seems to me that Clause 1 is unnecessary. I would go further and suggest that it could be harmful, because I believe that the attempt to legislate for good medical practice could indeed undermine the trust between doctor and patient.

But I should like to look at a further practical side and ask: If this Bill became law who would be responsible for enforcing this clause? Who would decide when pain was intolerable, and for how long the pain should be intolerable before something was done about it? But, above all, on this matter I am an optimist. All politicians have, in the nature of things, to be optimists, but perhaps over medical practice we have more reason to be optimistic than on many other subjects. For surely, some of the greatest advances made in the 20th century are in the practice of medicine. We, as a generation, are indeed fortunate that we have so little physical suffering in comparison to our forefathers. Modern developments in medicine mean that there is less and less physical suffering; not that all is ended, but that there is less than there was. It does not seem to me that this piece of legislation will produce any more money for more doctors, any more money for more research, either into illness or the relief of pain; nor will it provide better hospitals, and ultimately that is what is needed in order to relieve physical pain of this sort.

Turning to Clause 2, my concern here is of a different order, because it seems to me very difficult to write into legislation something which is not true. To say that a person who has caused his own death has died by misadventure must, surely, not be a true statement, for that person has killed himself deliberately. To go further and to say that it is unlawful for a doctor or any other person to prevent that person from taking his own life not only comes between the professional judgment of the doctor and the patient, but must surely put an intolerable burden on those who are caring for the person; and I think in this instance particularly of the relatives of a patient who may be looking after him at home.

I am not sure that Clause 2 is intended to be—as I understood the noble Baroness, Lady Wootton, to imply, if not to state—a declaration that is a matter for an individual only. But I wonder whether this really is the case. Alas, sin is ever with us, and it seems to me that great pressures could be put on a person to end his own life, even if that person might not wish to sign such a declaration. It would put great pressures on the doctor. What advice would he give to a patient about his condition, knowing that if that patient knew that his disease was incurable he would take his own life, and that pressures might be put on him to do so?

Baroness WOOTTON of ABINGER

My Lords, if the noble Baroness would allow me to intervene, while this clause may be badly drafted, it does refer to a patient who has taken that course action taken by the patient. It does not deal with the prevention of that action; it deals with the action after it is taken, and it is intended to deal with the attempt at suicide, not with the prevention of suicide.

Baroness YOUNG

My Lords, I am very grateful to the noble Baroness for making that clear; but I am not quite sure that it invalidates my argument. After all, if one sees someone attempting suicide, I believe it would be one's duty to try to prevent it, even if one did not wish to do so.

Baroness WOOTTON of ABINGER

My Lords, this is dealing with someone who has taken a course of action, not someone who is proposing to take it or to attempt it.

Baroness YOUNG

My Lords, this is perhaps an argument that we should pursue at some other time. I still believe that even if they had actually attempted that course of action it would be right for someone to intervene to prevent it. Furthermore, I believe that there is a real possibility, if this Bill is enacted, that it could lead to the neglect of the patient, since someone might then ask for his life to be ended because he was suffering and others might ask for him to be put out of his misery.

If I may again be very practical, I was very interested to hear what the noble Lord, Lord Wells-Pestell, said about the implementation of this Bill. I tried to imagine the Government circular that would accompany it to explain the circumstances in which it was to be carried out. It seems to me that the drafting of the advice which would have to be given to doctors and to health authorities, would be very difficult indeed. But it would not simply be advice to doctors and health authorities. Advice would have to be given to everybody. If relatives nurse someone who is very ill at home, even if this is relatively rare, the relatives would have to know where they stood in law and when they were acting unlawfully.

My Lords, most difficult of all must be Clause 3, for it seems to me, like Clause 2, to open up an entirely new concept; that is, the right of people to choose whether to live or to die. I believe that in many instances this option will itself cause suffering. Everyone would now have to ask himself the question: "Should I sign a declaration, if not because I particularly believe it, but (if one was an unselfish person one might say) for the sake of my family? I ought to sign such a declaration, even if my family would not wish me to do it. "We might think that our families would wish us to do it, or that it ought to become a new moral principle that we ought to do it. Then one would have to ask what would be its effect on those who would have to carry out the task. I do not wish in any way to be involved in discussions on the effects of the Abortion Act, but I believe it to be true that it is often distressing to young nurses and doctors. I cannot see that the situation under this Bill could be anything else but deeply distressing in some circumstances to those who would have to carry it out. I wonder whether one has a right to put this kind of pressure on other people.

Again, who would enforce Clause 3? When it became law, could the family say: "Well, you did not allow so-and-so to die. You have broken the law". It could have most undesirable effects because statistics could be kept in different areas as to the numbers of people who had died under this Act, as, of course, medical statistics are kept of all other sorts of illnesses and operations, and so on. We could have the ghoulish situation in which some areas could become better known for this kind of death than others. The more one considers it, Clause 3 is certainly not for the squeamish. There is, indeed, a singular lack of definitions, and one of them seems to me to be on the question of "sound mind". I appreciate that this phrase is used in law, but I wonder whether it really means that an 18-year-old might make such a declaration, witnessed by two other 18-year-olds, or alternatively by an old person who might be confused at one time but perfectly lucid at another.

Above all, I believe that this Bill could well have the opposite effect to that which is intended. It could well increase suffering by offering options which at present do not exist, and it could increase suffering to those least able to bear it—the elderly. It seems to me that it could take away a major incentive to relieve suffering, because it could well be argued that resources of money and of medicine need not be used for improvements in the techniques of relieving pain because the techniques themselves would have become unnecessary. It could well interfere with the relationship between a doctor and his patient, and to attempt to legislate for what is good medical practice may cause some people to suffer more. After all, there are times when a doctor does not officiously strive to keep alive, but it is better not to put into legislation what they are.

My noble friend Lord Ferrers, who is very sorry indeed not to be here today, wrote to me a long letter indicating what he would have said had he been here. I should like to quote one paragraph from the letter: The administration of a drug to give comfort, or to relieve pain may hasten death. This is wholly different to giving, or refusing, drugs in order to terminate life. My answer to the reply 'lives are terminated now, make it lawful' would be this: what in law may be legally wrong may, in the totality of all the concepts of life, be justifiable, but to make that which in the totality of life may be justifiable become legally right is totally different. I think that he has made a very great and profound point there. If it is enacted, I fear that this is a Bill which could be used by the unscrupulous, and I regret to say that I believe that it would be the thin edge of the wedge to further legislation. Even if this is not a Bill strictly about euthanasia, it could lead to it.

I enjoyed, as I am sure we all did, Lady Wootton's amusing analogy about having a glass of wine at lunch. But perhaps the analogy is not quite right, because who is to say that if we were starting again we would believe that it was right for people to drink, because after all drink can cause a lot of evil. The fact of the matter is that we do it, and we have done it for hundreds of years, and we are unlikely to stop it. But if we are starting something completely new, when we have the opportunity to consider carefully what the consequences may be, this is the time to pause to say, "We really ought not to do it at all". I think this is the view that we should take at this time.

On considering this matter carefully, I shall vote for the Amendment of my noble friend Lord Cork and Orrery, but in so doing I believe that the Bill has certainly caused me, and I am sure many others, to think far more deeply about the question of dying and the relief of suffering than I would have otherwise done. I hope that the noble Baroness, Lady Wootton, will recognise that we all want to relieve suffering, and that we all believe profoundly that society needs far more care, skilled and compassionate care of every kind, than it has at present.

5.25 p.m.

Lord AMULREE

My Lords, I am sure that I am voicing the opinion of every Member of this House when I say that we entirely agree with the intention of the noble Baroness in bringing her Bill before us, but I feel, and have felt since I saw the Bill the first time, that the Bill itself is unnecessary and might possibly have dangerous effects. To start with a minor point, we do not really know what is meant by "incurable" except as something which the doctor is said to say. I have been involved for a very long time with the Royal Hospital for Incurables at Putney where we have people not, I admit, suffering a great deal of pain—that can be coped with, and is coped with—but suffering from the gravest disabilities and deformities. In all the time that I have been involved there, there has been no question at all of their wanting drugs to make death come, or to dispose of their disability or deformity.

It is now becoming more and more the practice in medicine that we know a great deal more about the management of pain and the treatment of pain, partly because drugs are used more intelligently and partly because the variety of drugs available is a great deal greater than it was. Reference has already been made to the work of Dr. Saunders at the St. Christopher's Hospice at Sydenham. I am pleased to be told that there are about thirteen or fourteen similar places working in the country where the same kind of work is being done and, what is more important, where teaching is being given to students and young doctors in the way to cope with pain.

The Earl of CORK and ORRERY

My Lords, may I intervene to offer a correction? I think the number is not 13 or 14 but 28 such places.

Lord AMULREE

My Lords, I did not know that it had gone up so far as that. I knew that there were quite a number. There is another way in which training and teaching is being done. I am involved in a large student group, called the London Medical Group which does work in the 12 London teaching hospitals. It carries out its work by means of voluntary lectures, voluntary seminars, and a big annual conference. Great interest is taken there by the young medical students and the young doctors in the management of pain and the relief of suffering in the care of the dying, if you care to put it like that. Therefore, a good deal of training is being carried on in that kind of way as well. The practice has now spread to quite a number of the medical schools in the country. Again, I am not very good at figures, as the noble Earl, Lord Cork and Orrery, pointed out, but I think that there are about seven or eight similar groups working in other medical schools in the country. That is why, although I am not at all complacent about the situation, the outlook for the care of such patients is far better now than it was some time ago.

Where it can also be dangerous, as has already been pointed out, is in a disinterested elderly person—and, shall we say, an interested relative—using pressure to have himself or herself declared in intolerable pain and, therefore, to be "put away", as you might say. Personally, I do not mind sometimes calling it "killed", just to be certain what one is talking about. I am not so sure about the value of changing the verdict "suicide" to "misadventure", because if a verdict of misadventure were to be brought in—and I think it was the noble Earl, Lord Cork, who said this—people might say, "We knew there was some- thing wrong there", and they would assume that it was a case of suicide.

I should not have thought that one would want to amend the Suicide Act to remove the penalty of 14 years' imprisonment for those who assist people actively to commit suicide because, again, that might be looked at wrongly by interested people.

I have some sympathy for the last clause in the Bill, because I think it is morally and ethically wrong to keep alive by artificial means somebody who has no possibility of a normal life. However, I am not sure that it can be done in this sort of way. I would leave it to consultation between the relatives and the doctors, and they should learn when to withhold their therapeutic hand and not try to keep somebody alive as long as is humanly possible. The purpose behind the Bill is admirable and it has been of great value to this House to have been able to discuss the measure and the points behind it. However, teaching, training and experience are better than law and, for goodness' sake! let us keep the law out of the relationship between doctor and patient.

5.32 p.m.

Lord RAGLAN

My Lords, I am happy to speak following the noble Lord, Lord Amulree, because we differ in what I might call degree but not in spirit. Nearly seven years ago I sponsored a measure called the Voluntary Euthanasia Bill. The word "euthanasia" has, it seems, acquired some unfortunate connotations; in many people's minds it means bumping off in a painless way somebody who is not particularly wanted. Certainly I was accused of wanting to do away with harmless old people and sometimes I would be told, "I agree that we should not allow handicapped children to survive."

One sees from these remarks how muddled people are about the purposes of a voluntary enthanasia Bill or a Bill of this nature which, as my noble friend said, is not, strictly speaking, a euthanasia Bill. However, Clause 8 of the Bill which I introduced had the same purpose as Clause 1 of this Bill, and the declaration referred to in my Bill had a similar purpose to the written statement referred to in Clause 3 of this Bill.

When the Bill which I sponsored was published it caused a great stir, one for which I was not well enough prepared at the time. There was a long debate in this House; there were articles, leading articles, radio discussions, books published for and against a Church of England investigation, no less. I was asked to give lectures, I took part in debates, I wrote articles, reviews and so on. I had much opportunity, therefore, to form opinions on the subject, some but not all of which it might be helpful to put to your Lordships; not all because I intend to make a short speech in view of today's list of speakers.

The adoption of stances which are firmly pro or anti has frequently obscured the issues, just as I know that there have been many misapprehensions, not to say misrepresentations, as to what my Bill was about and what this Bill is about. I am not so sure now as when I spoke to my Bill that it would have achieved what it set out to do. I say that not because I think its objectives were wrong but because I have come to the conclusion that it would have taken better drafting than any I have seen so far to produce an acceptably worded Bill. The same criticism could be, and has been, levelled at this Bill, but we are here discussing the principles of the measure and not the details of necessarily amateur drafting. But what I am sure of is that the very debate over this Bill—and my Bill—and the fierce discussion it has provoked has advanced the cause of its supporters by drawing attention to the very real deficiencies in care which so widely exist and of which my noble friend gave examples from her own knowledge. The discussion which this Bill has aroused is having the same effect as mine; the Bill's opponents are having to defend their position by bending their minds towards improving the state of affairs which the efforts of the Bill's supporters are directed to correcting and improving.

Extraordinarily little attention has been paid so far in our society to psychological understanding of the aged. We know a great deal more about babies than we do about the old, which is strange considering how little babies know. Gerontology is in its infancy; the science, if it is a science, of geriatrics is not a glamorous occupation. As for the care of the dying, perhaps your Lordships will be as astounded as I was to hear that, in something like half the teaching hospitals in London, including University College Hospital, there is still no education given on the care of the dying. This is the garden in which we are asked to believe that all is lovely and that if only we leave it to the doctors, everything will be all right. With respect to the noble Lord, Lord Amulree, who has done more than his share towards improving matters and has certainly very much helped me, it is partly because it has been left only to the doctors that it is not all right, for in doctoring as in other disciplines, which I shall not mention today, we suffer from time to time from the effects of the experts making their own rules and conventions and saying, in effect, that they are above criticism. They are not above criticism and what your Lordships are witnessing in this Bill is another attempt to change conventional medical practice by consumer pressure.

