§ 9.5 p.m.
§ Lord McColl of Dulwich
rose to ask Her Majesty's Government how they view the practice of euthanasia in the Netherlands.
The noble Lord said: My Lords, I am grateful for the opportunity of discussing the current practice of euthanasia whereby Dutch doctors are allowed to end a patient's life intentionally if the patient agrees.
708 My first experience of the Dutch euthanasia law occurred when I visited the Netherlands as a member of the Select Committee on Medical Ethics, chaired by the noble Lord, Lord Walton of Detchant. The Dutch doctors told us:We agonised over our first case of euthanasia all day, but the second case was much easier and the third was a piece of cake".We found that rather chilling.
Further interest in the Dutch situation was fuelled by the BBC television programme, "Death on Request", which showed a Dutch doctor giving a lethal injection to a patient with motor neurone disease. The programme caused considerable public outrage, with over 100 Members in another place tabling a Motion criticising the BBC for screening it.
My own particular criticism of the programme was the rather puzzling statement by the Dutch doctor that his patient was likely to die from suffocation, but Dr. Nigel Sykes of St. Christopher's Hospice in Sydenham has cared for some 300 patients with motor neurone disease and not a single one has died from suffocation.
The television programme was hailed by the media and others as providing a strong case for legalising euthanasia, but in fact the programme was really an indictment of the poor hospice provision in the Netherlands. At the time of our visit to the Netherlands, there seemed to be only one hospice for the whole of that country.
The debate about the Dutch situation goes on. But I should like to draw the attention of the House to two points this evening. First, when the Dutch Parliament agreed to voluntary euthanasia for the incurably ill it failed to provide an adequate framework to prevent the slide towards non-voluntary euthanasia in spite of the dangers discovered two years before by the Dutch authorities. In 1991 the Dutch Government under Justice Remmelink established a committee of inquiry to find out the extent of the practice of euthanasia in the Netherlands. The committee was established by two government departments and consisted of three lawyers and three physicians under the auspices of Supreme Court Judge Remmelink.
The committee published its report in 1991. It showed that euthanasia had been practised on more than 3,000 people in 1990 and that in 1,030 cases there had been no specific request by the patient for euthanasia. Despite that report in 1991 which revealed that non-voluntary euthanasia was being widely practised, the Dutch Parliament ignored the facts and gave the green light to euthanasia.
The position has continued to deteriorate. Further evidence came to light in 1994 which revealed that not only was non-voluntary euthanasia being practised without prosecution in the Netherlands but that it was being practised on those who were not dying or incurably ill. In 1994 the Dutch Supreme Court heard that Dr. Chabot had assisted the death of a patient who had been suffering from depression. She had suffered a number of family tragedies and, not surprisingly, was in considerable mental distress. Contrary to the law, Dr. Chabot had assisted her to die and yet the Dutch 709 Supreme Court upheld his decision. Indeed, the legal advisers to the Dutch Medical Association welcomed the clarification and Dr. Chabot himself stated that what was needed was a test case involving people who were elderly or who had AIDS and wished to be killed even though they were currently healthy. Therefore, the slippery slope continued.
There is empirical evidence to show that the current practice of euthanasia in the Netherlands is out of control. Further academic confirmation of this is to be found in a book by Professor John Griffiths of the University of Groningen entitled Euthanasia and the Law in the Netherlands. He states that the system of regulation is not working. Doctors are not reporting cases of euthanasia that they are practising and this is confirmed by the conclusions of the Remmelink Commission which found that the number of reported cases of euthanasia was as low as 18 per cent. The interesting point about Professor Griffiths' findings is that he himself is in favour of euthanasia. He believes that it is now the time to legalise euthanasia, to have total decriminalisation and to see it as a form of medical treatment with doctors regulating themselves.
The full effect of the current situation was brought home to me following a meeting last week with a Dutch lady now living in the United Kingdom. She has a large number of elderly relatives in the Netherlands and members of the family are medical practitioners. She is informed and well educated about medical practice in the Netherlands. Last week she told me that her elderly relatives felt threatened by the current practice of euthanasia and worried that their lives would be ended without their consent. They felt betrayed by the Dutch Government for not protecting them.
