HL Deb 16 February 1993 vol 542 cc991-1007

3.6 p.m.

The Lord Privy Seal (Lord Wakeham)

My Lords, I beg to move the Motion standing in my name on the Order Paper.

The House will recall that, in approving the report from the Liaison Committee on 7th December, the House agreed in principle that an ad hoc committee should be established to consider the subject of euthanasia. Since then, consultation has taken place to establish appropriate terms of reference for such a committee. The Liaison Committee has itself now proposed to your Lordships the terms of reference on the Order Paper today. A number of amendments have been tabled to those terms of reference. It may be for the convenience of the House if we debate all the amendments together when the noble Lord, Lord Stallard, moves his first amendment and that at the same time your Lordships might raise any general points which may assist the committee in its deliberations. The questions on each amendment can then be put after our debate.

Perhaps I may add a word or two of explanation. First, I should like to stress that the establishment of this committee should by no means be taken to imply that any change in the law is intended. I realise that opinions on all sides about this sensitive subject are very strongly held. There is no question but that the House would wish to respect those views, and if I may speak for a moment as a Member of the Government, I know that my colleagues are equally sensitive to the legitimate worries which exist. But recent events—and I am obviously thinking in particular of both the case of Anthony Bland and the conviction of Dr. Nigel Cox—have shown that the question of what we expect from doctors and those placed in a position of care, and the appropriate response to such expectations, raise fundamental questions for all concerned, not least in the light of continuing developments in medical technology and the care of the terminally ill. It is therefore my hope that the committee might provide a forum for serious and thoughtful consideration of the range of difficult issues encompassed by its terms of reference, and that its report, supported by the evidence which it will no doubt wish to receive, will provide a focus for informed public debate. It is my understanding that, in this country at least, no such wide-ranging study has ever been undertaken at this level.

The terms of reference which I am now proposing to your Lordships, on behalf of the Liaison Committee, have deliberately been drawn widely to enable the committee to consider a variety of circumstances in which patients, doctors and others are called on to make decisions of great sensitivity. I realise that this is a matter of concern in particular to the noble Lord, Lord Stallard. But I suggest that the committee's remit should be broad, and should in particular cover not only euthanasia as commonly understood—that is, the commission of an act which may be expected to shorten life—but also circumstances in which treatment can legitimately be withheld—that is, the omission of an act which might prolong life. The reason for this is that, although cases differ, the underlying ethical and moral questions of administration and omission of medical treatment are, I think, similar; and it would be regrettable to limit the committee to consideration of any one set of circumstances.

I would particularly point out that the terms of reference are broad enough to allow consideration of the kinds of circumstances which were recently the subject of the judicial appeal to the House in the case of Anthony Bland and which some members of the Appellate Committee specifically suggested might with benefit be considered by Parliament. They also allow for a wider consideration of separate arguments for and against so-called "mercy killing" that different cases have provoked.

The terms of reference have also been drafted so as to enable the committee to consider so-called advance directives, or living wills—by which people may express in advance views as to the sorts of treatment that they would or would not wish to receive in the event that they were no longer able to give or withhold consent. I understand that a Private Member's Bill on advance directives, and indeed a further Private Member's Bill on the termination of medical treatment, are currently being considered for introduction to your Lordships' House. It would certainly be open to the House to refer such Bills to the committee after Second Reading, should that be thought desirable.

Lastly, perhaps I could say a word about the timetable for the committee's deliberations. I am sure that your Lordships would agree that it is preferable that the committee should itself determine its timetable. I hope, however, that the committee may be in a position to report to the House by the end of this year; too long an inquiry can lose its momentum and topicality. I beg to move.

Moved, That a Select Committee be appointed to consider the ethical, legal and clinical implications of a person's right to withhold consent to life-prolonging treatment, and the position of persons who are no longer able to give or withhold consent; and to consider whether and in what circumstances actions that have as their intention or a likely consequence the shortening of another person's life may be justified on the grounds that they accord with that person's wishes or with that person's best interests.—(Lord Wakeham.)

3.12 p.m.

Lord Stallard moved Amendment No. 1, as an amendment to the Title of the Motion: Leave out ("Medical Ethics") and insert ("Euthanasia")

The noble Lord said: My Lords, before speaking to my amendment I must state what is obvious. I am not legally qualified, nor do I speak as a member of the Bar. I am not medically qualified so I do not speak as a physician. I am a simple layman. Perhaps at another time and when adequate transport schemes were available I would have been called "the man on the Clapham bus". In the absence of the Clapham bus, I do not know what the current term would be.