I have had the privilege of being taken round an establishment where the experts did not stick to the rules and are pioneers. I refer to St. Christopher's Hospice in Streatham which is run by Dame Albertine Winner and Dr. Cicely Saunders, mentioned by the noble Earl, Lord Cork and Orrery; they are both very splendid people. I do not know, but I guess that, if all other hospitals aspired to the standards of this hospice and were infused with its ideas and ideals, Clause 1 of this Bill might never have been brought forward. But it is not for my noble friend Lady Wootton to defend Clause 1; it is for its critics to set about demonstrating in a practical way throughout the country, in every hospital and home, why it is not necessary to pass it into law. It is not enough just to talk about good medical practice; we must do something.

Clause 3 differs from the major part of my Bill in that the word "euthanasia" is not mentioned, since the clause refers only to the refusal of life sustaining treatment and not to the administering of a lethal dose. There is, I suppose, a difference between cutting off a means of life and inducing a means of death; but I do not find it very clear, for both mean killing. If one accepts that good medical practice sometimes entails removing life-sustaining equipment, one inevitably accepts that good medical practice sometimes entails killing. I think that we must not shy away from facing that fact in those terms.

Of the written statement referred to in Clause 3, much has been said. It has even been called a death warrant and dear old Aunty Times which, Bill or no Bill, we all hope will go on for ever, yesterday called it a death warrant. In my opinion, no written statement can ever be more than an invitation to a doctor of a patient's preference at the time that that document was signed. The doctor would legally be required to take notice of it but there is no legal duty for him to act upon it if it is against his better judgment at the time, and nothing in any declaration that I have ever seen places on the doctor a legal obligation to withdraw life-sustaining support. May I read from paragraph 8 of the declaration which was attached to my Bill: I wish it to be understood that I have confidence in the good faith of my relatives and physicians and fear degeneration and indignity far more than I fear premature death. I ask and authorise the physician in charge of my case to bear these statements in mind when considering what my wishes would be in any uncertain situation. That is not a death warrant.

Broadly speaking, there are two kinds of supporter for a Bill of this nature. There are those of a kindly and merciful disposition who cannot bear to see suffering prolonged. As I have tried to indicate, I do not think that they are as foolish and ignorant as they are so often made out to be. There is a second group who, in my belief, are just as important, but who are usually left out of account. I have had the luck to know a large number of people who are vigorous, able and of a lively intellect—the sort of person one goes to for advice or for the sheer pleasure of their company. They enjoy their vigour and intellect and are proud of it. This is their life. They cannot bear the idea of being senile or being smitten ga-ga with a paralytic stroke, those of their friends who are left coming to see them out of a sense of duty and not for pleasure or instruction. Occasionally, I am sure, one or two of these strong-minded people arrange their own deaths, but others are liable to become afflicted before they can do anything—if, indeed, they ever wanted to do anything. But surely these people merit consideration. They do not want to be kept alive after their personalities have changed. These are the people who are most likely to want to sign a declaration. Partly, you may say, it would be a protest against frailty and old age, but principally they want to retain in their dotage some of the power to resist compulsory medication which, as my noble friend pointed out, they possessed when they had all their faculties.

I think that Clause 2 refers to the same kind of people, only in that case they would be presumed to know what they were doing. I would not venture to say whether the clause would encourage suicide or, on the other hand, would not discourage it. I think that my noble friend would say the latter. But here we are on ground where I would tread carefully. Once or twice I have been asked to defend the proposition that there is a right to die and I have refused, because our rights can be construed only in relation to the people among whom we live, and there are times when I would say that someone might have a duty to stay alive. But circumstances alter cases, and deliberately to withhold a means of suicide out of the mistaken principle that in no case should anyone be allowed to take his own life is, in my view, mere paternalistic busybody ness, to put it no higher than that.

We are discussing a subject which is very complex and highly emotive and it is one that is exceedingly difficult to discuss on the Floor of the House. Noble Lords who are uncommitted, if they sit through the debate and hear all the pros and cons, will still have many questions to ask at the end of it. I know I will, much though I have become acquainted with the subject. I think that the debate—which, if it is like the last one, is a very serious one indeed—will not clarify issues when there is so much forceful opinion on both sides. I should like to ask questions of both pro and anti.

If your Lordships will give this Bill a Second Reading, even though you may disapprove strongly of parts of it, or if you are in sympathy with some or all of its ideals but do not agree with how the Bill proposes to translate them into practice, or even if you think that it may not properly be a subject for the law at all yet believe that the matter merits deep investigation, I will move that it go to a Select Committee of your Lordships' House. I will do so because, first, I have the highest opinion of your Lordships' Select Committees as instruments for acquiring knowledge in a skilled, unbiased, unsensational and methodical way. Select Committees have no power to subpoena, of course, but they can ask for evidence and opinions from all who care to give them, including doctors and lawyers. They can meet in their own time and all the proceedings would be printed and published and could be studied at leisure. And after that your Lordships can act upon that evidence just as your Lordships please.

The other reason why I think that this is a subject eminently suitable for study by a Select Committee is that the very fact that a Bill of this nature (whatever your Lordships may have thought of me and my Bill) is being brought by someone so sane, intelligent, perceptive, able and undramatic as my noble friend, means that something is very wrong with regard to our care for the dying. It causes very deep worry and concern to many, many people. It needs investigation and correction. It really is too serious a matter to leave only to experts. Awkward though the subject may be, it is too important to brush under the carpet and pretend it is not there, which would be the effect of voting against the Bill tonight. I very much hope that your Lordships will give the Bill a Second Reading so that I may move that it go to a Select Committee.

5.49 p.m.

The Lord Bishop of DURHAM

My Lords, so many excellent things have been said in this debate so far that I am sure that, like myself, many of your Lordships who are to follow me as speakers are already mentally tearing up a great deal of what they were planning to say. I particularly wish to associate myself with many of the detailed comments made by the noble Lord, Lord Wells-Pestell, and the noble Baroness, Lady Young. I also wish, even at this late stage in the debate, to add my tribute to what has been said about the noble Baroness, Lady Wootton of Abinger, to express my sympathy for her motives in bringing forward this Bill, and to express concern about the abuses which it seeks to remedy.

I remind your Lordships that clergy, like doctors, have a particular concern with this area, and like those in the medical profession, we perhaps see more of those who might come within the category of this Bill than do most people. It so happened that during the past few months I myself have been very close to a person who might easily have come into this category—a young woman dying of cancer, who was seemingly unable to die. The illness dragged on for week after week, to the enormous distress of herself, the hospital authorities, and her family. Knowing that this debate was to take place, I asked myself, in that very real and practical situation, what effect would this legislation have on this woman's attitude towards her illness, and what kind of effect would it have on her family?

I came to the conclusion that, despite all the pressures, I would regret profoundly any legislation which could add to the burden of guilt and possible recrimination of people who took a certain action and then perhaps spent the rest of their lives—and I am referring here to the family wondering whether it was right, wondering whether such a person might, perhaps impossibly, have recovered after all. A fortnight ago I had the privilege of addressing a conference of doctors and nurses as part of a symposium on the care of the dying. This was part of a normal training programme in a large general hospital. As part of my remarks I gave the doctors and nurses assembled a brief resume of this Bill. The immediate reaction from one doctor was that this is a horrifying indictment of the medical profession. The more considered reaction of the symposium was that this was a plea to the medical profession to listen to symptoms, to listen to what patients are actually saying about fears, distress, pain and so forth.

I believe that this debate will do good if it is widely reported and makes the medical profession more aware now of the deep disquiet felt by many ordinary people about some cases. Having said this in partial criticism of the medical profession, I believe, as some of your Lordships have said, that awareness of the needs of patients in this kind of situation is growing; there is better education of doctors taking place; and the conference of which I was a part is a witness to it. I also note that recently a Working Party of the Council of Europe has made recommendations that there should be more discussion of this kind of issue and greater facilities for educating doctors about it.

There is also a great need for moral support and guidance for doctors in the exceedingly difficult decisions which they often have to make. The noble Lord, Lord Raglan, proposed a Select Committee—I am not very familiar with the actual procedures—but it seems to me that already a great deal is going on among ethical committees and groups of doctors. Mention has already been made of the London Medical Ethical Group. It was interesting in the conference to which I referred, and which, so far as I know was entirely unselected, that of 100 or more doctors and nurses not one single voice was raised in support of this Bill.

The noble Earl, Lord Cork and Orrery, referred earlier to the phrase "meddle-some medicine". I suggest that this Bill might be called "meddlesome legislation"; legislation which could do only harm by intruding a very blunt instrument into a very delicate area. I will not repeat some of the dangers that have already been mentioned at length. But we have many sad examples, have we not?, of the perpetual problems of liberalising legislation; of good, noble and sympathetic people who, for the highest motives, attempt to put through legislation which in fact brings new pressures to bear on the very people whom it is designed to help.

The noble Lord, Lord Raglan, referred to the small, strong-minded, minority who might be the beneficiaries of this kind of legislation. But, alas!, the very things which ease the lot of the small, strong-minded, minority always have widespread and unintended side effects. Several of your Lordships have been through the clauses of the Bill in detail and I will not weary you by going over the same ground. I believe that the deficiencies are not just in drafting. But before saying where I believe the main objections to it are to be found, I shall refer again to the genuine fears which underly it; the feeling that there are doctors waiting with a whole battery of techniques—with syringes and what-have-you—trying to keep miserable patients alive.

This is a subject which has been discussed now over a period of 10 years, and if any of your Lordships are unaware of it I should remind you of a report produced for the then Church Assembly, entitled Decisions about life and death, published in 1965. This made the fundamental point, which I believe is still valid; namely, that the right question to ask, from the medical point of view, is how far does one go in treatment; and the right point to recognise is that one goes so far and no farther. I hope that we shall not go on quoting the couplet, Thou shalt not kill; But needst not strive Officiously to keep alive as if it were some kind of commandment. As your Lordships well know, this is satirical. One could quote other couplets from the same satirical poem—for example, Thou shalt not covet But tradition approves All forms of competition", which no doubt would set your Lordships talking about other matters at great length.

The point is that we are concerned with good medicine, not with legal rights. In looking at the clauses of the Bill I should like to give two illustrations which perhaps highlight points already made. Under Clause 1(1) of the Bill, I wonder how one would exclude the drug addict who, in certain circumstances, might well be certified as incurable, who is certainly suffering from a distressing physical illness, and who might easily therefore demand unlimited drugs, and in terms of the Bill, be entitled to receive them. One can perhaps illustrate the ambiguities of the notion of incurable from the example of the patient who learns that he has multiple sclerosis. Here is a disease which is certainly incurable and which certainly causes great distress. Certainly in the first stages of discovering that one has the disease, one might well find the thought intolerable. Yet the very fact that the option of suicide or unlimited drugs is not open to a patient makes him come to terms with it.

In fact, those dealing with this kind of patient testify again and again to the way in which people can come to terms with that illness and are glad to have done so; and I believe that this Bill could undermine the will to tackle this kind of condition.

Now let me turn to the central point and say that I myself do not believe that this is a euthanasia Bill, and I very much hope that the debate will not extend into that territory. But it does introduce a new and potentially dangerous concept which is referred to in many circles as "the right to die". Perhaps I may spend just a moment or two trying to distinguish three senses in which that phrase is currently used, so that there can be no confusion. There is, or there could be claimed, the right to have one's life ended by another person. This is euthanasia strictly so called; and, at the risk of advertising, may I remind your Lordships of the extremely good report on this particular subject, which is to be debated by the General Synod of the Church of England the week after next, entitled On Dying Well. That is euthanasia. Secondly, by "the right to die" people mean the right to end one's own life, and this, it seems to me, is what Clause 2 of this Bill is about.

But thirdly—and this is where the confusion often takes place—by "the right to die" people mean the right to die in peace and dignity, and this surely is a right which exists already. If one endeavours to strengthen it by the kind of legislation proposed here, then inevitably one widens it to include, for some people, a presumed duty to die, because rights always have the dangerous propensity to turn into quasi-duties. This, I believe, is where the real harm of this Bill could lie: in the kind of pressures which it would put on people, the kind of expectations which it would arouse, both among society at large and in the medical profession, who in the long run would become conditioned to taking the easy way out.

My Lords, one final point about the third clause of the Bill.

Lord GEORGE-BROWN

My Lords, before the right reverend Prelate comes to that, perhaps he will allow me to interrupt him. I have just had to face this: a very dignified, very honourable, very distinguished man—my father—lying and dying in a most undignified way. It was not quite clear why the right reverend Prelate said—and I speak as an Anglo-Catholic—that one should watch the most undignified demise of a once very dis- tinguished man. It did not seem to me, if I may say so, that the right reverend Prelate really answered the question. I would myself have been ready to administer, not only the last rites but the end of his life. Would the right reverend Prelate just develop his thoughts a little further on that?

The Lord Bishop of DURHAM

I think all of us, my Lords, and probably from our own experience, can think of distressing cases of this kind, but (and I am afraid that it is a platitude) hard cases make had law. The point I want to make is simply that legislation to relieve individual cases of an extremely distressing kind, may be passed with the best will in the world. Whether it was necessary here in terms of good medical practice, I do not know; I will not judge. But, granted that there may be some cases of this kind which are still inescapable: nevertheless, if one legislates to make the quick way out possible, one is in fact creating profound social consequences which have all sorts of unintended effects on many people who were never envisaged in the original legislation. This is my point, and this is my main point.

As I was saying about Clause 3, on the face of it this is less objectionable, but some weighty arguments have been levelled against it. I would simply ask this question: In the case of those who did not sign some document saying that they did not wish to receive intensive or life-sustaining treatment, would a clause of this kind create a presumption that they did want to receive it? I am not sufficient of a lawyer to know, but I would at least wish to express this fear. I would conclude by repeating that this Bill deals with real fears and abuses, and I therefore hope that the medical profession will take very careful note of this debate. Legislatively, I believe it could be a disaster, because it is not a marginal affair dealing with a few hard cases and with relieving the condition of a minority. It deals, as the noble Baroness, Lady Young, said, with one of the most profound and important facts of life; namely, the fact of death—and beliefs, attitudes and assumptions about death have an enormous effect on the society which holds them.