My second point concerns the lessons that can be learned from current euthanasia practice in the Netherlands. There are those in this country who advocate that we embrace a similar statutory framework as that used in Holland. The current general secretary of the Voluntary Euthanasia Society, John Oliver, said in a recent magazine interview that he doubted that politicians would have the courage to change it themselves and they weretoo frightened of broad ethical debates and of pro-life groups accusing them of Nazi-style eugenics. Instead, change will probably come in the form of judicial review with the law being reshaped in the courts exactly as it was in Holland".The current statutory framework in the Netherlands developed as a result of a number of legal cases brought before the Dutch courts in the 1970s and 1980s. As a result of a number of lenient judgments, accepted medical practice in the Netherlands changed and, with the sanction of the Royal Dutch Medical Profession, the practice became acceptable. By the time parliament considered the matter in 1993, it was a case of attempting to shut the stable door after the horse had bolted.
Attempts are already underway to mirror the Dutch experience in this country. Indeed, the recent Lindsell case, which your Lordships debated in November, was a striking example of the pro-euthanasia lobby at work. The Voluntary Euthanasia Society financed the case in 710 which counsel, first, mistakenly claimed that there was a lack of clarity as to the criminal law and good medical practice in the palliative treatment of the terminally ill. Secondly, counsel suggested that the hospice movement was inadequate in treating motor neurone disease. Thirdly, counsel stated that conscientious doctors seeking to act in the best interest of the patients were left in a state of uncertainty and anxiety and were worried about being taken to court over their care of the terminally ill.
These claims are without foundation and simply confirm that the real purpose behind the Annie Lindsell case was to try to obtain permission—as set out in the first affidavit—to give an unlimited and unspecified dose of heroin, which could have resulted in her immediate death and would then have been hailed as the first legal case of euthanasia in this country.
Having discussed the case with a number of court sources, I remain concerned that the costs were not awarded against the Annie Lindsell team, despite a request to that effect from the Official Solicitor. In the debate last November, the noble Lord, Lord Lester of Herne Hill, stated that the judge rejected this cost order because he was so satisfied that the case was properly founded. My Lords, that simply is not true. Costs were not awarded against the Lindsell team because of her frail state and the possibility of a public outcry—
§ Lord McColl of Dulwich
My Lords, the evidence for that statement can be found through consultation with the President of the Family Division of the High Court.
§ Lord McColl of Dulwich
My Lords, perhaps the public might have thought differently had they known that the taxpayers were going to pay the expenses for a case that was completely unnecessary and had collapsed, as it was nothing more or less than a public relations exercise.
Anyone who earlier this year saw the ITV programme "Fighting for Dignity" could have been forgiven for experiencing a sense of déjà vu. It is apparent to me that the pro-euthanasia lobby has found its natural successor to Annie Lindsell; namely, Jane McDonald, who featured in the programme. It can only be a matter of time before a further challenge either through Miss McDonald or other cases intensifies pressure on the courts.
In conclusion, I have found the noble Lord, Lord Williams of Mostyn, very helpful on this subject in the past. I look forward to hearing the Government's views on the practice of euthanasia in the Netherlands and whether its practice is not a contravention of the 711 spirit of the European Convention on Human Rights. How can we be sure that what happens in Holland today will not happen in this country tomorrow?
§ 9.17 p.m.
§ Lord Jenkins of Putney
My Lords, I had doubts about whether the debate was appropriate. My fears have been renewed by the repetition of statements made on various occasions in recent years by the noble Lord, Lord McColl. The statements have been answered by various Dutch organisations. They have been gathered together and one can read them. I propose to present to my noble friend Lord Williams of Mostyn a copy of some of the refutations—there is a vast quantity—and I shall provide the noble Lord, Lord McColl, with a copy, too. I shall also place a copy in the Library so that noble Lords can read for themselves and make up their minds about whether this blanket condemnation of the entire Dutch system, which on the whole bears good comparison with our own National Health Service, is justified on this point.
I believe that the practice of voluntary euthanasia will develop and spread and will become accepted as anaesthesia is accepted today. In fact, we might improve its chances by calling it "permanent anaesthesia".
I have been presented with a distressing tale about the alleged scene in Holland, as have all your Lordships. My information, which I have reason to believe is reliable, is that the strong resemblance that this output has to that of the small Dutch group hostile to voluntary euthanasia is no accident. I would detail the reply, but there is no time for that to be done. As I say, I shall provide copies of it.