I share with ordinary folk, of whom I know many and from whom I have received thousands of letters, their confusion, their worry, their suspicions, their cynicisms and many other problems that they consider to be involved with the whole question of euthanasia—call it what we will at this moment. I share their anxiety about the need for adequate safeguards (and that is a big subject) not only for patients, but also for relatives and the medical profession—the doctors and nurses involved in the whole situation. There are millions of people who doubt the moral rectitude of the proposals in the first instance.

Amendment No. 1 seeks to leave out "Medical Ethics" and insert the word "Euthanasia" as the title of the Motion. That is to make sure that both the House and the public are in no doubt as to what the committee will be considering. It may be helpful to recall the history. On 24th November 1992 the Liaison Committee recommended, under paragraph 8 of its First Report, that an ad hoc committee be set up to discuss euthanasia. That was to be the title of the Motion.

Members submitted their names to the Whips' Office to serve on the committee. When the proposals to establish a committee were being discussed the Leader of the House told us that flexibility in all matters was the order of the day. It seems to be stretching flexibility a bit too far when we go from the title that had been agreed by the House as "Euthanasia" and broaden it to the extent that it will deal with a whole range of medical ethics. That is a big subject. If we were to table amendments to that title, I do not know where we would stop.

It may be that we could suggest for discussion in that wider title the question of sex selection. Medical ethics must come into that. If that was tabled as an amendment, would it be accepted or discussed? What would be the position? After all, the title is "Medical Ethics". The public do not want the debate to be fuzzed; they do not want the real issue to be lost.

I understand and accept that the Law Lords' judgment mentioned by the noble Lord in his opening remarks pointed to a number of grey areas in the law as it stands. They suggested that legislation may be needed to tidy up various aspects, as they saw them, proceeding through the course of the judgment. But this seems to be a rushed effort to change the title and change the emphasis. It is an effort to give that judgment further support so that the Law Lords can be satisfied with regard to those difficulties.

I have heard it said, and read, that it is perhaps also to help the Government and the authorities out of a difficulty. I understand that there are over 1,000 outstanding cases similar in many respects to the case discussed by the Law Lords. I understand also that it costs £40 million a year to keep those people alive. It may be cynical, but it may be said that that is another good reason for the present Government, with their services, cost-cutting and everything else, to be attracted to a debate wide enough to cover the whole area. We were promised a debate on euthanasia and that is what it should be.

The noble Lord also said that a widely accepted definition of euthanasia is the intentional killing by act or omission, or both, of a person whose life is felt not to be worth living. But matters of life-prolonging treatment and the shortening of another person's life are best described by the term "euthanasia"—the original term. In my view there should be no confusion as to what the committee is considering. If it starts with a confused title and a title that is capable of provoking argument, then it will not have a good start. Everybody in the country will understand what is meant by "euthanasia", whatever their fears or views.

My views are well known. I will not support euthanasia and I do not hide that view for a moment. However, I would welcome a debate on euthanasia so that all the points may be put, and that would be a different debate from the one that would take place on the broad platform of "medical ethics". Somebody said that the title does not matter as long as the terms are accurate; but it does matter. The title is definitely "Euthanasia". That is the title we were promised; it is the title we expect. Certainly the other title has never been discussed by the House. It has never been brought back and said that the Standing Committee, the Select Committee, the Liaison Committee, the normal channels or anybody else has decided that we should change the recommendation in paragraph 8, which is quite clear. It said that an ad hoc committee should be set up to discuss euthanasia. It did not mention medical ethics. There were sufficient medical people present at the time to have brought up medical ethics if that is what they meant, but they did not. There was obviously a lot of clarity on their point, as there is on mine, as to the meaning and reasons for the debate. I beg to move.

Lord Harmar-Nicholls

My Lords, I do not know whether it was accidental but my noble friend the Leader of the House seemed to agree with the amendment moved by the noble Lord, Lord Stallard. When he moved his Motion a few minutes ago, instead of using the words "legal and clinical implications" in the Motion, he referred to euthanasia. As he wanted to make himself clear to the House he used a word which seemed to encompass all things. Later on he seemed to suggest that the words which he had not used covered a wider area that ought to be discussed. There seemed to be a little confusion. If in order to be clear he thought fit to use the word "euthanasia", why not have that word as proposed in the amendment?

The Archbishop of York

My Lords, perhaps I may suggest that the amendment should be rejected. One of the problems in this whole area is that all language is loaded. The word "euthanasia" is itself an ambiguous term which has been used in a wide variety of senses. It seems to me, therefore, very much better to leave the Select Committee with a wide brief which is clearly set out in the statement about it but with a title which does not assume any answer to precisely what the word "euthanasia" means.