Recently, a fascinating work has been written by a certain James Dunn called The City of the Gods, in which he has tried to write a history of civilisation in the light of people's attitudes towards death; and I would suggest that this might be a document well worth study by those who are concerned to legislate in this area. I would simply say that it is no light matter to legislate about death; but we may be thankful for this Bill, which has brought the matter into the open, and we may be thankful for much that is already happening in medicine to make this kind of Bill unnecessary. Our debate will, I hope, encourage the better education of doctors and their better moral support in the extremely difficult decisions which they have to make, but I trust that we shall allow the Bill itself to go no further.

6.8 p.m.

Lord HUNT of FAWLEY

My Lords, the noble Baroness, Lady Wootton, feels as I do about the need for more to be done for patients with distressing and incurable complaints. Like every other speaker, I am full of sympathy for the compassion which has prompted her to bring this Bill before us today. It has made us all think hard once again about the extremely difficult, emotive and complicated problem of ensuring for everyone a quiet and easy death; and the means of procuring this", which is the Shorter Oxford Dictionary definition of "Euthanasia"; and I agree with what my noble friend Lord Cork and Orrery has said, that we cannot accept that this Bill is not about any type of euthanasia.

I agree with the noble Lord, Lord Raglan, that in the past there has been considerable confusion over this term, which has now been in use in our country for more than 300 years. I believe that we shall think more clearly about it in future if, when it is used in any context other than "quiet and easy death", it is always qualified: "natural euthanasia", as when an old lady dies peacefully in her sleep or after being unconscious for some time, as most people die; "voluntary euthanasia", which is suicide, or complicity in suicide, which is manslaughter; and "enforced euthanasia", which is murder as our law stands at present.

It is with the second of these divisions of euthanasia, voluntary euthanasia through a signed statement, with which I believe this Bill is largely concerned. The border-line is ill-defined between natural euthanasia (helped by drugs for severe pain or discomfort) and enforced euthanasia as we have described it. Almost every doctor must have been worried at some time or other as to how much of a drug he might, without breaking the law, give to a dying patient to relieve discomfort and distress. Forty years ago Lord Dawson of Penn said in this House: Surely, in such cases, our duty and our privilege is to do what we can to make that passage between a painful illness and the inevitable end as gentle as we can."—[Official Report, 1/12/36; col. 481.] In 1960 Sir Patrick Devlin, a famous judge, now Lord Devlin, speaking to the Medical Society of London in a lecture on "Medicine and the Law", agreed with this; and he added: The deliberate acceleration of death must prima facie be murder… Where I, as a family doctor, differ from the noble Baroness is that I believe good doctors now already do, as they have done for centuries, the things which are essential to achieve a quiet and easy death for their patients without contravening our present laws by entangling themselves in the second and third types of euthanasia. These, according to our present laws, can so easily become involved in the criminal offences of complicity in suicide and manslaughter. Better training is needed of medical students, young doctors, nurses, priests, health visitors, and social workers in how to help nature achieve a gentle and painless death for everyone. Such training is being carried out so well now in St. Christopher's (under Dr. Cicely Saunders) and St. Joseph's Hospices, and in about 50 others like them which are already working (or are planned) in enlightened medical schools, and in many other places by various medical groups around the country largely run by students, and by organisations for cancer relief medical and religious. More geriatric hospitals are needed and more research. I am quite sure that very few seriously ill patients, even those with generalised malignant disease, need suffer severely, now, from intolerable pain and distress if they are properly treated.

My Lords, to turn to the details of the Bill that we are discussing. Many of us doctors disagree profoundly with the suggestions made in Clauses I and 3 about the premeditated drugging of some of our incurable but not necessarily dying patients, up to the point of unconsciousness which might, quite often, lead to death. We are horrified at the suggestions about suicide in Clause 2. As an example: a pretty young girl is badly scarred and maimed in a car accident and her engagement is broken off because of this. She is seriously thinking of suicide because of her incurable and intolerable physical disabilities and distress. If someone finds her half out of a fifth-floor window and encourages her to jump, or pushes her out, she would be deemed (according to this Bill) to have died by misadventure (or "ill luck" as my dictionary defines that term). Any attempt by her mother, father or doctor to dissuade her from jumping or to pull her back into the room would be unlawful and liable to be punished, if this Bill becomes law. It would be hard to think of anything much more extraordinary than that.

Through the kindness of your Lordships' librarians, who made me photocopies, I have read carefully through the debates on euthanasia which took place in this House in 1936, 1950 and 1969. I was a little surprised that in only the last of these were Arthur Hugh Clough's words in a poem on the Ten Commandments, written more than a century ago, quoted; and then by Lord Brock: Thou shalt not kill; but need'st not strive officiously to keep alive. No Christian teaching urges us to prolong life at all costs. Some years ago when my eldest son, then my only son, aged 5, was dying of leukaemia, uncomfortable and being sick, the specialist said that he might live a few more weeks if he was given a blood transfusion. My wife and I decided not to prolong his unhappy little life in that way; and I am sure we were right.

Other doctors will speak today from their experience as specialists. For myself, over the years I have cared for many incurable and dying people, both in hospital and in general practice. More than half a million people die in Britain every year and about half of these deaths occur in patients' homes or in the houses of their relatives and friends. A family doctor, as I am now, is in contact with patients throughout long illnesses and is often left responsible for terminal care, in their homes, when specialists and hospitals can do no more. Looking after such patients is never easy.

I had one middle-aged woman who was ill at home for many months with a generalised muscular weakness which grew steadily worse until she could not move a single muscle in her limbs, nor speak. But she was comparatively comfortable and was being well-nursed. Her relatives said to me one day that they could not stand it any longer. "Why can you not give her an injection, doctor, and put her at rest?" I replied, "There are four of us here; any one of us can put a pillow over her face and she will be dead in three minutes." They said, "We could not do that; it would be murder." I told them "Neither could I. If I gave a large injection to kill her in a few minutes that would be murder, too." They understood and did not mention the subject again. This patient died a few days later of respiratory weakness, having been given enough small injections to keep her comfortable.

Many families, particularly those of the Jewish faith, feel that they have special responsibilities to support and care for those of their members who grow old and frail and ill. We are told that there are about 1 million old people in Britain now about one-fiftieth of our total population—who live in single rooms and seldom, if ever, leave them. Many of them say: "This is no life, doctor. I don't want to live much longer." But, paradoxically, they do not want to die, either. Few of them attempt suicide, or refuse food, antibiotics or operations. With what seems extraordinary tenacity, some of them cling to life and some may say. "I must wait until I am called, doctor".

I look after one old lady who has said this sort of thing to me many times over the past 26 years. She is now 103 and remarkably bright, tough and aggressive for her age. She is in no pain or great distress; and she is liable to hit, even to bite, anyone who comes near her with a syringe! Very few doctors, nurses or relatives want to assume or usurp the role of the Almighty and be personally responsible for the death of these old folk, however incurable, difficult, tiresome, crippled, incontinent, mentally confused, blind or deaf they become. Many of them have lived, and perhaps fought, through two world wars; have survived the blitz and the 1929 to 1931 depression; have done good work and have brought up their families under, perhaps, difficult conditions. At the end of life they are dependent on others, as they were at the beginning. I feel that it is our duty to look after them and keep them as happy and comfortable as possible.

At the other end of the scale are the children with severe birth injuries or gross deformities—tragic problems which we doctors and their parents solve as best we can. They are not mentioned in this Bill. Will parental consent take the place of patients' consent? To illustrate some of the difficulties. Not long ago one of my newly-married patients had a "blue baby" which we put into an oxygen tent and sent to a teaching hospital for investigation for a possible hole in the heart. Tests showed that its heart was sound but it had too little lung to survive on this planet outside an oxygen tent. There was talk of a possible lung transplant later. so we were not sure that it was incurable. It remained in that little plastic oxygen tent for a year. It had its first birthday there with its toys. The parents visited daily. The nurses and doctors became fond of it—it was a sweet kid—and no one would turn off the oxygen. A short while later it crawled out of the tent one night and was found dead beside it—a merciful release without any guilt felt by the parents, doctors or nurses.

Under Clause 1 of this Bill, a man who is totally blinded and finds that he has also lost both his hands in a severe accident, might easily feel, at the time, that his world had come to an end; that he had nothing more to live for and would welcome an easy way to die. Clause 1 of this Bill makes such a man, with seemingly incurable and unbearable physical disabilities entitled, with his consent, to be given drugs to give him full relief and even to make him unconscious until he will surely die. I happen to be on the Council of St. Dunstans. In October 1971 I dined in the Dudley Hotel, Hove, near Brighton with 12 such men and two women—some of the 21 handless St. Dunstaners—all blind with no hands. A more cheerful and happy dinner I have seldom attended. Most of them were married (their wives and husbands were there), many had children. All were doing jobs. One who was very deaf too, with a hearing aid, could not come to the meeting before the dinner because was too busy in his travel agency taking messages and bookings!

Just after being wounded, any one of these men or women, with such terrible disabilities, could easily have been persuaded to agree to his or her life being ended and to accept a gentle and easy death. What this Bill does not take into account are the marvellous results of encouragement and modern rehabilitation, the wonderful resilience of the human spirit and the courage of people to overcome even the worst disabilities in a truly heroic way. They come to terms with superadded depression and with troubles which are at first truly intolerable. This does not apply only to accidents. A young or middle-aged person developing bad multiple sclerosis, or an old lady with severe rheumatism or paralysis, may feel hopeless and wish to die at one stage of the illness; but, as morale improves, they may adapt themselves remarkably well and, later, have second thoughts about wanting to end their lives. All such patients need protection and much encouragement at the height of their illnesses and in the depths of their unhappiness and distress; rather than someone suggesting to them, as one of their options, that they could sign forms giving permission for them to be given large doses of drugs. Many suicidal attempts, even in the presence of incurable disease, are cries for help rather than for termination.

I shall do no more than mention how difficult it is, sometimes, to say that a condition is really incurable. Illnesses which were hopeless a few years ago can now be put right, as with some cases of leukaemia. Medical diagnosis is not infallible. I heard of a man who jumped out of a window after being told he had cancer. The post-mortem showed no malignant disease at all. Another point about Clause 1. Who will give the injections if the doctors and nurses are unwilling to do so on ethical or religious grounds? Will each district and each district hospital have its own mercy doctor? How will he or she be protected from prosecution under our present laws of manslaughter and murder? Or will it be suggested that these laws be changed first? Will young doctors not be appointed to the staffs of hospitals, or to partnerships in practice, if they are unwilling to act in this capacity?

What will the doctor write as the cause of death on the death certificate and perhaps on the cremation certificate? "Poisoning" would be the truth, by whatever drug is used. By law all cases of poisoning must be referred to the coroner. Will he ask for a post mortem examination, as he must do as the law stands at present? What will the postmortem diagnosis be? What verdict would the coroner bring in? Would it be manslaughter or premeditated homicide (which would be the truth), and if so by whom? Would the culprit be punished?

In Clause 2, in the case of a young girl jumping out of a window, the coroner's verdict could not, surely, be "misadventure" or ill luck. That a coroner should record a false verdict is an intolerable suggestion, besides falsifying the Registrar General's statistics. As our law stands at present, the verdict must be suicide, complicity in suicide or manslaughter, or even murder with malice aforethought if she was pushed out. As in suicide pacts, when one of the two people concerned survives, the deliberate encouragement, or aiding and abetting of suicide (complicity in suicide) is now manslaughter, liable to imprisonment not exceeding 14 years.

I have an uneasy feeling, and I know that many others have it too, that the encouragement of suicides, as this Bill suggests, might be open to abuse and even corruption by unscrupulous people. It is sometimes comparatively easy to get an old person to sign a document, if this is done in a persuasive enough way saying that it is for his own good, and perhaps after he has been given a tranquillising pill or a drink. He can be persuaded to think that he is not wanted and is a burden on his relatives or on society. How long, one may ask, will voluntary suicide under these conditions remain truly voluntary? How easy to put an open bottle of 100 sleeping pills beside an old patient's bed and say, "Two should help you to sleep; but if they do not work take some more". In the morning they are gone—both the pills and the patient.

In conclusion, nearly all of us (except those who wish to die in battle) want to bow out of life peacefully and with dignity, in reasonable comfort under good medical care given by a doctor whom we trust and who will not allow us to suffer too much. That is natural euthanasia, helped when necessary, by drugs given to control pain and distress. Doctors with compassion, understanding and discretion, have not done too badly in the past when making these life and death decisions. Bonds of sympathy and confidence have been forged between them, their patients and the patients' relatives. With more training in this special subject they should do even better in future.

My Lords, I do not want to be too unkind to the noble Baroness, Lady Wootton of Abinger, with whose merciful feelings I agree. But I have discussed this Bill with many medical men and women, specialists and general practitioners, who have had wide experience of treating incurable and dying patients, I have discussed it with the president of the General Medical Council, with two coroners, two bishops and other clergy, with one of Her Majesty's judges with special experience in criminal law, and with several other members of the legal profession. They all tell me they believe that this is an appallingly misconceived and dangerous Bill, bristling with formidable, practical, difficulties with many omissions and with serious inconsistencies in relation to our present legislation on suicide, manslaughter and murder. Much of it is so wrong that we do not think it can be put right by rewording or by reference to a Select Committee. I urge your Lordships to accept the Amendment put forward by my noble friend Lord Cork and Orrery which will ensure that it goes no further.

6.30 p.m.

Lady KINLOSS

My Lords, I am glad to support the Amendment of the noble Earl, Lord Cork and Orrery. As a Christian and a Roman Catholic, I found his speech an excellent and most persuasive one. I fully support all that he has said and what has been said also by other speakers who have expressed agreement with him.