However, I shall mention one matter. I am not sure whether the noble Lord spoke of it this evening but I do not believe that he will disown it. This is a statement that in Holland, old people are frightened for their lives. The noble Lord will be familiar with that statement. There is absolutely no proof that that is true. That myth seems to have come partly from a survey carried out by the Dutch physicians league, a small association of only several hundred doctors who are against euthanasia. Only its own members were surveyed.
There is also no evidence to show that residents of nursing homes are terrified of being killed against their will. In fact, a report of the Dutch voluntary euthanasia society showed that euthanasia hardly ever takes place in residential homes. Every year, out of 55,000 patients in residential homes, about 300 ask for euthanasia. Of those, only 25 requests are granted. We shall hear later in the debate why that tremendous reduction takes place and why so many requests are refused. There is in fact obviously no reason for fears to exist.
I do not wish to defend everything in the Dutch garden and to say that it is all lovely. In this respect, the Dutch are pioneers and pioneers sometimes make mistakes. They often get into trouble. I look at the coming millennium with some trepidation. However, in that respect, I believe that permanent anaesthesia provides a way of removing some of the terrors of life in this frightening nuclear age of ours.
712 As I have said, I warmly welcome the debate because it has given me an opportunity to say once again that this is something which is beneficial to mankind and which will grow and spread. Over a period of time—and it will take a period of time—we shall succeed in overcoming the fears which I have no doubt the noble Lord, Lord McColl, holds sincerely but most of which, on examination, proved to be illusory. I believe that my time is almost up, but before I sit down I must thank the noble Lord for introducing the debate.
§ 9.23 p.m.
§ Lord Taverne
My Lords, I believe that the test of the quality of our civilisation is the degree to which we value human life. That means that we should be concerned with the value of lives to individuals and of life to individuals, not some abstract principle.
It is claimed and argued by the noble Lord, Lord McColl, that the Dutch do not in effect show proper respect for the value of life because they allow euthanasia if a patient consents to it. If the Dutch had abandoned or modified their respect for human life, it would be extremely uncharacteristic of them and would very much go against the admirable record which they have built up over centuries of respecting human rights. The Dutch have mostly been found to be at the forefront of progress towards more respect for human rights.
If one goes back to the 17th century, as has been recorded in that magnificent book by Simon Schama, Embarrassment of Riches, the Dutch at that stage were by far the most civilised nation in Europe. Indeed, they were the most tolerant of dissent; they provided a home and asylum for the Jews; they were far ahead in the recognition of women's rights; they believed in the rehabilitation of criminals, although by rather crude and primitive methods; they had the lowest degree of poverty and no malnutrition; and they even had democracy on their "men of war", their warships, instead of enforcing discipline by the lash.
Today, again generally, I am sure it would be agreed that the Dutch are noted as one of the most civilised of the European nations. They are noted for their low level of poverty; they have one of the best healthcare systems in the European Union; they have a high respect for law and civil liberty; they have a high degree of concern for the environment; and they perform a role as very responsible international citizens. I am not saying that they are unique among countries in that respect, but they are certainly one of the leading civilised nations.
It is argued that suddenly the Dutch have abandoned that enlightened attitude—these enlightened principles—because they have embraced euthanasia. I submit that the reverse is the case and that the Dutch have again shown the way which civilised society should follow and that, in practice, they show the highest regard for the value of human life because they give consideration to the individual and put it before abstract principle.
As the noble Lord, Lord Jenkins, pointed out, it is not true that anyone who requests to die can do so under the Dutch system; indeed, the majority of requests are turned down. I believe that the noble Lord gave us figures regarding people in residential homes. The 713 reason for that is that there are 10 very strict rules which apply. Those rules are accepted by the courts and have been accepted by the Parliament in that country. I should like to refer to eight of those 10 strict rules—the most important ones.
The first rule is that there must be a physical or mental suffering which a sufferer finds unbearable; secondly, the suffering and the desire to die must be lasting and not temporary; thirdly, the decision to die must be patient's own decision; and, fourthly, the patient must have a correct and clear understanding of his or her condition and the prognosis. The fifth rule states that there must be no other solution that is acceptable to the patient. The sixth rules states that the time and the way that the patient dies must not cause unavoidable misery to others—for example, the next of kin. The seventh rules states that the decision to help a patient die must be made by more than one person and that the doctor involved has to consult another professional. The eighth rule states that a medical doctor must be involved in the decision and in prescribing the correct drugs.