Lord Jenkin of Roding

My Lords, I venture to agree with the most reverend Primate. I do not think that the suggested amendment is the right one. Some few years back I was asked to conduct an investigation into the working of a body called the Institute of Medical Ethics. I think that I was invited to do this because it was felt that I did not know a great deal about it and could come to it with a fresh mind. Most of the subject of my investigation is not for this occasion, nor, I suspect, for this House. As I met the people who were concerned with and involved in writing about, studying, researching and publishing information about medical ethics I became aware of the enormous importance of the subject not just to the practitioners—the doctors who are primarily concerned—but to everyone.

As medical science has advanced over recent years the opportunities open to make decisions about the treatment of patients have greatly enlarged. I believe that "medical ethics" is exactly the right term. But we are not inviting the committee to look at the whole of medical ethics. That would indeed be an impossible task. My noble friend's Motion seems to express exactly the ambit which we are inviting the committee to investigate. To label it at the beginning by calling it euthanasia, as the noble Lord, Lord Stallard, suggests in his amendment, would to my mind prejudice the inquiry because, with the greatest respect to the noble Lord, a whole lot of what this inquiry is about would not by any stretch of the imagination be called euthanasia. It would have the effect of limiting the debate and perhaps alarming those who might be expected to give evidence.

To my mind "medical ethics" is a title which is well understood by many of those who are involved in the study, practice and teaching of medical ethics. As a result of the work of the Institute of Medical Ethics there is now a medical ethics committee in every medical college in this country. The Motion has exactly the right title. Like the most reverend Primate, I hope that we reject the amendment.

Lord Tordoff

My Lords, perhaps I may intervene very briefly with regard to the standing of the first amendment. The Motion before us does not contain the words "medical ethics". That is a headline which has been put on by other parts of this organisation. Indeed, the words "medical ethics" do not occur in the Motion. It therefore seems to me that the first amendment is totally out of order.

Lord Elton

My Lords, I wonder whether my noble friend can guide us further. At the start he invited us to address ourselves to all the amendments together and to matters generally. We are now well into a very neat and apposite debate on the first amendment only. I wonder whether it would be in order to deal with the first amendment before we go on to the others.

Lord Jenkins of Putney

My Lords, I wonder whether it would be possible for someone who supports the mover of the amendment to say so. Everyone else seems to be opposed to the amendment. In my view the noble Lord the Leader of the House is well disposed towards the amendment. I may be wrong about that but I think he is rightly so well disposed for this reason. The words "medical ethics" are quite contradictory. This is not only about medical ethics. It is not, however, about the wider issue of ethics. If the words "medical ethics" are there one starts by being totally contradictory even in the title. If one reads the body of the amendment one finds that it is not about medical ethics at all. It is wholly and entirely about the subject of euthanasia. Therefore, we should not run away from the issue and pretend that by calling it euthanasia we are, as it were, predicting what the result will be. I am entirely opposed to my noble friend. He is against euthanasia. I am for it. But I agree with him that that is the subject the amendment should be about. We should call a spade a spade.

The Earl of Halsbury

My Lords, are we not becoming confused about naming? What is "medical ethics" the name of? Is it the name of our proceedings this afternoon; is it the name of the Motion that we are asked to pass; or is it the name of the committee which is set up by the Motion? What we are asked to pass is a Motion which tells exactly what "medical ethics" mean from the standpoint of the committee that we are setting up.

Lord Alport

My Lords, I hope that these amendments will not be pressed. The Motion covers immensely adequately the difficult problem that the Select Committee is being asked to consider and gives it full scope in so doing. In its present form it will be warmly welcomed by many members of the medical profession, particularly those specialising in the problems of old age and extreme disability. The investigation is long overdue. A Select Committee of your Lordships' House is a most appropriate form and far better than the alternative, which would be an expensive and cumbrous Royal Commission. I very much hope that the Motion will be approved and that the amendments will not be pressed.

Lord Ashley of Stoke

My Lords, I am one of those people who wants to make progress on this whole issue but I want to move very slowly and very carefully because it is one of immense complexity. It is not black and white, but if we use the word "euthanasia" it becomes black and white. That is entirely the wrong way to go about it. The amendment is misconceived. The Motion from the Leader of the House will give the Select Committee an opportunity to consider all these complex issues. It would be quite wrong merely for the Select Committee to confine itself to the black and white issue of euthanasia when the subject is very complicated and all these complex issues need to be examined.