I am certain that the noble Baroness, Lady Wootton, is completely sincere in presenting her Bill, but I cannot agree with her that it will operate in any way as she seems to imagine it will. All of us from time to time have to make painful decisions in regard to sick domestic animals, cats, dogs and so on. One knows how difficult and painful a decision that is to make. In this Bill, the noble Baroness wants the sick person to make that decision or to have it made antecedently. All this sounds very nice until one realises that it means that someone must kill someone else or put them in a position to kill themselves. It is true that we no longer punish attempted suicide, because we recognise it as a form of mental disturbance: sometimes only temporary. The Bill put forward by the noble Baroness goes one step further and encourages the incurably sick towards what she is pleased to call "self-deliverance", which she most curiously defines as "death by misadventure". My Lords, misadventure—hardly! I always thought that misadventure is when one slips on a banana skin, or something of the kind.

All that is to be desired is already available to us within the law. As several noble Lords have said, it would be monstrous to impose upon a doctor a decision of life and death in these circumstances. It is surely sufficient that he should be able to administer a narcotic for the purpose of relieving pain, even if it should result in the shortening of life. It can only be an invitation to murder if it is claimed as a right directly to dispose of life. The noble Baroness is no doubt aware of the very detailed and explicit statement of the late Pope Pius XII, entitled Relief of Pain, which was discussed at great length recently in a letter to The Times by an eminent neurologist. I must apologise to the noble Baroness for not having the reference by me but if need be I can find it, no doubt, in the Library.

In Clause 2(2), we have the situation that anyone interfering with a would-be suicide "contrary to the known wishes of the patient" is deemed to be guilty of an unlawful act. I have sat for 12 years in your Lordships' House, and I think this is the strangest clause that I have ever seen in a Bill. It seeks to make it unlawful to prevent another from committing suicide. It provides no penalties for such proposed unlawful action, nor does it state who is to determine it as being such an action. My Lords, I know of a case in point. He has been a friend for many years, and turned out schizophrenic. Eventually, he tried to jump out of a hospital window but was caught in time. Today, he is quite fit again after treatment and according to the last I heard is doing a useful job. What would have happened to those who saved him had this Bill been law and had he antecedently signed for himself, when still sane, a self-condemnation to death? When this man was mentally ill, his illness occurred several hundred miles from his normal residence, and thus from any declaration he might have signed previously. Were those who saved his life to be deemed guilty in terms of the proposals put forward by the noble Baroness? My Lords, this is an absurdity, and speaks for itself.

6.34 p.m.

Lord SOPER

My Lords, I shall endeavour to support the principle of this Bill. In the first instance, I should like to say that I am grateful to the noble Baroness who introduced it and who has spoken to its Second Reading, because it has to do with suffering. I have had no profound experience of suffering under a bodhi tree, but over the years I have seen so many old people suffer unnecessarily and within a context which I believe to be unchristian and certainly unwarrantable. I am sure there is another reason for which your Lordships will be grateful for this debate, whatever may be its outcome. Attention has been drawn to one of the most deplorable yet one of the most immediately important facts of contemporary life; that is, the need for much greater care for those who are in a terminal condition or who are close to death.

I find the intention and purpose of the Bill acceptable and I have given considerable thought to this. I find it is set within a contemporary framework which I believe deserves rather more attention than hitherto it has received. It is true that we are living in an age in which the competence and capabilities of the medical profession have fundamentally questioned certain principles which have remained more or less sacrosanct until this day. One of these to which the Roman Catholic Church has been committed is the indissolubility of marriage. It has to be taken in a new context when a medical profession, if it cannot produce, can facilitate, a total sex change. The very competence which the medical profession has today for altering the circumstances in which views have to be taken and principles have to be worked out, is at one and the same time a potential blessing and a very grave danger. If my noble friends and noble Lords in the medical profession will not misunderstand me, we in the spiritual field of the ecclesiastical affairs of a Church know how dangerous it is to be encouraged to "play God". There is a real danger here, which was referred to a moment or two ago, by the noble Lord who is a doctor, that questions of life and death are in the hands of the medical profession. I find that this is a dangerous as well as a hopeful situation, and I want that capacity to be stiffened and to be set within a framework of such public discipline as will safeguard the medical profession itself and will see to it that the effects of its competence are not dissipated or reserved for a comparative few of those who can benefit from that competence.

This I believe to be one of the essential characteristics of any approach to Clause 1 of this Bill, which does no more, so far as I have understood from the speeches that have been made up to now, than confirm in many respects what is already happening. If indeed there is infelicity in the actual wording—and I grant that—I have no hesitation in saying that the wording of the Bill, as it stands, is unacceptable. But if, for instance, the intention of the "terminal" in Clause 1 is in the mind of the noble Baroness, as I am sure it is, then that practice of so prescribing as to produce a short-term effect of the assuaging of pain, even if a longer-term effect of death is consequential, is already followed occasionally and should be practised with much greater certitude and uniformity. I believe that in circumstances of that description the august words of the Methodist Conference Declaration on these matters are worthy of repetition. It is in fact that: Doctors should have the support and protection of the law when they take these decisions. I turn now to Clause 2. I find myself in considerable trouble here over the moral question of suicide. One of my boyhood heroes was Captain Oates, who said, when he was near to his death (because his life prolonged was an in cumbrance to his confrères), "I am going out into the snow and may be some time". He committed suicide. He died not by misadventure but by faith; and before we make a moral judgment about the ending of life we must take into consideration what are the purposes for which life is cursorily ended. In some cases it is the highest and most sublime form of human courage and is in entire conformity with the principles of the Christian faith.

I shall speak only very briefly, and now come to the third part of this Bill. Here I find to my astonishment—and I have no doubt that this will be put right by my ecclesiastical friends—that no reference has yet been made to the fact that to a Christian death has to be seen sub specie aeternitatis. It is not the end: it is the beginning. It has always struck me as peculiar how those who believe ardently in the next world take the utmost precautions to stay in this one.

It was Mark Twain who on one occasion said that when the roll was called up yonder he proposed to be absent. He was an Agnostic and he did not think that his name was on the list, anyhow. But when, for instance, Methodists sing a hymn which contains the words, Linger shivering on the brink, And fear to launch away", they are being reprimanded by Isaac Watts, because they do not take the very positive action of entering eternity but wait for the next tide. Though this is not necessarily a cogent argument for those who have no concept of a future life, it has everything to do with those who believe that in some cases it is perfectly right for human beings to put a term to that kind of life in which they believe they can properly serve the generation in which they live, and to secure the opportunity, when that office of service is no longer valid, to opt out.

As the doctors in your Lordships' House are aware, there are many old people in terminal conditions—and we are talking about terminal conditions, and not those conditions of difficulty and suffering and sorrow, which I would as cordially agree as anyone else in your Lordships' House should be treated with care; and we should remember that miracles happen which are irreparable. In those conditions I believe that those of sane mind and judgment can, in advance, declare their intention of no longer causing suffering to those who are round about them, the intention being that they should relieve the doctor of the requirement to go on prescribing the kind of drugs which will just keep going the mechanism from which life in any real sense has long since departed.

It is for those reasons that I commend the Bill, though I believe that it needs radical transformation in its wording. But I believe that we are moving into a world in which something of this kind will sooner or later be inevitable. It is the right way to do it; not to turn our backs upon it and say that this is some process to which we should give no assent, but rather to believe that the ministries of science, and particularly of medicine, can not only conduce to the benefactions of this world, but can usher us into, first, a better concept of, and then a deeper enjoyment of, that life which follows.

6.42 p.m.

Baroness MACLEOD of BORVE

My Lords, this is an interesting debate on a very serious subject. I want briefly to make three points. The first is that, as a Christian, I cannot agree with the principle that it is within our prerogative to decide when to die. The second is that medical knowledge of the relief of pain is increasing daily and is used more and more. The third is that I do not feel that at this stage legislation is needed to supersede the trust which is usually built up between doctor and patient. I agree with the noble Earl, Lord Cork and Orrery.

6.43 p.m.

Lord PLATT

My Lords, so much has already been said that I shall be as brief as I can. It seems from the amount of criticism to which this Bill has given rise, that it cannot possibly go through in its present form. But I must confess that the two speeches which are nearest to my point of view are those of the noble Lords, Lord Raglan and Lord Soper. I personally believe that there are circumstances in which one should terminate one's life, and should be allowed to do so.

I have heard only two references, though I may have missed some, to the effect on the relatives of a dying patient who goes on dying for perhaps as long as five years, when the wife or daughter or somebody else has to give up her profession in order to look after somebody who can no longer move without help, whose bodily needs have to be attended to every day, and who is incapable of communication. I myself have signed a document to say that I hope that, if I find myself getting into that position, nobody will try to keep me alive. I unashamedly belong to what I think the noble Lord, Lord Raglan, referred to as the minority of people who think very deeply about these matters and have come to the conclusion that they do not want to end their lives like that, and would rather take an overdose of drugs before it happens. Not only do I believe in this, but I know people who have said that they were going to do it and have done it.

Many speeches have been made by people who, naturally in this House, tend rather to think of the ideal conditions, the conditions in which grandma or grandpa can be perfectly well looked after by a nurse or by relatives. Questions of money do not seriously come into it. If they have to go into a home, it can be a carefully chosen one where conditions are as nearly ideal as possible. That, I believe, is not the end of most people. I think that when they reach the stage when day and night attention is needed, they are pushed off into a geriatric ward and, although I am quite sure that if they were in a ward of the noble Lord, Lord Amulree, they would get the best possible attention, many of them are absolutely miserable. They feel that their independence has been taken away from them. Their only company is some old people who are more ga-ga than themselves. These points have not been brought out by anybody.

So I suggest, whatever our feelings about this Bill and its shortcomings, that we should give it a Second Reading on the assurance that we have been given by the noble Lord, Lord Raglan, that he will then move that it be sent to a Select Committee. There is a great deal to be discussed here, as the noble Lord, Lord Soper, among other speakers, has most forcibly pointed out. It is quite wrong to say that all doctors are against this kind of thing. When there was a national opinion poll of doctors, I think 70 per cent. said that they believed in hastening death in certain circumstances. The first euthanasia Bill to be brought before this House was the Bill of Lord Moynihan, a very distinguished President of the Royal College of Surgeons, in 1936. Unfortunately, he died before the Bill could be brought in and it was introduced instead by Lord Ponson by. Whether his death at that moment was an act of God, I do not know, but that is what happened.

As regards the disadvantages, I am impressed by the arguments about pressure being brought to bear on people. I am frightened of that. One has to realise that although most of one's friends are honest and scrupulous people, there are a very large number of people in this world who are certainly unscrupulous. So I am worried as to whether any Bill, whether it be a euthanasia Bill or something leading in that direction, can be drafted with sufficient safeguards to prevent misuse. Your Lordships must realise that the points of view which have been expressed are not universal. Every time I have spoken or written on the subject of euthanasia, I have received sheaves of letters. I only remember one that was abusive. The others were from very old people who said, "We are tired of it. Can't you find a way of hastening us out of the world? Can't you bring in a law quickly? We have nothing left to live for. We don't like our surroundings. All the things we really care for in life are over." I have certainly received at least 100 letters strongly in favour of that point of view.

6.50 p.m.

Lord CHORLEY

My Lords, I do not want to detain your Lordships very long in this most interesting debate. As the noble Lord, Lord Raglan, pointed out, it raises fundamental principles of liberty. What is the citizen's right to remove his own life when it has become a burden to him and when he feels that he is losing his humanity? Important aspects of this kind have not been much touched upon this afternoon, although there have been notable exceptions such as the speech of the noble Lord, Lord Soper, with whom I found myself not only very much in sympathy but also very much in agreement.

Earlier discussions of this kind, concentrating on voluntary euthansia, have been referred to. As one of those who introduced a discussion on this subject some 24 or 25 years ago my mind naturally went back to that particular occasion, but what determined me to take part in this discussion was the receipt of a letter from a well-known Birmingham medical practitioner to whom the noble Baroness, Lady Wootton, referred during her speech. In that letter he set out his argument which was to the effect that this was all completely unnecessary because he had been operating a terminal clinic for a number of years and was completely satisfied that everything was very happy in the garden. He saw no need for anything of this sort to be done.

That makes one feel very angry. It recalls to my mind that exactly the same sort of argument was advanced in the debate which was initiated by Lord Horder, who was once the most authoritative medical specialist of the time. He assured your Lordships that it was all nonsense about drugs failing to remove the terrible pain and cruelty of the final stages of terminal cancer and other such scourges of the human race. Naturally, coming from an authority of Lord Horder's quality, this assurance enormously impressed your Lordships' House. I could feel the ground slipping from under my feet as a fairly full House listened to what his Lordship said. I was somewhat mollified by the fact that, during the succeeding weeks, I received letters from nurses, sisters and others working in hospitals where there were many such cases, telling me not to pay any attention to what Lord Horder said. They pointed out that he did not see the results. He merely administered the narcotics to the patient, who appeared soothed, and away he went. But they were left to look after the unfortunate people and they said, "Don't you believe that by giving these injections all pain is removed, and that the unfortunate sufferer from cancer or whatever it may be is made comfortable."

Indeed, cancer is not the worst of these diseases which call for the sort of treatment which the noble Baroness, Lady Wootton, is commending to us. We have had some examples this afternoon of this rather too easy self-assurance of the medical profession. Naturally, one has a very high regard for the doctors and particularly for those Members of your Lordships' House who are members of the profession and who give us the advantage of their views about these things. However, they do not seem to feel the responsibility which the invention of these special new machines, which enable them to keep people alive as vegetables rather than as human beings, places on them. In many ways, these new gadgets are of the very highest value and many patients up and down the land have enormously benefited from their use and have been brought back to health.

Surely, however, the invention of such a machine and its use places responsibilities on the inventors and on the medical practitioners who use it to see that it is not used in the way which the noble Baroness is trying to prevent by means of the Bill and which everyone who has thought about the matter must have realised is one of the real terrors of modern life. To think that one may be struck down by a stroke and kept alive for month after month as a sort of vegetable lacking in any real humanity, is one of the things which casts one into a terrible state of frustration and lack of confidence in the profession in which one ought to have so much confidence and in which, on the whole, one has such confidence.