The noble Lord, Lord McColl, suggested that, having started on the process of voluntary euthanasia, the Dutch are now sliding down a slippery slope and that there is an increase in number of patients whose lives are ended without their consent. Of course, that is quite untrue. As I said, the matter has been examined by the parliament and the courts in the Netherlands and, after examination, they have thoroughly recommended the system, which has widespread support throughout the country. It is perfectly true that the Remmelink report in 1990 found, among a thousand cases, that in something like 0.8 per cent. of the total number of deaths euthanasia had taken place without the patient's explicit consent at the time. Incidentally, it also found that all these were cases where the matter had been discussed between the doctor and the patient, or where the patient had previously expressed the wish that life should be ended in those particular circumstances. When the matter was considered again some five years later, it was found that, far from this doctrine of the slippery slope, the actual number of cases in that category had actually declined; it had declined from 0.8 per cent. to 0.7 per cent. Compared with Holland (where voluntary euthanasia is strictly controlled and, therefore, accepted), it is worth noting that in Australia, where euthanasia is illegal, the proportion of deaths without consent under similar circumstances was not 0.7 per cent. but 3.5 per cent.
The Dutch system is open. It may well be that not all doctors report cases, although according to the study which I believe the noble Lord, Lord McColl, quoted, the number is rising and has more than doubled over the past few years. However, the same is true of the United Kingdom. We do not know what is happening in the United Kingdom. A British Medical Journal study reported in 1994 that one in 10 doctors interviewed said that they had actively hastened patients' deaths.
Of course this is a difficult and most delicate question. I have the greatest admiration for the work which is done in hospices. There can be no question of encouraging the terminally ill to consent to euthanasia, but, on the other hand, in a civilised society one should 714 respect the wishes of those who want to avoid horrible suffering at the end of their lives and who want to die in dignity and do not wish to go on living. I know of several cases where life has been considered quite intolerable and people end their days in total misery begging for someone to help them to die.
In my view the Dutch have shown how society can become more, not less, compassionate. In their approach to, and rules on, voluntary euthanasia they have shown a greater, and not a lesser, respect for the value of human life.
§ 9.30 p.m.
§ The Lord Bishop of Oxford
My Lords, I am grateful to the noble Lord, Lord McColl, for introducing a debate on this important subject. First, I want to raise the question of human autonomy. According to the Dutch definition, in use since 1985, euthanasia refers to intentional acts that are deliberately taken to end the life of a person, at his own request, by someone else. In short, the emphasis is upon a person's own choice, decision and request.
However, according to Christian thinking, human autonomy can never be absolute. As the joint submission from the Church of England House of Bishops and the Roman Catholic Bishops' Conference of England and Wales to the House of Lords Select Committee on Medical Ethics put it,Neither of our Churches insists that a dying or seriously ill person should be kept alive by all possible means for as long as possible. On the other hand we do not believe that the right to personal autonomy is absolute. It is valid only when it recognises other moral values, especially the respect due to human life as such, whether someone else's or one's own".I also wish to focus on the increase in the number of requests for euthanasia, whether or not all of these are granted. The number of explicit requests for euthanasia to be performed without long delay in 1995 was 9,700—an increase of 9 per cent. on 1990. In addition there were 34,500 requests for euthanasia at some point in the future, when the appropriate time arrived—an increase of 37 per cent. compared with 1990. What worries me about these figures is the creation of a culture in which the whole focus is on the request for euthanasia, and when the time might be right for it. It seems to me that this must inevitably distract attention from where our efforts should be directed; namely, to the increased quality of palliative care.