Lord Stoddart of Swindon

My Lords, I wish to support my noble friend Lord Stallard because already we find that the whole issue has been widened. Originally the Liaison Committee recommended that there should be some form of committee to discuss euthanasia but already the issues to be discussed by the Select Committee have been widened. They have been widened to include the implications of the Cox case and the Bland case which are nothing at all to do with euthanasia. Therefore, it is incumbent on this House to consider exactly what it is doing. To be fair to the Liaison Committee, it was dealing with a particular situation whereby a number of Bills were expected to come before the House dealing with euthanasia and nothing wider than that. Therefore, its recommendation was for a committee to consider that particular matter.

At this stage it would be wrong for the House to widen the terms of reference. I disagree profoundly with the noble Lord, Lord Alport. The wider implications are not for this House to consider. There are many more implications to be considered than this House can deal with. The proper manner in which to conduct that investigation is through a Royal Commission and not through a committee of this House. That is the only way in which the mass of problems which have arisen over a number of cases can be dealt with. Therefore, I hope that for the sake of complete clarity the House will agree to the amendment which has been moved by my noble friend.

3.30 p.m.

Lord Richard

My Lords, as a Member of the Liaison Committee and one who supports the Motion on the Order Paper, perhaps I may make three very brief points. First, I do not believe that the title as set out in the Motion on the Order Paper makes a scrap of difference to the way in which the committee will either be set up or to the way in which it will operate. What is important are the terms of reference, which are clearly set out in the Motion.

Secondly, we are told that there are difficult and delicate issues of medico-legal ethics to be considered arising from the Cox case or the Bland case. I am sure that that is true. If it is true, as my noble friend Lord Stallard said, there would be a thousand cases of that sort in existence which need to be considered. My reaction is that it is right that the committee should get on and consider them and not say that they are issues which the committee should not consider. Even if one calls it euthanasia and one has narrowed the terms of reference to that point at the present time—I understand from my classical friend that euthanasia merely means a peaceful death—the issues are bound to spill over into the difficult questions of where the doctors draw the line and when they have the right, to withhold consent to life-prolonging treatment which are precisely the words in the Motion on the Order Paper.

Although I entirely understand the motives behind my noble friend's amendments and deeply respect the views that he holds on the issue, I believe that the terms of reference are clear. When the committee is set up it will have a clear job of work to do. It is one that needs to be done. A Select Committee of this House is probably the best way to do it at this stage. I hope that the House will support the noble Lord the Leader of the House.

Lord Ennals

My Lords, I shall be brief. We are presented with two choices of title, neither of which is appropriate. "Medical Ethics" is far too wide and "Euthanasia" is far too narrow. If we agree with the terms of reference as set out in the Motion, why do we need to include the words "Medical Ethics" in advance? A title is not required because it is contained in the terms of reference.

The Earl of Cork and Orrery

My Lords, at the risk of seeming to change the subject, perhaps I may say something about my own amendment. I confess that I do not feel deeply moved whether we call this Motion one thing or the other. The noble Lord, Lord Ennals, has just said that we are really talking about the terms of reference and nothing else.

My amendment proposes to remove from the terms of reference the concluding reference to "that person's best interests", and to do so on the grounds that the words "best interests" are not only misleading but dangerous. That is not in a general way, of course, or even in the generality of cases, but in the special case of the patient who is in what is known as the "persistent vegetative state", which is of the type which affects Anthony Bland. That it is impossible to ascertain what is or might be in the best interests of such a person is immediately obvious as there is no way in which he can make his feelings or his wishes known.

Here I would like to quote from the judgment in that case given by the noble and learned Lord, Lord Mustill. He is speaking of the mental anguish and suffering of the patient's relations and not of the patient himself. He said: But it seems to me to be stretching the concept of personal rights beyond breaking point to say that Anthony Bland has an interest in ending these sources of others' distress. Unlike the conscious patient he does not know what is happening to his body, and cannot be affronted by it; he does not know of his family's continuing sorrow. By ending his life the doctors will not relieve him of a burden become intolerable, for others carry the burden and he has none. What other considerations could make it better for him to die now rather than later? None that we can measure, for of death we know nothing. The distressing truth which must not be shirked is that the proposed conduct is not in the best interests of Anthony Bland, for he has no best interests of any kind". It would not seem unreasonable for anyone faced with such a case, to begin imagining on the patient's behalf that death was the best thing that he could hope for, because … or, on the other hand, that life was the best thing, because … But, my Lords, because what, in either case? To answer that question with any certainty it would be necessary to understand what really was represented for the patient by the alternatives of life and death. How can that be done if we do not know what death is like?

Various questions suggest themselves at once, all of them more or less unanswerable. For example, is there or is there not any kind of survival beyond the grave? If there is, what is likely to be the effect, if any, on the newly departed who has been deprived of the possibility—or is it perhaps a right?—to die as a result of the ordinarily hostile forces of nature? What we may believe or disbelieve about the answer to such questions is quite without significance. The simple inescapable fact is that we do not and cannot know.