This matter was strongly brought into my mind and I want to dwell on this aspect that cancer is all too far from being under control. It is still one of the great killers. I have been in this world for four score years and ever since I can remember it has been a worry to the medical profession and to tens of thousands of citizens and it has become more worrying as time has gone on because efforts to find cures fail time after time. It is true, and we are grateful for it, that doctors have in many ways succeeded in keeping down the terrors of the terminal stage, but they have only done so up to a point. I agree with the noble Lord, Lord Raglan, that this is too important a matter to be left entirely in the hands of doctors. It is not right that we should be asked to accept the ipse dixit of doctors on so fundamental a point.

Only the other day I had a letter telling me that a cousin of mine had died after three years of cancer, borne, as his daughter who had nursed him throughout said, with great fortitude and peace of mind at the end. However, she said that it had been a terrible servitude—or, rather, not a servitude because she had loved doing it for him; but it had been terrible to see him suffer and to be able to do so little and to see the doctors able to do so little for him. I said to myself, "Euthanasia is the answer." This is not a euthanasia Bill but it goes some way in that direction. I am a convinced believer in voluntary euthanasia in proper cases and I welcome and accept this Bill because at least in certain aspects it helps us along that road.

7.0 p.m.

The Lord Bishop of NORWICH

My Lords, I think all of us are in debt to the noble Baroness, Lady Wootton of Abinger, for making possible what is perhaps one of the most serious debates that we have had in this House, certainly for a number of months. I believe all of us have a recognition that behind nearly every speech have been personal experiences of suffering, often in the family circle in which we live, and most of us remember the letter that the noble Baroness, Lady Wootton, wrote to The Times on 16th December. It was by coincidence of course that the letter beside it happened to come from a Member of the other place, written as he was dying and printed "from the late Member for Coventry, North-West", reminding us that people can and do work right up to the last moment of what I was brought up to call their "home call". In the dishevelled world in which we live I think that is not a bad word to remind ourselves of again.

Having said that, I feel that we could not pass this Bill, and we could not pass it for the basic reason that the sanctity of human life is bound up in this particular Bill and in the very heart of it. I believe there is a sense in which life comes from God and goes to God and that the great phrase of St. Augustine, Oh God, thou has made us for Thyself. Our hearts find no rest till they find their rest in Thee underlies the very deep notes that are being struck throughout this debate because the simple principle which has been held to and which is basic to so much of our national life, that human life is sacred, in fact comes right through our discussions.

But I believe it is a wrong time historically to bring in this particular Bill. I believe it would cut the nerve of a wholly new movement which is taking place in our country. It has been referred to time and time again. For want of a better word I call it simply "the hospice movement". Although the name of Dr. Cicely Saunders has often been mentioned, she would be the first to want to say that she is part of a whole new team, both of Christian doctors of all denominations and of doctors of general good will but not of specifically Christian outlook, whose aim in the care of the dying is based on realism and on confidence and on trust: realism that death in fact comes to all of us one day at least the insurance companies know this and work from that point of view; confidence that there is help which can increasingly be given through this last adventurous and sometimes very difficult stage of the human pilgrimage; and trust so built up between patient and caring team that the patients know at the deepest level that they are in the hands of those who are seeking their deepest and greatest care.

One of the young doctors working in this still very new sphere of the 1970s reminds us first about pain, and in the terminal malignancy cases he deals with he finds that 50 per cent. of patients suffer no pain, 10 per cent. have moderate discomfort and 40 per cent. have severe pain. He then speaks of the fact that a patient with unspoken fears and anxieties bottled up inside him—and compassion compels me to say that the clauses of this Bill seem to make it more lonely for the patient who wonders whether those around him hold these views or will support him through the dark valley—may suffer agony and be resistant even to powerful drugs; yet if the same person is given an opportunity to talk, to unburden himself and to discuss his fears his pain may radically alter, becoming less in intensity and altogether more responsive to pain killing drugs. In a caring environment, with good nursing care and modern drugs no patient need wholly and bitterly suffer. Of course the irrevocable response of this Bill means that the pressures, the problems and the adventure of this caring work cannot go on.

I believe we are at a time when, having given so much concern to the care of little children we are beginning to see, in the caring nation which is developing, that we have a new duty and a new opportunity to care for those who have cared for us down the years and in this way to develop new medical and Christian and social caring techniques in the hospice movement. I do not want to disappoint the noble Baroness by saying this so bluntly, but although I hope sincerely that this Bill will not go any further I believe she is doing us a great service by bringing the seriousness of this debate before us, because if from it a new emphasis of national money and caring and research and medical and Christian support can develop, the hospice work can go forward in increasing ways. We shall have this sense of responsibility, literally of caring for people, as on 5th July 1948 was written across the headlines when the National Health Service first started: "Security from the cradle to the grave". People will be taken through the dark valley into the world beyond and we shall have this compassion at even deeper levels of caring for people all the way home.

7.7 p.m.

Lord BEAUMONT of WHITLEY

My Lords, there is really only one point that I want to make and it is not about the real merits of the Bill as such, although for the record I should declare that I believe firmly in the right to commit suicide and therefore even more so in the right to commit suicide at the moment when one may very deeply want to and not be in a physical condition to do so. But it is not just because I am in favour of the principle behind this Bill that I ask your Lordships to let it go to a Select Committee. I say that because I think there is a great deal of investigation and examination to be done about the matters which have arisen from this Bill. There are many different ideas as to what are the facts that we are talking about; very different ideas as to how much pain can be controlled; how much our society can afford to use up its resources on the hospice movement, and matters like that.

One of the main points on which I differ from the right reverend Prelate the Bishop of Durham is that, as I see it, he seems to think that what we are dealing with in this Bill is just the exceptional case. I think it is far more than that, and the problems outlined which this Bill seeks to deal with are widespread indeed. It is not just a matter of hard cases making bad law; that applies only when they are in a tiny minority. The right reverend Prelate the Bishop of Durham drew attention to the fact that a very interesting document had been drawn up as a working paper by the Council of Europe. This came up three weeks ago at Strasbourg, where I had the honour to be present as one of the British Parliamentary representatives. After a long and fascinating debate, a Motion was passed by a very large majority commending the study of these problems to all the Member countries.

This Motion was passed on 29th January this year. Among other things, it recommended that the Committee of Ministers, invite the Governments of the Member-States among other things to establish national commissions of inquiry composed of representatives at all levels of the medical profession, lawyers, moral theologians, psychologists and sociologists to establish ethical rules for the treatment of persons approaching the end of life ". As one of the things that should be considered, the Motion mentioned the question of written declarations made by legally competent persons authorising doctors to abstain from life-prolonging measures, in particular in the case of the cessation of brain function. The Committee of Ministers will meet and in due course will probably approve the suggestion, which will then go to the Member-Governments, and a number, including, I suspect our own, will do absolutely nothing about it. I think something ought to be done about it.

I cannot think of a better place than a Select Committee of your Lordships' House to go into this question much further and much more deeply. We would be doing a very real service to everyone. No one, whether he be in favour of or against this Bill, can want the matter to end with no one being quite certain what is being done, or with a large number of guesses about what is the situation, what the numbers are, what the state of medical knowledge is, what the patients really think, and what people really want.

The best way to try to answer all those questions would be to give this Bill a Second Reading, with all its imperfections. I entirely agree with a number of criticisms made, but let us give it a Second Reading. Let it go to a Select Committee, and let us go into these matters in detail. Even if it goes no further, and I suspect if there is a Select Committee it will go no further, it seems to me that we will have done a real service to the community at large.

7.12 p.m.

Lord MOWBRAY and STOURTON

My Lords, I should like to pay tribute to the intentions of the noble Baroness, Lady Wootton of Abinger, in bringing forward this Bill. Her efforts in this direction over a period of years are well-known. However, like my noble friends who have spoken, I find it impossible to go along with this Bill. I do not want to repeat the arguments made. In fact every argument has already been made, so I will just pinpoint two matters which I think are worthy of being pinpointed.

My Lords, I happen to agree with the view expressed that the majority of the medical profession do not regard this Bill as necessary. I believe the medical profession is capable of relieving pain adequately, and of not forcing life in a body when life is no longer able to be kept there by normal means. I do not, I must confess, subscribe to the philosophy expressed by the noble Lord, Lord Soper, that because Heaven is round the corner, we are entitled to take short cuts to get there. I agree with the right reverend Prelate the Bishop of Norwich that life is God given and sacred, and is not for us to tinker with. As a Christian I firmly hold that view, and as a Christian House I hope we are able to say this with a loud and resounding vote tonight.

The other aspect I really dislike about this Bill is in Clause 2, the legalising of assisted suicide, the putting of whatever medicine or poison it may be beside the person concerned, who may be a relation, a friend, or indeed a complete stranger. But the putting there of something which may well take their life I find most repugnant. What is more, as was said by my noble friend Lady Young, how could one stand by and see it happen to someone who, because at that moment they were probably unwell and suffering, wanted to do away with themselves? Could one really stand by and see it happen? I agree with my noble friend that to do so would be very difficult. How many of these patients who think they have incurable trouble, within a matter of months have perhaps taken a particular drug which has been found to cure them, or have had performed a particular operation which has cured them?

Baroness WOOTTON of ABINGER

My Lords, would the noble Lord, Lord Mowbray and Stourton, quote the words in the Bill which authorise someone to put the poison beside the bedside of a would-be suicide?

Lord MOWBRAY and STOURTON

My Lords, I would not personally approve of any form of assisted suicide by lay people.

Baroness WOOTTON of ABINGER

My Lords, would the noble Lord quote the words in the Bill which would make that legal?

Lord MOWBRAY and STOURTON

My Lords, when I read Clause 2, it is perfectly simple. Clause 2(2) says: No person shall be under a duty to interfere with any course of action taken by an incurable patient …". Above that sentence, we read: An incurable patient who causes his own death by overdosing or other intentional action shall be deemed to have died by misadventure. Such persons are probably quite capable of pointing to the poison and, as I read it, presumably you would be hindering them. It can be interpreted that way. That is the objection I see in this Bill.

My Lords, I do not want to detain the House for too long, but the other objection I see is the grave danger that old people who are getting what the noble Lord, Lord Platt, called "ga-ga", will be wished out of the way by well-meaning people who find them a bit too much like a cabbage, on the grounds that they are not doing much good to mankind, themselves, or to anyone. It is quite possible, I would have foreseen, if such a Bill as this became law and became common practice, that when our day came to go to an old peoples' home, we could be given forms to sign, which will be for our next of kin and so on. We would be told, "Just sign that", and, "big brother needs this". There is a danger that old people might sign something without fully realising what they are doing, and that this could be used against them later. Old people are very susceptible to persuasion. I am sure that we all know of old people who, on being told to say something which they do not really mean, are quite capable of saying it because they want to be kind and helpful. There is a great danger in this Bill that that form of coercion or persuasion, albeit with the best of intentions, could be used. That is something to which I should not like to be a party.

7.18 p.m.

Baroness GAITSKELL

My Lords, I think the noble Lord, Lord Mowbray and Stourton, will understand if I do not follow him in his arguments in what I shall say. I support the Bill of my noble friend Lady Wootton of Abinger, because I should like to take advantage of these measures if they should ever become law, but especially because it is not compulsory for those who oppose it. It is for myself that I endorse it. I support this Bill because I know my noble friend speaks from a wealth of sad experience of prolonged and painful deaths of a number of her friends and relations. She is not one who has just witnessed their suffering but for several of them she speaks from the experience of nursing them until their end. For her, this Bill is not just an academic exercise.

Also, I have great sympathy with my noble friend Lord Raglan who made an outstanding speech. I have seldom heard a better speech on all the aspects of this emotive subject. I began by feeling very strongly against the idea of a Select Committee, but I have completely come round to the idea of a Select Committee if we achieve a Second Reading for this Bill. But I think there should be a Select Committee in this House, not in the House of Commons, which goes in for so many Select Committees which I think are unnecessary, and sometimes come to wrong conclusions.

I support my noble friend's Bill because it seeks to enlarge and declare the rights of incurable patients, and because the Bill is limited to the patients who consent. I spell this out because so many noble Lords have spoken and given just the opposite impression, as if this Bill is compulsory on those who do not agree with it. I support it also because its objective is to get relief from pain, which, with some medical practice—I know not with the best medical practice, but with a great deal of medical practice, in my experience—has been very inadequate. Also, I support it because it regards the wishes of the patient as paramount. It states that, and I do not know why many of us have gone off at a tangent denying this. It seeks to counter the condemnation of the Church and society when Patients obtain relief from pain by unconsciousness. I need not spell this out: I think your Lordships know exactly what I mean.

My Lords, it is not the prospect of death or pain or incurability that fills me personally with terror. What fills me with terror is the thought of senility and brain damage and the results of these two. On this I am in the greatest sympathy with the purpose of this Bill. I find that this part of the Bill accords with my personal feelings and desires. It embraces aprocedure which I would welcome for myself, and I speak only for myself. Though I support this Bill, I would not, as I have told my noble friend, campaign for it, because there are other issues that I feel more strongly about.

Reading the many letters on this issue in The Times, I find myself moved by two particular ones, one from the noble Lord, Lord Amulree, and one from Dame Albertine Winner. The one that least affected me was from the Moderator of the General Assembly of the Church of Scotland and others who wrote: …to uphold the great ideal of the sanctity of human life. —lumping this Bill with euthanasia and abortion, a package deal which I absolutely refute.

The truth is that, in this debate, I have noticed that very few people have referred to the sanctity of human life, even from the Bishops' Benches. I welcome this, because I often feel very uneasy when the phrase about "sanctity of human life" is trotted out. There is no moral logic when we start discussing morality and the sanctity of human life. The prevalence of wars throughout the world makes a mockery of this phrase of sanctity. The latest example, a very small example I will give before I end, is allowing mercenaries to go to Angola, making it legal for them to kill themselves as well as others. This is only one of the examples of the complicated and conflicting emotions and irrational reactions to a Bill like this. I hope that we shall give this Bill a Second Reading and that it will then go to a Select Committee.