If a teenager is obsessed by ideas of suicide, we do not collude with him in debating whether it may or may not be right for him to end his life. We want to get him out of that state of mind altogether. We recognise that there is something fundamentally wrong that needs to be changed. It may be that he is depressed and will need anti-depressants, or he may need help in finding a fulfilling job or in forming relationships. But when the conditions and circumstances of that person's life are changed, it is likely that he will no longer wish to kill himself. Of course the parallel with the person seriously ill at the end of his life, facing a painful or undignified future, is not exact. A teenager has a life ahead of him; someone who is seriously ill does not. Nevertheless there is one important point of comparison; namely, that 715 if the person's circumstances are changed, he may well get out of a state where he focuses on whether or not to ask for euthanasia. In short, if the pain can be brought under control; if the person is in a community in which he feels valued and cared for; if there is a spiritual environment in which the ending of a life is seen as part of our preparation for a movement into a larger life, the desire to end it all will be much rarer, if indeed it is present at all.
As we all know, palliative care has improved enormously in recent decades, not least due to the hospice movement, with its Christian inspiration. It is widely recognised that most pain can now be controlled and that the environment in which a person is cared for makes all the difference. My concern is that encouraging people to focus on the request for euthanasia—whether and when they should ask for it—distracts society from where our efforts should be channelled; namely, to ensuring really good palliative care throughout the country.
It is interesting that the alleviation of physical pain is the actual reason for asking for euthanasia in only 30 per cent. of cases in the Netherlands. More is involved than physical pain—there is the emotional and spiritual side. People just feel valueless and hopeless, a burden to themselves and others. Here, I believe that Christian and other forms of humanism have a crucial contribution to make. We are of value in ourselves, for ourselves, whatever our circumstances or condition, whether we are healthy or sick, young or dying, able-bodied or struggling with some disability. Christian theology emphasises the fact that we do not have to achieve in order to be of worth; we do not have to prove ourselves nor to strive to be accounted of value. We simply are of worth, in our own person, for ourselves. It is this philosophy which under-girds and suffuses the best palliative care.
Then there is the whole question of becoming increasingly dependent on others. I think we need to question the modern assumption that only the active, dynamic, initiative-taking life is valuable. There is a proper place in human existence for letting things take their course, for allowing oneself to be passive, for accepting dependence on others, if that is the way things are. Shakespeare reminded us that the seventh and last stage of human existence is to be "sans teeth, sans eyes, sans taste, sans everything". This decline is likely to bring about an increasing dependence on other people, even when we are not suffering from a terrible disease, and I certainly do not want in any way to underplay the potential indignity of this process. But the fact is that we are dependent upon one another. That is one of the fundamental features of what it is to be a human being. The fact is that as we get older we are increasingly in the grip of what Teilhard de Chardin called "the forces of diminishment". He was able to see these forces, as others have, as apparently cruel but truly beneficent in the long run. To be able to let go, to let things take their course, to allow oneself to be dependent, to be cared for by others, is to reflect a wisdom inherent in creation. It is this wisdom to which we should be sensitive rather than looking for legal ways of putting that final decision into our own hands.
716 I respect the fact that in the Netherlands the approach to euthanasia has been conscientious and responsible. Nevertheless, it is fundamentally misconceived, a wrong turning which history will, I hope, quickly judge to be a cul-de-sac. I believe that in allowing people, in increasing numbers, to focus on the question of when and under what conditions they might ask for euthanasia, distracts society from its proper concern, which is how to improve palliative care and how to bring good palliative care to everybody in society. The request to die indicates that something is wrong. Let us concentrate on identifying what is wrong and doing all we can to make it right. If it is physical pain, let us improve our pain-controlling drugs; if it is the fear of indignity or the thought of becoming useless and a burden, let us create a caring context in which such feelings can be expressed and talked through. For, as I have already quoted, the figures indicate that 63 per cent. of the requests to die have nothing to do with physical pain at all.
The issues have to do with human relationships and caring communities. Underlying what is wrong, of course, is our mortality, the fact that we peter out with the loss of so much of what we once enjoyed and valued. Here we have to oppose the idea that it is only if we are the great hero, taking control of our lives at every point, that we are of value. To live a human life includes dependency as well as activity, being passive as well as active, letting go as well as taking charge. And, if this wisdom is reflected in society as a whole, a society encouraged by networks of relationships and communities that pay attention to the emotional and spiritual needs of the sick and dying as well as their physical ones, the requests to be put out of misery will stop. So, looking at what the Dutch do, however conscientiously, let us decide to go down another road altogether.
§ 9.40 p.m.