From that it follows that if we decide that the best interests of the patient point to his death at our hands, we would be making a decision and performing a resulting action not in this world only, but also in a world that lies (or perhaps does not lie—who knows?) beyond the tenuous line that divides us from the unknown. In so doing we have crossed the boundary between the known intelligible and the unknown; the metaphysical world in which—and this is my contention—parliaments and debating chambers have no place.

Certainly it is within the human competence to make such decisions in individual cases. But to make a law about it, to enact by parliamentary decision that such-and-such an action may be taken in such-and-such a situation, is to arrogate to oneself the authority to act in the metaphysical world as well as the physical. To take a step as revolutionary as that—for I believe that no such step has been taken before—is to establish a precedent whose outcome we can hardly begin to imagine.

My amendment will very slightly widen the whole scope of the terms of reference, but to no detriment. Nothing has been removed except the Instruction to the committee, if it is set up, to consider something which I personally believe should not be considered.

Lord Robertson of Oakridge

My Lords, I should like to speak to Amendment No. 4, but before doing so I offer a word of caution about something that we have already touched on. I refer to the warning "Beware of euphemisms". When discussing ethical questions, we always seem to meet expressions which replace the usual phrases with bland and sometimes misleading alternatives. "Abortion" becomes "the termination of pregnancy" and the "embryo" becomes the "pre-embryo". I fear that I could never bring myself to say, for example, that King Charles I had his life "shortened" in Whitehall, because that sounds rather as if he was overworked by his civil servants rather than that he was beheaded.

I seek now to establish the need for my amendment. As they now stand, the terms of reference of the Select Committee are focused on the rights and needs of individuals. That is good as far as it goes, but if we leave it there we may well end with a situation in which the law and medical practice are based on the needs of a number of hard cases and ignore the effect of any changes on society as a whole. In recent times, we have seen how seemingly modest changes in the law have led, for better or for worse, to drastic and far-reaching changes for society. One only has to think of changes in the law on abortion, homosexuality or even divorce.

It is absolutely vital that the Select Committee should seek answers to the following questions in relation to any proposed changes to the law or to medical practice. Of course, it is not an exhaustive list. First, what would be the effect on the relationship between doctors and their patients? What would be the effect on family relationships? How does one compare the removal of the fear of a distressing and lingering death with the insecurity of fearing that one's family may be plotting one's death illegally? Perhaps most important of all, how would the proposed changes alter the value accorded by society to human life?

As they now stand, the terms of reference would not require consideration of those or similar questions and might even be held to exclude them. Furthermore, the Motion has been drawn up in such a way that consideration of ethical, legal and clinical implications applies to the first part of the Motion only. The Motion continues: and to consider whether and in what circumstances actions that have as their intention or a likely consequence the shortening of another person's life". That part is not affected by or tied up with the concept of ethical, legal and clinical implications. My amendment would ensure that it is, and that that is considered by the Committee. My amendment therefore seeks to ensure that consideration should be given to the effects of the proposed changes on society as a whole.

Lord Wigoder

My Lords, perhaps I may return for a moment to the question of the title of the committee. I agree with three propositions that have been advanced in your Lordships' House. The first is that the term "Medical Ethics" may not be entirely appropriate. The second is that the term "Euthanasia" may not be entirely appropriate. The third is that the title of the committee is not in itself a matter of the slightest consequence. Perhaps I may suggest to the noble Lord the Leader of the House that what we should do today is agree the terms of reference, then set up the committee, and invite it to consider for itself what, for convenience, it wishes to be known as.

3.45 p.m.

Lord Simon of Glaisdale

My Lords, in my respectful submission, the terms of this Motion, carefully drawn by the Liaison Committee, should be adhered to for three reasons in addition to or repeating those that have been advanced. The first is that "euthanasia" is a highly emotive word which might appear to prejudge consideration by the committee. The second is that it raises wide issues in its widest sense. One has only to consider the views which the Home Office has put forward when the matter has been raised in your Lordships' House. I entirely agree that in its widest issue it demands the consideration of a Royal Commission, both on precedent and on principle. The third is connected with that. The medical profession needs general guidance pretty quickly—as quickly as possible. In the meantime, it has been laid down by your Lordships' Appellate Committee, in a report accepted by your Lordships, that every case of this nature, such as the Bland case, must be brought before the courts. I very much hope that, as a result of the speeches that have been made, your Lordships will agree to this Motion.