7.24 p.m.

Lord BROCK

My Lords, the simplest point I want to make is that I wish to associate myself with those who oppose this Bill, and I hope it will not be enacted. I acknowledge the compassion it contains, but also recognise the dangerous complications that can flow from it. The most dangerous of these is the fear that it will engender of the nurse and the doctor. Many patients will ask themselves, "Is this doctor, this nurse, going to kill me, as he or she may now do, instead of helping me in my illness?" I criticise the title for two reasons. First, it is not fully informative and fails to disclose that it is really, indeed essentially, a Bill to permit euthanasia. I do not know whether or not this is deliberate, but it certainly could be so. Secondly, it contains no proper definition of what "incurable" means. I exclude Clause 1(2) from this, as it is entirely unacceptable as a definition. A much more precise and satisfying definition is not only necessary but essential.

This is no new problem. It was, in fact, encountered 250 years ago by the Governors of the Hospital founded by Thomas Guy; at one time, that was labelled, "Guy's Hospital for Incurables". Parish authorities and private individuals saw a means of ridding themselves, not at that time by euthanasia but by passing it on to others, of the burden of the care of persons of whom they were glad to be relieved. It was, and still is, tempting, for anyone burdened with the care of an elderly, infirm or virtually helpless individual, who cannot take care of himself or herself and is a nuisance, to seek to pass the responsibility on to someone else.

This Bill would open the door to another more radical way of dealing with the problem, and would provide a means of persuading the unfortunate individual that the law now permitted a way by which the burden borne by others could be completely taken away. The criticisms of the Governors of Guy's Hospital became so numerous and insistent, that they were not fulfilling the terms of Guy's will, that the Governors were driven to issue a disclaimer and to show that the terms of the will had been quite clear in laying down what Guy intended and what they should do. The special mandate that Guy gave to his hospital was that it was not to rest content with the immediate cure or control of disease, but he wished his hospital to strive in every way to rebuild the convalescent so as to make him lit enough to return to his usual life and work. He laid down that his hospital was to receive and care for poor persons labouring under any disorder thought capable of relief by medicine or surgery.

When we recall the enormous advances made in medicine and surgery by curing all sorts of disorders thought at that time—that is 1725—to be incurable, we at once should realise how unsatisfactory it was at that time to label any disorder as incurable. We should realise also that, although very great advances have been made, there are still many striking advances to be achieved. I think I have had adequate clinical experience as a doctor to state that many disorders can today be considered as incurable whereas tomorrow it will have been found that they can be cured, or at least satisfactorily relieved, by advances in medicine and surgery. In my experience of half a century, Irecall the profound advances that have been made in many groups of diseases, such as, for example, diseases of the lungs and of the heart. Cancer of the lung was once considered to be a uniformly fatal disease. Today, many can be cured.

The story of pulmonary tuberculosis is even more striking. The old days of consumption have gone, when a young person with the disease was almost certainly doomed. Now the position is totally different. The horrible sufferings of John Keats, the poet, are not seen today. Today he would not have had to inquire: How long is this posthumous life of mine to last? Not only is the disease largely under control but its incidence is far less. An incurable state is now eminently curable, and once more I contrast this with the horrible sufferings of Keats, from which he would have welcomed euthanasia.

I see also the whole range of heart diseases, both congenital and those caused by rheumatic fever and by coronary artery disease. It is, to me, a very vivid memory. Countless patients with rheumatic heart disease who endured years of disability and distress with no hope of relief, and were generally accepted as incurable, can now be cured or restored to a reasonable, acceptable and enjoyable life which provides pleasure and contentment to them and to their families. The same is being achieved in many cases of severe coronary artery disease only a few years ago considered incurable and now open to cure in many cases. It is when I look upon these great achievements, and especially on the way in which successful treatment was considered unlikely or impossible by many, even by doctors, that I am very disturbed by the proposal that what is accepted as incurable today may be judged as deserving a death sentence.

Lord BROWN

My Lords, may I interrupt the noble Lord for one moment? I am trying to follow the logic of what he is saying. I understood him to say that nothing can be considered as incurable. The question is this: would he then therefore use every possible means of keeping a person alive, whatever the disease he was suffering from and whatever the pain he was suffering, in the light of his argument that all illnesses might become curable?

Lord BROCK

No, my Lords that argument is entirely incorrect. All I am discussing is the Title of this Bill, which refers to Incurable Patients, and I am pointing out that the definition is completely inadequate. Noble Lords are postulating something which I did not suggest. It is an entirely different matter. I am pointing out that the Title of the Bill is totally unsatisfactory, because it is talking about incurable people and it is impossible to say that a condition is necessarily incurable.

I do not wish to argue this matter along the many lines which control and direct it. I take it that deliberate killing is not a part of the doctor's task. This is not a matter to be controlled in detail by legislation. The right reverend Prelate the Bishop of Durham has referred to meddlesome legislation. I am also concerned about the way in which doctors are thought to be unreliable in their judgment in this matter. Of course we all vary in our ability and achievements, whether we have been men of science, footballers, athletes, or doctors. It is suggested by many, and apparently also by this Bill, that the innate wisdom of a layman must often be superior to the training of many a doctor; that doctors can well be guided or instructed by laymen as to how they could look after their patients better than they are doing; that an intelligent layman can tell them when they shall alter their treatment so as to render their patient unconscious, or destroy him. I am afraid I can in no way accept this. We all know that the spectators at football matches are allowed to shout free advice to the players, but who would accept that these amateur advisers should be permitted to join in and take over the part of the professionals?

I view with much alarm the suggestion that a well intentioned lay person should interfere clinically with even an indifferent doctor. There is a great temptation to become deeply involved in arguments about this matter on ethical, moral, religious and legal grounds.

Lord BROWN

My Lords, may I interrupt the noble Lord?

Lord BROCK

My Lords, may I just finish this sentence and then I can sit down entirely. I resist temptation and confine myself to some random thoughts that I think are important and relevant.

Lord BROWN

My Lords, it really is improper to import into this Bill things that are not there. The suggestion that laymen should interfere with medical opinion according to this Bill is not there, and it is quite improper to suggest this.

Lord BROCK

My Lords, I would just suggest that the fact that the Bill has been introduced by a lay person suggests this.

7.34 p.m.

The Duke of NORFOLK

My Lords, I should like just for a few moments to emphasise one or two fundamental principles, which you all know very well but which have sometimes got rather lost in this debate. I think that it is true to say that Christians and all religions believe in the sanctity of human life. Humanists and most other philosophies share this ethical view. Our medical profession has followed this tradition, which in their case has also been enshrined in a code of honour based on the Hippocratic oath. On the one hand, our medical profession has aimed to relieve a patient of suffering and pain and return him to health; on the other hand, when death has become inevitable through the onslaught of an incurable disease or the misfortune of a fatal accident, our doctors rightly accept the will of God and stand aside and do not seek to prolong life nor challenge the course of nature.

I emphasise that the artificial prolongation of life that has no chance of recovery, as in the Quinlan case in America, and as is happening in many American hospitals, has always been contrary to our medical code. I had a New York doctor spend the weekend with me. He is a doctor at the Presbyterian Medical Centre in New York. He has told me of a terrible situation: how many doctors there are afraid of being prosecuted for negligence unless they prolong life unnecessarily. Our medical profession, in its wisdom and in the lack of having too many laws, has never been in that position and it does not find itself liable to be sued for prolonging life unnecessarily. It allows the will of God, or the course of nature, however you wish to describe it, to take place. I personally can find no need for this Bill. Where it exonerates those who assist suicide it is based on the cold comfort of despair. It would destroy the hope and trust which is the relationship that our doctors have with their patients.

7.37 p.m.

Lord CLIFFORD of CHUDLEIGH

My Lords, may I make one or two points. First of all, we have to realise that there are large numbers of people who, in their middle age, are of an Agnostic humanistic turn of mind and are prepared dogmatically to lay down what they think ought to be done to themselves 20 to 30 years later, but when it comes to that time they do not feel the same. My own father, then a widower in his early forties, gave me, a 14-year-old, Warwick Deeping's book Sorrell and Son with instructions that I should do likewise. I noticed that in his seventies he had changed his mind.

Secondly, doctors know full well that patients often have to be protected from themselves, especially at the height of illness, and especially just before they turn the corner. This is where, to my mind, Clause 2 is so dangerous, and Clause 2(2) an invitation to those responsible to neglect their patients. I think that this clause is fraught with possible misuse by relatives who want to "get rid of granny ".

Clause 3 rings a personal bell. As many of your Lordships know, my eldest son had a serious accident last August resulting in brain damage, and for weeks he was certainly, to quote the Bill, "incapable of giving directions". Now if my wife and I had been abroad and his younger brother had been of evil intent, surely this could have led to awful skulduggery in order to inherit the title and a bankrupt estate. If this Bill had been on the Statute Book 50 years ago, Agatha Christie would have been out of a job. Who, in these circumstances, may I ask, can define the word "permanently"? If a £500,000 EMI scanner could not do it in the case I am referring to, how can you expect anybody, either in the law or a doctor, to make that decision? Even quite normal people do stupid things when young, like signing declarations, joining the Communists. The unscrupulous could, therefore, following on from that, enforce a suit under Clause 3(3) before the patient has time to regain his compos mentis.

This is extremely unfair on doctors, and it seems to me—I do not know, but I feel that most of your Lordships would agree—that if any body of men should be left alone to make their own judgment according to their own training and their Hippocratic Oath, then the British medical profession is such. To try legalistically to bind them to a scientific, humanist charter such as this is anathema.

I asked a doctor, for whom I and my noble friend Lord Platt have great regard, for his comments on the Bill. They were short and succinct: Re Clause 1: I regard it as an insult to the medical profession to put this forward. Re Clause 2: This is beyond the scope of any legislation. The patient is often incapable of determining the curability or otherwise of his illness with all known cases where apparently sane people have taken their own lives in the mistaken conviction that they were suffering from cancer. Re Clause 3: Here again, any legislation seems quite inappropriate; brain damage is more than difficult to define. He ended by saying: For the sake of God—and I do not write this irreverently—do not meddle with what in this country at least works reasonably well and is understood by both laity and the medical profession. If we had had this legislation years ago, think of all the drugs that probably would not have been invented. But I will not go into that now. There is and must be a distinction between making a patient unconscious at the risk of killing him and killing him to make him unconscious. I would reiterate the dangers of Clause 2: surely inheritances could be wangled, trusts altered, wives and husbands got rid of by acquisitive mistresses and even straightforward wills put prematurely into effect. I finish, as I did in 1969, with the old doggerel: They bumped old grannie off, you know; She only had a cold, Her sufferings, they were told in court, Were dreadful to behold. The judge was kind 'Besides', he said 'she's getting rather old,'So they left the court and went away To share old grannie's gold.

7.42 p.m.

Baroness PHILLIPS

My Lords, at this stage in the debate there can be nothing new to add to the many splendid contributions that have been made by so many distinguished noble Lords, by Lords Spiritual, by those in medicine and by others who have feelings about this Bill. I regret that my noble friend Lady Wootton, for whom I have great regard, must learn that I cannot support this Bill. I start from the very simple standpoint that as a Christian, and one who attempts to be a reasonably good Catholic, I simply believe that one does not have the right to take one's own life. I do not think that anybody has actually stated that fact, although I believe it to be the philosophy on which the whole Christian doctrine is founded.

In my view, this is an attempt to thrust on the medical profession a responsibility and task they do not wish to accept. Indeed, the noble Lord, Lord Hunt of Fawley, the noble Lord, Lord Brock, and others have emphasised this. I well recall talking to the doctor in my family, when he was in general practice, about the Bill that was before the House earlier and he said. "In all my years in general practice I have never once had a patient ask me to be put out of life". He added, On the other hand, I have had many relatives ask me to help dear grannie or auntie"—unfortunately, I notice, it always seems to be the female who lives on—"to leave this world, but never have I had a patient ask me." What right have we to ask someone else, as he put it, to commit murder three times a week? It seems significant that those who clamour for capital and corporal punishment are the kind of folk who would certainly not wish to carry out the very dictates that they would lay down for others, and so it would be the case with this Bill. This would thrust the responsibility wholly on the medical profession, the members of which already have to take many serious decisions.

We have heard from eminent scientists that we cannot define what is incurable. I had the experience of seeing my husband, when he collapsed from brain damage, lying in hospital speechless and unable to write and this at a time when nobody knew precisely the damage. That could easily have been the kind of thing that might have been described as incurable, but six months of going to and from the neurosurgical unit, which I did, taught me, first, that those with brain damage invariably do not seem to be in pain and, secondly, that many of the brilliant operations bring them back to a reasonable degree of life. I would, therefore, challenge what is incurable; indeed, we have heard that what was considered incurable in our own lifetime has changed completely. It would also suggest that it might act as a disincentive to seek cures if there were so many ways of dealing with this situation. We have no right to take even the life of an animal, let alone that of another human being.

7.45 p.m.

Baroness MASHAM of ILTON

My Lords, I must declare a personal interest in this Bill. I have been an incurable patient, and no doubt if I get ill again at some time I will again be an incurable patient in hospital. When I had my accident 17 years ago I was taken to the casualty department of an accident hospital with a fractured spine, a suspected fractured skull, several fractured ribs, internal haemorrhage and semi-conscious. The doctor on duty, after examining me, said to my fiance, "If she lives through the night she will never move again". The view of my attendant physician was that I was suffering without any reasonable prospect of cure from a distressing physical disability and he may well have thought it intolerable. Under the cover of a Bill like this, that doctor might well have let me die. For one or even two doctors to be able to take such decisions on behalf of a person would, in my view, be totally unacceptable. In that instance the doctor was foreign and very likely not of my faith. Clause 1(2) does not make it clear who decides whether the condition is distressing. Is it the patient or the doctor?