§ Lord Patten
My Lords, I am very glad to follow the right reverend Prelate the Bishop of Oxford. I congratulate him warmly on the clear, unequivocal statements made on behalf of the Church, and for giving us his views about the wrong-headedness of the turn that the Dutch have taken. It is good to hear such unequivocal voices coming from the Bench of Bishops.
A trip down memory lane will enable me to explain to your Lordships' House my own attitude in another place over the 18 years between 1979 and 1997. I voted on every occasion I could against abortion, capital punishment and euthanasia. It may not be very cool and modern, but that is what I have done over the past 18 years in another place.
Another trip down memory lane will enable me to tell your Lordships of a trip to Holland in the mid-1980s. I went there as a junior Minister in the Home Office—which is a right, fit and proper calling, as I am sure the noble Lord, Lord Williams of Mostyn, on the Front Bench, will agree. In particular, I visited Amsterdam to look at the endemic and state-enhanced drugs culture that exists there. I returned thinking, "That will never happen here. There will never be pressure for that kind of thing in the United Kingdom".
717 Yet since the mid-1980s we have seen a growing surge of public pressure to relax our drugs laws, all the time turning towards the Dutch example. We have seen this increasingly on the pages of broadsheet newspapers, by learned columnists—most of them late middle-aged baby boomers trying to recreate the 1960s that never happened. But it is not now restricted only to the broadsheet papers. One ex-editress of a broadsheet has gone to the Daily Express to assume the editorial chair. We may well find that the campaign she has run to legalise cannabis and other soft drugs—finding its fountainhead in the Dutch example—will now occur in the tabloid newspapers.
What seemed impossible 10 or 12 years ago when I went on that trip as a junior Minister now seems all too possible in the minds of many commentators. As did the right reverend Prelate, I fear that the same pressure may come on this side of the water.
I wish to make only two points. First, one cannot have a little bit of euthanasia. Once one has a bit of euthanasia, one will get a lot more. One will find the slippery slope all too easy to travel down. What may start with a few painstakingly examined and argued about distressing cases of a medical kind will lead little by little to an easing of law and public attitudes towards euthanasia. I can well see that if, next year, we made that sort of thing possible, within a decade we would find pressures growing, in particular on the elderly, to consider euthanasia for social reasons. I believe that that happens in some jurisdictions around the world.
I can imagine people whose lives have been happily prolonged much beyond the three score years and ten they might have expected into, let us say, their 80s or 90s—years for which they have not provided—feeling that they are a burden on their families. For the most noble of sentiments, they may decide that perhaps a bit of euthanasia is the way to ease the problems that their families face.
It is a dangerous slope indeed; and it is one I am fearful that some of the learned judges, through the process of judicial review, may try to introduce into the law of this land. To borrow the headline from that newspaper people sometimes try to sell me in the streets outside Westminster Cathedral, the "big issue" in the new millennium will be how to curb the hunger of the judiciary to ever extend its powers of judicial review. The judiciary is, I say with respect, as bad as a pack of politicians in wishing to extend its unelected powers. I am fearful of the possibility of the judiciary undermining the intentions of Parliament.
I congratulate warmly the right honourable gentleman the Home Secretary on the stand he has taken against any further changes to laws on drug taking. I hope that my support will not alarm him, but I support him warmly in what he has done there. I hope that the Government will now take a similarly robust attitude towards the preservation of life.
My second and final point relates to fear. I believe that there are now a few elderly people in this country who, because they read about the euthanasia debate and see television programmes about it, are somehow fearful 718 that the doctors and the medical world who are their best friends might present a threat in future years. Many subjects in this country willingly and freely carry in their wallets, purses and handbags donor cards stating that if unfortunately they should die, their organs—their kidneys, eyes or whatever else—should be used for medical purposes. I do not see it as too far-fetched, if the pressure for euthanasia continues, that people will wish to carry in their wallets and handbags a "right to life" card, which they could have as a legally binding document, stating that they wish to have their life preserved.
I wish to hear one thing only from the noble Lord, Lord Williams of Mostyn, who will reply—that is, a clear and unequivocal statement on behalf of the Government that they support the right to life among our citizens.
§ 9.45 p.m.
§ Lord Alton of Liverpool
My Lords, in the 18 years during which the noble Lord, Lord Patten, and I were in the other place, it was always a great pleasure to be in what he described as the "neither cool nor modern lobbies" when we voted on these issues. It is a pleasure to follow him again this evening.