Baroness Platt of Writtle

My Lords, perhaps in the light of the public controversy raised by various recent legal cases on this subject it may be necessary for the House to consider this matter, as my noble friend the Lord Privy Seal has just stated. He has also invited us to make general points this afternoon. I hope that the composition of the committee will be very carefully considered so that it includes experienced doctors and lawyers and, considering the religious aspects of the matter of life and death, a senior Bishop.

There is disagreement this afternoon on the definitions of "medical ethics" and "euthanasia". For me, that is a very fine line. As the patron of our local hospice, which, together with hospices all over the country, has done such excellent work on the relief of pain and the preservation of the dignity and quality of life of terminally ill patients, I am against euthanasia or mercy killing or whatever it is called. It seems to me to lie at the top of a slippery slope which could lead to most undesirable consequences in the future.

I was a member of the Select Committee on Murder and Life Imprisonment of this House, and we deliberately decided not to make recommendations on mercy killing. I remember then receiving correspondence from the medical profession, particularly the hospice movement, stating their opposition on the matter. I have received further correspondence on that point in relation to this committee. I also recollect receiving some evidence stating that elderly people in the Netherlands, where euthanasia is not frowned upon, were often very fearful on entering hospital that they would not receive the full treatment that they desired as they might be regarded as a poor risk or, indeed, so elderly as to be hardly worth trouble or expenditure.

Some years ago, as a member of a local rural district council, we had requests from the grown-up children of tenants that, as their parents grew elderly, the tenancy should be registered in their name to give them security of tenure on the death of their parents. To begin with, we acceded to this, but found that in some places there was a subsequent change of attitude by the young people so that the elderly parents felt unwanted in their own homes. As a result, we changed our policy.

This is the sort of slippery slope to which any loosening of restrictions on euthanasia could lead. It is very difficult for any unqualified person to know when any other person's pain is too much to bear or when that person's hope for any future quality of life is non-existent. To discuss that would require supra-human qualities.

I hope, therefore, that the committee will consider the matter very carefully indeed, not only from the point of view of a few hard cases (which make bad law anyway), but much more from the point of view of the positive care that frail and elderly people need, even when terminally ill. Modern miracles are always possible and, indeed, happen in hospices today in ways that we could not have imagined only a few years ago.

Lord Monkswell

My Lords, I thank the noble Lord the Leader of the House for the way he introduced this debate. He was eminently sensible in saying that we should consider all the amendments together, have a debate, and then make a decision on each one. We have now heard from the movers of all the amendments before us and I should like to compliment each on the way in which he moved his amendments. I thank also my noble friend the Leader of the Opposition for the way in which he explained the dictionary definition of the word "euthanasia". I think that he said that it meant a peaceful death. We are effectively starting a debate on the whole subject which I hope we all agree should end in a peaceful death for every one of our citizens and, eventually, ourselves.

Perhaps I may mention each of the amendments—

Noble Lords

No!

Lord Monkswell

My Lords, when I first saw the title "Medical Ethics", I thought of two things: Depo-Provera and transplants. However, they are not included in the Motion. We therefore have a problem with that description. I agree with my noble friend Lord Stallard that the word "euthanasia" is understood, understandable and explicit. However, I would not go so far as to support his second amendment, because it would make the Select Committee's work too restrictive. We must give the Select Committee the widest terms of reference when it deals with this important subject. I support the amendments tabled by the noble Earl, Lord Cork and Orrery, and the noble Lord, Lord Robertson of Oakridge. I hope that the committee will automatically take note of what happens in other countries, as provided for in the rider added by my noble friend Lord Stallard.

My father was a general medical practitioner. He faced the decisions about which we are talking day in and day out. So I have a little experience of the difficulties that the medical profession faces. We have all known the deaths of friends or relatives from various different causes. I am sure that we all wish everyone to have a peaceful death. For those reasons, I support some of the amendments, but not all of them.

The Lord Bishop of Chester

My Lords, I support the amendment tabled by the noble Lord, Lord Robertson of Oakridge. It helps to amplify the committee's terms of reference to include the social consequences of the issue. To ignore them would be a grave omission in the committee's work. Euthanasia has sometimes been described as a middle-class issue. It is said that what can be discussed to the music of Beethoven in Virginia Water will sound very different in a tenement block in Tower Hamlets. There is considerable fear of the persuasions that will be brought to bear upon people as they may move towards Alzheimer's disease or something of that kind in the less affluent areas of our nation. Because the social consequences could be considerable, not just in that area but, medically, on doctors, nurses and so on, I hope we will include that amendment as part of the Select Committee's terms of reference.

Lord Ashbourne

My Lords—

Noble Lords

The Leader of the House!