I do not know how one measures pain. I know that in the first three weeks of injury my pain was indescribable. Had I had the chance to demand pain-killing drugs I would most likely have died many years ago as a drug addict. When one is suffering and sweating pain there is somehow a light at the end of the tunnel, and that is the light of hope. Even with patients with a terminal condition who should, and generally do, have drugs, there is the hope that they will have blessed peace and, if they are Christians, that they will reach Heaven. It is encouraging to hear of the many new hospices being set up and of the increasing concern towards the care of the dying. If a patient can die in calm dignity it is a relief for all concerned, but the individual legal and spiritual rights must be safeguarded. Education is surely better than legislation in this case.

I do not believe that the intentions of the noble Baroness, Lady Wootton, have been to frighten people, but all sorts of complications occur with some legislation, and already this Bill will have caused a great deal of harm. Only a few days ago I heard the Minister for the Disabled say at a public meeting that far fewer disabled people than had been expected had come forward for their benefits. Is it surprising that they do not want to register? The Royal College of Nursing has stated that this Bill could well pave the way for euthanasia; disabled people suffering from all sorts of incurable conditions may feel that it could be paving the way for extermination camps.

In the last few days I have received many disturbing calls for help from disabled people who no longer can work and the Government are taking away their only means of transport, their three-wheeler invalid tricycles, leaving them isolated and rejected. I have also received two desperate letters from men injured at work, each with a wife and four children, who cannot go home because they cannot get rehoused. They have to remain in Hexham General Hospital when they should be at home with their families and thinking about work. It amazes me that the miners who are so successful at campaigning for more wages do nothing for their members who are injured at work and who need a suitable house. If incurable patients are to be protected from avoidable suffering and their rights strengthened, their social conditions and accommodation needs are vital, otherwise they will lose all hope and feel not wanted. Is it to ease our consciences that we have here the phrase, "Death by misadventure"?

Last Friday I spent the morning in the casualty department of a large teaching hospital. How could a Bill like this operate in that atmosphere? There is one aim and that is to try to save life. If a patient arrives in casualty with a written statement deciding that medical survival is to be withdrawn, is he to be pushed into a corner to die? What happens if a person in sound mind makes a statement and then has a stroke and cannot talk or write, and then realises that he wants to live? How does a doctor know whether an attempted suicide is just a call for help or whether it is serious? On Friday an elderly woman was admitted and was being wheeled in a bed from casualty. She was calling out, "They are killing me, they are killing me! This will be the end of me". So often when people come into hospital they are confused and frightened and not in a normal state of mind. This Bill will only increase the fear of patients entering hospital. It will do nothing to build up the confidence so needed between patients and hospital staff.

Clause 2(2) is contrary to the ethical principles of most nursing and medical staff and it would be morally wrong to enforce this pressure on anyone. In fact, the senior consultant in casualty told me that if this ever became law he would resign or emigrate. The Bill says nothing about children. Would a parent have the right to sign? The death penalty has been done away with for criminals of all kinds, yet it is being recommended today for incurable patients.

I should like to pay a tribute to all the people who do a wonderful job in looking after so many incurable patients so well. But there are, my Lords, sadly, far too many dishonest people in our society. To give them a licence to murder would be putting many helpless people in a position of terrible risk. Therefore, my Lords, I support the Amendment.

7.53 p.m.

Viscount BARRINGTON

My Lords, I must apologise for the fact that I had not noticed that names had been crossed off the list of speakers. May I say that I will spare your Lordships a prepared speech—not because it is not prepared but because it would take much too long to give—and that I will concentrate on only two points. I agree very much with what was said by the noble Baroness, Lady Phillips, that all the arguments on either side are before your Lordships. I have an interest in this matter. In fact, I have two interests. One is an interest in death. The other is an interest in what was said by the noble Baroness, Lady Wootton of Abinger, and that is the interest which I should like to mention first. On only one occasion have I felt any distinction in this House. That was when I was one of two Members of your Lordships'House—the noble Baroness was the other who were members of a delegation to the then Home Secretary on the subject of the sanctity of life that asked the Minister to look into the working of the Abortion Act, which even at that time was thought to be quite unsatisfactory. I say that only in order to convince the noble Baroness, if she were here, that if anybody could persuade me that this was a Bill to which a Second Reading should be given it would be she.

I thought that her speech was brilliant but I will confine myself to the last remark in it, which was a quotation. The right reverend Prelate the Bishop of Norwich hoped that nobody else would refer to it, but it illustrates the point that I want to make: Thou shalt not kill; but needst not strive Officiously to keep alive". The right reverend Prelate pointed out that that was satirical, but it states the law of England as it is and as I think it should be about death generally: that it is a crime to kill, but not a crime not to prevent death. That is to say, if I watch a child drowning in two feet of water I am not committing a crime (although I would be in France) unless I have a "duty of care." We are talking about doctors, who have a duty of care to their patients. The question is, what are those duties of care? That is what the whole of this debate is about.

All of us are agreed that one of the duties of a doctor is to alleviate pain, so far as possible. Another duty is to preserve life, so far as possible. Those two duties often lead to very difficult decisions which we have heard about today: how far to alleviate pain, even if it endangers life; how far to preserve life, even if it means increasing pain or inflicting it. We have all had these problems. I had it when I was asked by a doctor what he should do about my mother who had cancer. I had no doubt whatever: by all means alleviate pain but do not do it in order to kill.

This Bill would give a third duty to doctors; that is, to help people, to put it bluntly, to kill themselves. That is the opposite of the duty to preserve life. Whatever one's views on suicide—and I have very great sympathy with those who contemplate it because, like some of your Lordships, I have been rather close to it myself and possibly it might have been better for your Lordships if I had committed suicide but whatever one's views on suicide, I cannot agree with the view of the noble Lord, Lord Soper, and the noble Lord, Lord Beaumont of Whitley, that taking one's life for a good cause, like Captain Oates who has been mentioned, is the same as taking one's life in order to opt out of it. But in either case, whatever the noble Lord, Lord Soper, may say about the timidity of those who fear to launch away, I would rather have a doctor who feared to launch me away than one whom I knew was ready to do it. Without being frivolous, that is a very serious objection which has been brought out in all these cases. I mean that even good doctors could be tempted to do it. I do not mean people like Dr. Crippin.

Further, it is a fact that if you have two doctors—let us call them by impersonal names like Edward and Henry—and if you allow this Bill to go through, with all kinds of Agatha Christie minded members of families in the background, the danger is that all the running would be made not by Dr. HenryJekyll but by Mr. Edward Hyde. For that reason, I think that this is one of the cases in which the first step—which this Bill would be even if it were sent to a Select Committee—would be a very dangerous one to take, and I think that we ought not to take it.

7.59 p.m.

Lord HARVINGTON

My Lords, I know that your Lordships are anxious to come to a conclusion upon the business before the House and I shall detain you only for a few moments. I seek to make one point. Throughout the 1960s I was chairman of an independent hospital in London, the Hospital of St. John and St. Elizabeth. It is a Catholic hospital, but one which takes patients who are overwhelmingly non-Catholic—perhaps of the order of 80 or 85 per cent. Naturally, during that time I had to live very closely with this problem, because we had two or three geriatric wards. I was in close touch with the doctors and found that this never presented itself to us as a serious problem—at least, not from the point of view of the patients. What does present a problem is the pressure which is often brought to bear upon the staff and, indeed, upon the patients themselves by their relatives. However, it is not a problem which has bothered patients personally to any extent because we have been able to give the type of nursing which has brought them to a happy death. Therefore, I think that this Bill really ought not to receive a Second Reading. It is utterly unworkable, unnecessary, and un-Christian, and I hope that your Lordships will deal with it as it should be dealt with.

8 p.m.

Lord SOMERS

My Lords, practically everything that I intended to say has already been said during this debate, so I will content myself by saying that I support entirely the noble Earl's Amendment and everything that has been said in support of it. In particular, I should like to agree with the point with which the noble Baroness, Lady Phillips, opened her speech; namely, that it is not our right to decide when we shall die. With that I wholeheartedly agree.

8.1 p.m.

Lord SUDELEY

My Lords, despite all that has been said, I should like to call attention to one or two weaknesses in the Bill. The first clause is an instance of how the Bill does not recognise current realities in medicine, and much has been said already on how pain can be relieved by modern drugs. It is worth observing, in connection with this clause, that there is no objection in Christianity or law to shortening the life of a patient by the administration of pain-killing drugs, because when the patient dies the question which arises is: what did he die of? The answer is: of cancer or of some other incurable disease—not of the drugs which weakened his resistance.

The second clause lays the door open to the activities of unscrupulous persons and so turns this into a euthanasia Bill. The lethal dose would be prescribed by the physician, who would then tell the patient that he was going to have a "hell of a time". As the pain can be relieved by modern drugs, this statement would not be true, and after death occurred it would be hard to deny that the patient had not been murdered by his physician. And who could tell whether the physician had not been bribed to commit the murder by relations of the patient who had an interest in the patient's inheritance? Subsection (2) of Clause 2 is an instance of the practical difficulties which would arise if the Bill became law. Accident wards are very busy places which accept many suicides. If the Bill became law, it would appear that if the suicide is revived, which is just standard treatment, and then it was subsequently found that the patient had an incurable disease with a death wish, the casualty officer would have acted unlawfully, and under the provisions of the Bill legal proceedings could be taken against the casualty officer.

The second subsection of Clause 2 should also never become law because it ignores the reality that few who attempt to commit suicide really wish to die. If all who attempted suicide really wished to die, then it is not very likely that the number of attempted suicides would have dropped so sharply during the junior doctors'40-hour week. Both Clauses 2 and 3, involving as they do the actual death of the patient, ignore the fact, made plain already, that, particularly within the first stages of brain damage, a doctor's prognosis may be far from infallible. To support the statement I have just made, I should like to quote from the writing of Dr. Lamerton, Chairman of the Human Rights Society, who runs St. Joseph's Hospice, in Hackney. Dr. Lamerton has written: Anyway, doctors are not always right. On several occasions in which I have been asked to provide terminal care it turned out that the patients were not dying at all. Irreversible brain damage which recovered, cancers which turned out to be cysts, despite all evidence to the contrary, proven cancers which regressed and disappeared—all these have come my way. Diagnosis of medical conditions is still largely an art. It is only partly scientific. My Lords, I have torn up the rest of my speech dealing with what is wrong with suicide and euthanasia, because the hour is late. It seems that the argument against the Bill has already been won, and I should not like to spoil the Division.

8.5 p.m.

Viscount INGLEBY

My Lords, I should like to speak for a moment or two on the likely consequences of the Bill if it is passed. I am thinking now of the ordinary man in the street, or perhaps I should say the ordinary elderly disabled person. I believe that to them the idea will become established that in certain circumstances it is now legal for a doctor to remove life sustaining treatment. Of course I know that there is a voluntary declaration to be signed, but as a disabled person I also know how easy it would be for pressure to be put on to disabled people. It could easily be said that the most unselfish thing that I, or even the noble Baroness, Lady Masham of Ilton, sitting beside me here, could do with ourselves would be to get ourselves out of the way. Particularly in families with difficult housing problems it might be said how much easier Mary could get on with her exams if she had a room in which to study. This is a pressure which should not be allowed to be put on to disabled people.

I wish to say only one more thing. As it is at present, I feel that this Bill, no doubt without the intention of the noble Baroness, is a Bill of despair. Instead, I should prefer that there goes out from this House tonight a message of hope to the dying. Recently I visited St. George's Hospice and I talked there to three people with advanced cancer. It did me a great deal of good to talk to them. Their pain was being controlled—in one case breathlessness, in another case vomiting—and they were able to enjoy visits from their family, and to give and to receive from all those about them. The message I should like to give tonight would be a message that we should all do all we can to give the kind of care to the dying that we should like to receive when our turn comes.

8.8 p.m.

The Earl of LISTOWEL

My Lords, I shall address my very few remarks—and your Lordships will be relieved at this late hour to hear that my remarks will be few and short—to the need for an inquiry by a Select Committee of the House. as suggested in the Motion put forward by the noble Lord, Lord Raglan, into the proposals in this Bill. We should all agree that the care and treatment of the incurably sick has become, with recent advances in medical knowledge and technology, a major social problem which has caused widespread public concern, not only here in this country, but among our neighbours in Western Europe. It is symptomatic of the growing public concern that we have had so many speakers in the debate. My memory goes back further than I care to think, and I cannot recollect a larger number of speakers on the Second Reading of a Private Member's Bill. The speeches to which we have listened were marked by extraordinary and exceptionally deep conviction.

Further evidence to the same effect is that the Assembly of the Council of Europe which, as your Lordships are aware, reflects public opinion in 19 West European countries, discussed this subject at great length only last month, January. The recommendation which it decided to make to the Council of Ministers, representing the 19 Member Governments, was to set up in each country a national commission of inquiry. The purpose of this inquiry would be to consider all the questions arising from the care of the incurably sick, including—I quote: written declarations made by legally competent persons, authorising doctors to abstain from life prolonging measures, in particular in the case of irreversible cessation of brain function, and…the application of extraordinary measures to prolong life". My Lords, I suppose the nearest approach to a national inquiry here would be a Royal Commission, but time presses and a Royal Commission would take too long, I think, to find an effective answer. On the other hand, a Select Committee of this House which could call evidence from all those morally and professionally responsible for the incurably sick would report to your Lordships without undue delay on the precise question before the House this evening; namely, whether legislation as proposed in this Bill is required and, if so, what form it should take.

My Lords, those who have opposed this Bill have done so, I think, either because they consider it is unnecessary—the view that is held by a very large number of members of the legal profession—or because they think that the changes it would make in the law are simply undesirable. But whether legislation is either unnecessary or undesirable can surely be decided with much less risk of error after evidence has been heard from those with the greatest knowledge and experience of the incurably sick. That is why I would venture to hope that your Lordships, whether you approve or disapprove of the proposals in this Bill, would endorse the expression of European Parliamentary opinion in the Strasbourg Assembly (which included, of course, the opinion of our own Parliamentary colleagues) by deciding that public concern justifies an immediate inquiry by means of a Select Committee of this House. I would therefore ask your Lordships, however strong your personal feelings may be, to suspend your judgments about the merits of the Bill until they have been examined with outside help, and to allow the Bill to have a Second Reading so that it can can be referred to a Select Committee.