Perhaps I may congratulate the noble Lord, Lord McColl of Dulwich, on introducing this debate, and alerting us to the practice of euthanasia in the Netherlands. I wish to divide my remarks into three parts—first, a word about the origins of eugenic practices such as euthanasia; secondly, some remarks about the Dutch experience; and lastly, a word about the alternatives.
Although euthanasia is practised in Holland with legal sanction—and it is the only country in the world to have that unenviable and invidious distinction—euthanasia had its origins in the medical establishment of pre-war Germany.
In 1998 we commemorate the 50th anniversary of the United Nations Declaration on Human Rights. It is no coincidence that after the eugenics and genocide of the pre-war era, Article 3 of that declaration promulgated the very right to life itself—not, as the noble Lord, Lord Taverne, put it, "an abstract principle".
Europe's crimes against the Jews remind us of what happens when the inviolability of life is systematically eroded and institutions once bound by a common code of ethics are corrupted. No people have better cause to understand the consequences of the collapse of responsible citizenship, and what happens when society loses the concepts of right and wrong, than do the Jews. But even before the Holocaust, mentally and physically ill people had been sterilised, experimented upon and done away with. The film, "J'Accuse", was used to soften up German public opinion, and school textbooks even set mathematic problems asking children to work out the difference between caring for a disabled person or building new homes. Today, we use chat-show ethics and arguments about personal autonomy to accomplish the same ends.
The pre-war slide into eugenics did not happen all at once. Moments of monstrous inhumanity rarely do—and here are lessons for us today. Our contemporary anti-life 719 culture has gradually been evolving, and, as the Dutch experience reveals, old mistakes can easily be dressed up in the new clothes of progress.
As the noble Lord, Lord McColl, has told us, in 1991, the Remmelink Committee, named after the Dutch Attorney General, revealed that in that year more than 3,000 people had died through euthanasia in Holland and that in 1,030 cases it was not voluntary.
A 1995 study recorded that in that year there were 900 deaths from euthanasia with "no specific request from the patient". The British Medical Journal reported in December 1996 that most Dutch doctors do not fulfil the legal obligation to report euthanasia—so the number of such deaths may be even higher. The Dutch experience, then, is that the inevitable corollary of allowing personal autonomy—as the right reverend Prelate the Bishop of Oxford put it so eloquently—to trump the inviolability and sacredness of human life is involuntary euthanasia.
The Dutch experience is pertinent in two other respects. Public and political opinion was carefully conditioned by a series of high profile court cases. We heard earlier about the Chabot case in 1994. That case concerned a woman who was a depressive, not someone who was terminally ill or who was dying. The old juridical adage that hard cases make bad law, of which the noble Lord, Lord Patten, reminded us this evening, is amply demonstrated in Holland. But it is also self-evident in Britain, where 30 years ago legal abortion was to be practised in exceptional cases. Five million abortions later, and British laws which since 1991 have permitted destructive experiments on human embryos—more than 500,000, according to a report in last Sunday's Sunday Times—and abortion up to and even during birth of a disabled baby, show where calls to clarify the law can so easily lead: they lead to the overriding of ethical consideration. Choice and autonomy inevitably lead to tragedy.
In Britain we are now in the throes of considering the Law Commission's Bill on mental incapacity and the Government Green Paper, Who Decides? The Lord Chancellor states that neither publication contains recommendations on euthanasia. But that is a Trojan horse. The deliberate starving to death of a patient is being presented as something other than euthanasia. No one will be persuaded by this argument. It is not an issue for ambiguity or fudge.
The reason why the Voluntary Euthanasia Society supports that Bill is that they see it as a critical step towards establishing intentional killing as a routine part of medical practice. Once that fearsome breach has been made and the freedom of the doctor to act in the best interests of an incapacitated patient has been removed, it will not be long before Dutch practices become normative in Britain too. The Law Commission's proposals are euthanasia by default.