Lord Wakeham

My Lords, we have had a good debate on all the amendments, and I shall do my best to reply. I find the greatest difficulty in knowing what to say about the first amendment relating to the name of the committee. I find myself in the "Lord Tordoff" school of thought: that the title just emerged somehow from some part of the House. Nevertheless, there is an amendment to the title. If those who chose the name are told by the House that they should change it, then I am sure that they would willingly change it in accordance with the wishes of the House.

Having been a Minister for a fair number of years, I hoped that I was going to receive some guidance. I received a piece of paper but it repeats the question rather than giving me the answer that I want.

Lord Stallard

My Lords—

A noble Lord

Let us carry on.

Lord Stallard

I am sorry to hear the remark from behind the noble Lord the Leader of the House. The proposed title was not my suggestion. The Liaison Committee made a report to the House. It was the First Report of Session 1992–93, which was ordered to be printed on 24th November 1992. Paragraph 8 did not say what I said. It said: Euthanasia; we recommend the appointment of an ad hoc committee to consider the subject of euthanasia". We have heard speeches about the title being wrong and whether it matters. One noble Lord said that it does not matter. Does the noble Lord the Leader of the House accept that we have moved from the recommendation which was accepted by the House and that we should not now try to justify that change by some spurious means?

Lord Wakeham

My Lords, the noble Lord is absolutely right. I am proposing to do my best to do that. I was dealing with the title. It was then my intention to move to the more substantial points made by the noble Lord.

I wish to say one other important thing. I should like to stress at the outset that it is entirely a matter for the House whether it wishes to accept the amendments. I am sure, however, that the points raised in the debate will guide the committee in its deliberations on this difficult issue. We can look forward to debating the issues fully when the report is published. It will be important for the committee to consider the speeches made in this debate when it is studying the matter.

Let me say a word about the amendments tabled by the noble Lord, Lord Stallard. It may be easier to understand their impact if I read out the effect that all three amendments would have if taken together. They would produce the following result: Euthanasia—to consider the ethical, legal and clinical implications of the availability of life-prolonging treatment, the duty of doctors to care for patients, and the question of voluntary, non-voluntary and involuntary euthanasia; and to take account of the practice of euthanasia in the Netherlands". The House will be aware that if it accepts the amendments that would limit the committee merely to considering euthanasia and would exclude wider issues such as those raised by the Anthony Bland case. It is of course true to say, as the noble Lord said, that the House agreed originally to the proposal from the Liaison Committee to establish a committee on euthanasia. However, I should also point out that in the Liaison Committee's report reference was explicitly made to the likely introduction of two Private Members' Bills, one of which relates to so-called advance directives.

If your Lordships were to agree to limit the terms of reference, as now proposed by the noble Lord, Lord Stallard, that would rule out the possibility that the Liaison Committee always had in mind of enabling such a committee to look also at advance directives. Moreover, since the House agreed to the Liaison Committee's report in December, judgment has been given by the House, in its judicial capacity, in the recent and sad case of Anthony Bland. Members of the House will be aware that some members of the Appellate Committee urged in their judgment that Parliament should investigate the issues to which that case gave rise.

In my view, and, I believe, the view of the other members of the Liaison Committee, it would be unfortunate to exclude consideration of those issues or to decline to take up the invitation which those members of the Appellate Committee have issued.

Euthanasia, as defined by the Oxford English Dictionary means: Action of inducing a gentle and easy death". That is, it involves a deliberate act. The deliberate taking of life, even to relieve suffering, is murder. It is against the criminal law and medical ethics. Although the question of whether to discontinue the treatment of someone who is not benefiting from it is different, and is reflected as being different in the criminal law and under medical ethics, many of the underlying moral and ethical questions are the same. I therefore suggest that it would be unfortunate not to allow the committee to consider those issues during its inquiry. All the issues mentioned in the noble Lord's amendments are of course fully within the terms of reference of the committee that I have proposed.

I turn to the other amendments. Amendment No. 5 proposes that the committee should take account of the practice of euthanasia in the Netherlands. I believe that the committee will wish to take evidence about the practice in other countries. That will include not only the Netherlands but, for instance, the United States of America. I hesitate to recommend that your Lordships accept the noble Lord's amendment only because it might seem to single out the Netherlands to the possible exclusion of examples from other countries. I have no doubt that that was not the noble Lord's intention.

Amendment No. 3 was spoken to by my noble friend Lord Cork and Orrery. My noble friend expressed deeply held views which the whole House respects. I hope that he will not regard it amiss if I say that I am sympathetic to his anxieties. However, I believe that the effect of his amendment will be to broaden the scope of the committee's inquiry to embrace legal issues involving the nature of murder and manslaughter which go far beyond those which the House intends should be considered.