8.12 p.m.

Baroness WOOTTON of ABINGER

My Lords, a little while ago it looked as if the end of this debate would be about 1.30 a.m., but owing to the courtesy of your Lordships in making very succinct speeches we have greatly improved upon that—and I hope the improvements in medical care will be as rapid. First of all, may I say how gratified I am that, in raising this subject, there was, at least at the outset, such a very wide audience in your Lordships' House. It is clear that a very large part of the population represented here and, undoubtedly, from my mail, represented outside, is deeply interested and concerned in this subject.

I should particularly like to refer to the speech of my noble friend Lord Raglan and to his proposal that this measure, if your Lordships aregood enough to give it a Second Reading, should be referred to a Select Committee. In general, I am not very enamoured of the procedure of the Select Committee as a way to collect evidence, and in this particular case, of course, the unfortunate fact is that a great deal of the relevant evidence is by definition dead. But I would do nothing whatever to put obstacles in the way of my noble friend, and I hope that the Select Committee, if your Lordships should agree to the appointment of such a Committee, will succeed in producing a very much improved Bill. I fully agree that the Bill needs a great deal of improvement, and as your Lordships have been speaking I have been grateful to a number of noble Lords for the detailed improvements which they have suggested. Your Lordships do not want me to go over those, I am sure, one by one, but I should like to say that those which were suggested by the noble Earl, Lord Cork and Orrery, and also by my noble friend Lord Wells-Pestell mostly took the form of producing hypothetical cases which could arise out of the existing words of the Bill. This is an ingenious exercise in which civil servants, anyhow, have extremely high skill; and I think that those are things which could very well be put right by suitable Amendments to the Bill.

I noticed that nobody took up the facts, which were not hypothetical, which I quoted in support of what I still stand by —my declaration that, although there may be adequate drugs available, they are not in fact used. I sometimes wonder, my Lords, if I may say so, whether those distinguished doctors who have arrived at the eminence of this House are really still aware of what goes on up and down the country in small local hospitals. I have already mentioned that I have had a good deal of experience, and some very close experience, of it. I am trying to group the objections by subject rather than by name. A number of the objections were raised to the clause about the declaration. These objections were that there would be external pressure—"You make that declaration, because I do not want to have you on my hands when you are old and ga-ga. You might change your mind; and, after all, you may be ga-ga already, and I will get somebody to say so". These are very familiar objections, and I might say that they all apply to wills. People are under external pressure to make wills—"You leave all your money to me or I will see about it; I will see that you do not last. You are not really of sound mind, and I will get a suitable range of psychiatrists to say so". If you change your mind, you make a new will. Some people make a new will every other week, I understand from my solicitors. I do not do that myself. I seriously suggest that these are objections, all of which could be raised if I was now proposing as a new idea that people should be allowed to make testamentary dispositions of their property.

I then have to deal with the objection that we should not make legislation but should train doctors, nurses and the whole medical profession, and others, better. Nobody could support this more warmly than I would; but, my Lords, this is a very long process. This is what is always suggested when some immediate action is taken: Do not take any immediate action now so that consumers can get their rights, but let us better train those who supply them". Eventually, it will happen; and in fact I know that the climate of opinion is changing, that gradually new techniques are being developed and that new techniques are being widely used. But nobody has disputed the facts I have quoted to show that they are not used in a number of places where you might expect them to be.

To the noble Lord, Lord Brock, whose patients will be in terror that he is going to give them a lethal dose, I may say that he can ease their terror because he can tell them that, if he does so, under this Bill, he will still be liable to a charge of murder, just as much as he is now. This Bill does nothing to interfere with the present law of homicide; and I would be quite willing to accept an Amendment to say so—"that nothing in this Act shall alter the present law as to homicide".

Then there is the argument that this is the wrong time. My Lords, I have lived a very long time, and it is always the wrong time. All through my life I have decided that the right time to say something is the wrong time. If you say things at the wrong time, when they are held to be impossible—not the art of the possible—as the years go by they become potential, they become possible, they become probable, they become commonplace; and if you live as long as I have you will see that process happen very often. If it is the wrong time, I am very happy to make these proposals now.

Then: "We have hospices; let us wait until the hospices have spread and the treatment given in the hospices", of which nobody could be a greater admirer than I am, "is available for everybody". But how many persons in this Chamber at the moment will be alive when they are available to everybody by that process? It is a very slow process, this growth of hospices, to when there will be successful and painless treatment of the dying available to everybody.

Now, perhaps, my Lords, I might make a few specific references suggesting that perhaps even some of the members of the medical profession may be behind the views of their own time. It is 14 years ago since an editorial in The Lancet said: A clinician who persistently seeks to maintain a parody of life may end in serving nobody and nothing except pride in his own technical competence". That is one. May I also make a quotation, for the benefit of my Catholic friends here, from Pope Pius XII. Perhaps the later Popes have changed their minds, who knows? Asked whether the suppression of pain and even consciousness by means of drugs, when it is demanded by medical indications, is permitted by religion and morality, His Holiness replied that the administration of drugs, even if it shortens life, is justifiable if there is no other means in given circumstances of relieving pain.

Finally, I do not know what the views of the present Archbishop of Canterbury may be, but I quote from an address given by his predecessor in 1971. He said categorically: When a patient is lingering in a state of great distress without any possibility of continuing life or happiness it is not for the doctor to keep him alive. I commend those two quotations to my friends who feel very strongly the medical and religious objections to my proposal.

I should also like to say a few words about what is called the sanctity of life. It is, perhaps, not for me to use the word "sanctity"; but I should point out that those of us who believe that the brief interval between birth and death is the only certain experience that we know are not likely to attach less importance to that period than those who believe that there is a greater future beyond. I think that if anybody is good enough to look at my own personal record, they will not accuse me of introducing a Bill which is injurious to the sanctity of life. It was I who introduced into this House the Bill for the abolition of capital punishment and I am on record as being in opposition to unconditional abortion on demand. I also share to a great extent the views of my noble friend Lord Soper, on killing in warfare. The last thing that I would ever do would be to introduce here, with that record, something which was treating lightly the value of human life. I think that that is all I can say in reply, except to repeat the hope that your Lordships, especially in view of the proposition of my noble friend Lord Raglan, will be willing to give this Bill the Second Reading which I hope I may have succeeded in persuading you it deserves.

8.23 p.m.

The Earl of CORK and ORRERY

My Lords, it has been a long debate. Now it comes to an end and I find myself faced with precisely the difficulty with which I was faced when I stood up at 3.30 this afternoon. It happens that the noble Baroness, Lady Wootton, ended her speech by putting her finger almost precisely on it. I do not and cannot believe, and I do not believe that anyone else in this House can either, that she could possibly, knowingly or intentionally, introduce a Bill that could endanger life or in any way derogate from its sanctity. That I do not believe. The noble Baroness shakes her head. I am not sure that she does so because she agrees or because she disagrees with what I say. I hope it is because she agrees. She is going to disagree with me in a minute, but, I hope, not yet.

I think that the fact is—and I think I am not alone in this—that although this could not be her intention, it is what has happened. I am not persuaded away from any of the opinions that I held earlier which have been substantially upheld by a large number of noble Lords. This is a disagreeable situation. I do not believe that anybody in this House would wish to be unkind to the noble Baroness. I know that I was rough earlier in the debate. I think it was necessary but it gave me no pleasure. The noble Baroness may not believe that either.

Baroness WOOTTON of ABINGER

My Lords, I have already assured the noble Earl, in writing, that no difference in personal relationships will occur through differences on policies.

The Earl of CORK and ORRERY

My Lords, I have received that letter with pleasure and satisfaction. The noble Baroness has said that nothing in this Bill threatens the present law of homicide. I started my introductory speech by explaining why I was certain that it would do so. A number of noble Lords reinforced me in saying that it would do so; so that I think this is a subject that we had better drop, for clearly on this matter there is no communication between the noble Baroness and me. All I can say honestly is that I still believe it would do so. I think that it knocks the law of homicide for a loop.

My Lords, I shall take another point. The noble Baroness made an analogy between the signing of this document that people would have to sign in advance under Clause 3 with the signing of a will. Pressure, she rightly said, can be put on people to sign or not to sign in favour of this or that person—just as pressure can be put on them in the matter of this declaration. The fact that you can put pressure on the signatory of a will to his or anyone's detriment is surely no good reason in favour of admitting another kind of document to which the same principle could be applied. There is an interesting distinction between the declaration, which is made earlier in life, and a will which, admittedly, may be made at the same time. The will takes place after death, the declaration takes place before. Death is something of a dividing line. We ought not to compare the two things. Furthermore, you can contest a will; but not the other declaration, for you are dead.

Lord RAGLAN

My Lords, I do not mean to be offensive, but I cannot hear what the noble Earl is saying. Will he be so kind as to speak up a little?

The Earl of CORK and ORRERY

The noble Lord's request reminds me of an occasion when my uncle said in this House: "I cannot hear what the noble Lord is saying. Will somebody sitting next to him tell me whether it is worth while to complain?". My noble friend Lord Aberdare can hear me. I am sorry, I will speak up. Perhaps there is something wrong with the sound system.

My Lords, it is invidious to pick out speeches at the end of a long debate. I have picked out one and I think nobody could have failed to be moved and impressed by that of the noble Baroness, Lady Wootton. The other—and I hope that nobody else is going to be offended—was that of the noble Lord, Lord Raglan, who to my mind produced an excellently argued case in favour of sending this Bill to a Select Committee if it gets a Second Reading. That is the apotheosis: if it should do so. I approve of that argument. I think there is an excellent case for sending it to a Committee. I think the case was extremely well argued and was supported by the noble Lords. The only thing is that I do not think there is any case for letting this Bill have a Second Reading. I think that we are back to where we were at the end of the debate on the noble Lord's own Bill when the noble Lord, Lord Merthyr, produced the same Motion without warning—although the noble Lord, Lord Raglan, had put it on the Order Paper—for the same purpose.

My answer is the same as it was then. Certainly we should have an inquiry into all the matters, an inquiry of the deepest kind, designed to discover whether you can draft legislation of this kind in this field. I do notbelieve you can, but I think it would be excellent for some more authoritative answer to be given. One might well arise out of some inquiry. But an inquiry by a Select Committee would be by a Select Committee on this Bill.

By the time the Select Committee met, this Bill would have had its Second Reading and the fact would have been published in the newspapers. The message from this House and Parliament would be exactly the message that I said ought not to go out. Whether or not the Bill ever becomes law it would already have been said by Parliament that we need a Bill of this kind because the medical profession are not doing their job. This would cause pressures on old people and create fear. The noble Baroness is not correct in saying that nobody took up her point—I forget for a moment her words.

Baroness WOOTTON of ABINGER

My Lords, this was factual evidence that drugs are not adequately used. I quoted a number of cases.

CONTENTS
Aberdare, L.	Greenway, L.	Peddie, L.
Amherst of Hackney, L.	Grenfell, L.	Penrhyn, L.
Amulree, L.	Harvington, L.	Perth, E.
Barrington, V.	Hawke, L.	Phillips, B.
Berkeley, B.	Hornsby-Smith, B.	Pitt of Hampstead, L.
Beswick, L.	Hunt of Fawley, L.	Rankeillour, L.
Broadbridge, L.	Hylton, L.	Reading, M.
Brock, L.	Hylton-Foster, B.	Robertson of Oakridge, L.
Brougham and Vaux, L.	Iddesleigh, E.	Rochester, Bp.
Cathcart, E.	Ingleby, V. [Teller.]	Russell of Killowen, L.
Clifford of Chudleigh, L.	Kinloss, Ly.	St. Aldwyn, E.
Coleraine, L.	Lauderdale, E.	St. Helens, L.
Colville of Culross, V.	Lindsey and Abingdon, E.	Salisbury, Bp.
Cork and Orrery, E. [Teller.]	Long, V.	Sandford, L.
Craigmyle, L.	Lothian, M.	Sempill, Ly.
Cullen of Ashbourne, L.	Lyell, L.	Shepherd, L. (L. Privy Seal)
Darcy (de Knayth), B.	Lytton, E.	Somers, L.
Denham, L.	Macleod of Borve, B.	Stamp, L.
Derby, Bp.	Masham of Ilton, B.	Strabolgi, L.
Durham, Bp.	Monck, V.	Sudeley, L.
Eccles, V.	Monckton of Brenchley, V.	Swinton, E.
Elles, B.	Mowbray and Stourton, L.	Vivian, L.
Elton, L.	Newall, L.	Ward of North Tyneside, B.
Erskine of Rerrick, L.	Norfolk, D.	Wells-Pestell, L.
Falkland, V.	Northchurch, B.	Wigg, L.
Falmouth, V.	Norwich, Bp.	Windlesham, L.
Gainford, L.	Oxford and Asquith, E.	Young, B.
Gladwyn, L.	Oram, L.	Younger of Leckie, V.
Goronwy-Roberts, L.

The Earl of CORK and ORRERY

My Lords, not much was made of this point but it was not glossed over. I admitted—and it will appear in the Official Report—that there are cases where pain is not controlled as well as it might be. The noble Baroness put it more strongly; I concede she is entitled to do so. This is a lack of education and knowledge. But the knowledge is spreading and will continue to spread, and any authority which could be given by Parliament should be placed behind the spreading of the knowledge, whereas to enact a Bill in this field can do nothing but harm. I ask your Lordships to agree with me. This debate has been a long one and we might now bring it to an end and go home. The recommended way is to follow me through the Division Lobby, my Lords.

8.32 p.m.

On Question: Whether the said Amendment shall be agreed to?

Their Lordships divided: Contents, 85; Not-Contents, 23.

Seear, B.	Stow Hill, L.	Wootton of Abinger, B.[Teller.]
Segal, L.	Vernon, L.
Shackleton, L.	White, B.	Wynne-Jones, L.

Resolved in the affirmative, and Amendment agreed to accordingly.