With regard to Amendment No. 4, which was spoken to by the noble Lord, Lord Robertson of Oakridge, it would be the intention of the House that the committee should look at the social implications of withholding or administering treatment which as a result might lead to a shortening of life. I confess that I had expected that the terms of reference that I proposed to your Lordships would be broad enough to enable the committee to consider the social implications of the issues. That said, it seems to me that the noble Lord's amendment is consistent with the spirit and the range of ad hoc committee inquiries in this House. I, for one, see no objection to amending the terms of reference in that way if that is the wish of the House.

I also agree with the noble Lord, Lord Robertson, that the terms of reference as drafted appear to limit the committee to considering the ethical, legal and clinical implications of the first limb of the terms of reference rather than to allow them to look at the implications of both limbs. I stress that it is certainly my expectation that the committee will look at the wider implications of withholding treatment and actions which may shorten a person's life.

Those are my views on the various amendments before the House. Of course, it is for the House to decide the way in which they are disposed of. As I said in opening, in its deliberations the committee will take careful note of everything that has been said in today's debate. Nothing that any noble Lord has said will be precluded from proper consideration. In those circumstances, the House may feel that the original Motion is correct.

4 p.m.

Lord Stallard

My Lords, I thank all noble Lords who participated in the debate and I am grateful for their excellent contributions. I also thank the noble Lord the Leader of the House for his comments. I am not entirely satisfied about the title because I stuck to the parliamentary procedure as laid down by this House. If I am guilty of not being too keen on Parliament's decisions I can live with that and accept it.

Amendment No. 2 was not fully discussed but was dealt with in great part by the noble Lord, Lord Robertson. Again, I welcome the acceptance of that by the noble Lord, Lord Wakeham. However, those points should have been included in the committee's terms of reference, which refer to the "person's wishes". The terms of reference do not mention the availability of equipment, life-saving treatment and the detailed understanding of the types of medical care available. They do not mention palliative medicine and advanced medical technology, nor do they mention the effects on society as a whole. The omission of such issues must have been deliberate because we all know about them. They could have been, and should have been, included in the terms of reference because we should know what the committee are to discuss. That is a point that I did not like too much.

I welcome the acceptance of Amendment No. 5, by the noble Lord the Leader of the House. I am happy that consideration should go beyond the Netherlands, which appeared to be the most recent outstanding example of a country which has adopted euthanasia and made it legal. It seemed a good point at which to start, but I should be happy if the committee wished to go wider and look at other countries.

I am not totally happy with the change of title nor with the omissions from the terms of reference. In those circumstances I wish to test the opinion of the House.

On Question, Amendment No. 1, as an amendment to the Motion, negatived.

[Amendment No. 2, as an amendment to the Motion, not moved.]

The Earl of Cork and Orrery had given notice of his intention to move, as an amendment to the Motion, Amendment No. 3: Line 6, leave out ("on the grounds that they accord with that person's wishes or with that person's best interests").

The noble Earl said: My Lords, I have no doubt that the members of the committee, when it has been set up, will take notice of what was said in your Lordships' House today. It may be that the small measures that I uttered will be noted by it; but that is a matter for the committee. I am well content and I shall not move my amendment.

[Amendment No. 3, as an amendment to the Motion, not moved.]

Lord Robertson of Oakridge moved, as an amendment to the Motion, Amendment No. 4: Line 7, at end insert ("; and in all the foregoing considerations regard is to be paid to the likely effects of changes in law or medical practice on society as a whole.").

The noble Lord said: My Lords, I am grateful to the noble Lords who supported the amendment. I am also grateful for the words of the noble Lord the Leader of the House. I should prefer to see the words on paper and absorbed officially into the terms of reference. Therefore, I beg to move.

The Deputy Speaker (Lord Alport)

My Lords, the Question is, That Amendment No. 4 be agreed to? As many as are of that opinion will say, "Content", to the contrary, "Not-Content". I think the "Contents" have it. Clear the Bar.

Division called.

The Deputy Speaker

My Lords, Tellers for the "Not-Contents" have not been appointed pursuant to Standing Order No. 51. A Division therefore cannot take place, and I declare that the Contents have it.

Amendment to the Motion agreed to.

[Amendment No. 5, as an amendment to the Motion, not moved.]

On Question, Motion, as amended, agreed to.

Lord Wakeham

My Lords, I think it might be helpful to your Lordships if I explain what happened for those who did not follow it. In my response to the noble Lord, Lord Robertson, I said that it seemed to me that the noble Lord's amendment was consistent with the spirit and range of ad hoc committee inquiries in this House, and I for one saw no objection to amending the terms of reference in this way. Therefore, when the noble Lord pressed for the opinion of the House, I for one was not prepared to oppose him, and that was the view that we took.

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