Criminal law has traditionally held that the value of human life transcends the value of individual autonomy. We would be foolish indeed to allow the law to be changed in any way which changes that position. In Holland the medical profession has been corrupted by euthanasia. Contrary to what the noble Lord, Lord 720 Jenkins of Putney, said tonight, many elderly and infirm people are inevitably frightened to approach doctors who first practise murder on request and then kill their own patients without consent. The Hippocratic oath wisely held that, if you cannot help, you do not harm. It will be difficult to trust any doctor who resiles from that most basic code of ethics.
That is my third and final point. There is much we can do to help. The hospice movement is virtually non-existent in Holland. You do not need hospices, good palliative care or relief from suffering or pain if you kill the patient instead. Britain can be justly proud of a movement pioneered by that illustrious Englishwoman, Dame Cicely Saunders, in 1967 and which today boasts 200 flourishing hospices. They provide a radical alternative to the defeatism of euthanasia. Hospices do not confuse words like "care" and "kill". Through good palliative care, they can offer love and hope—what we used to call "a good death". It is impossible to imagine how Dutch practices, or those advocated by many here, would be conducive to the continued flourishing of the hospice movement. The origins of euthanasia, the Dutch experience and the alternatives are cogent and persuasive arguments against euthanasia. In November last a Bill was considered in the other place, grimly entitled the Doctor Assisted Dying Bill. Eighty-nine Members of Parliament voted for that Bill. Incidentally, 77 of those who voted for euthanasia voted against foxhunting. That is a bad case of political correctness and convoluted values. Tonight's timely and welcome debate reminds us of the importance of great vigilance in the months which lie ahead.
§ 9.53 p.m.
§ Baroness Elles
My Lords, I join with others in thanking my noble friend Lord McColl, who has brought this important matter before your Lordships this evening. It is a matter of considerable interest, especially to those who at different stages of their lives are faced with the question of what might happen to them if they have a terminal illness and whether they have what is called by many the "right to die". In the end, as we know, although no one evades the final ending of physical life, no doctor is entitled to act in such a way that may in consequence bring a patient's life to an end nor must he permit that consequence by not taking action. That is the law in this country at the moment, and long may it remain so. However, in the Netherlands, although euthanasia is said to be illegal under the criminal law, there are acknowledged to be situations in which a doctor may terminate the life of a patient and not be deemed guilty of committing a criminal act.
One report on the Dutch situation was instituted by an American psychologist, Herbert Henkin. It was referred to in the New York Times in July 1996 and set out certain disturbing features. It said,The Netherlands has moved from assisted suicide to euthanasia; from euthanasia for people who are terminally ill to euthanasia for those who are chronically ill, from euthanasia for physical illness to euthanasia for psychological distress, from voluntary euthanasia to involuntary euthanasia".721 In each case it is one step removed from the next.
The current state of Dutch law was referred to by many noble Lords this evening. A report on euthanasia was set out by the Foreign Information Department of the Ministry for Foreign Affairs by way of 20 questions and answers setting out the main issues. I shall refer to just one or two of those because many points have already been touched on by other noble Lords. The document said that euthanasia was defined as,the termination of life by a doctor at the express request of a patient provided that the request is explicit, carefully considered and voluntary; and the patient's suffering is unbearable and there is no prospect of improvement".Also, although illegal in practice, doctors may be exempt from criminal proceedings under certain conditions. For instance, if acting under force majeure on the patient who has made voluntary, well considered, persistent and explicit requests for euthanasia.
There is therefore clear evidence of euthanasia being practised and condoned, if not legally permitted. Not only voluntary euthanasia is being practised, but also involuntary euthanasia where a person has not requested to die. Cases have occurred where a doctor decided that his patient's bed was needed and he considered the patient's life no longer worth while. In that situation, a patient's life is exchanged for a bed.
Those tragic cases are difficult to estimate, as has already been said. Figures have been given to show that persons have died in accordance with their own wishes. They were estimated at around 1,000 in 1990 and a similar figure in 1995. But since then it has not always been considered necessary for a doctor to report such a case to the Department of Public Prosecutions. It is considered therefore that that number is much exceeded. Estimates vary from 3,000 up to a high of 10,000, or 8 per cent. of all deaths in one year. Those are only estimates and cannot be proven. But that is the kind of figure that has been circulating. I do not suggest that it is accurate.
It is profoundly to be hoped that, as palliative care is developed in the United Kingdom—whether in the 279 specialist hospices, as we were informed in November 1997 by my noble friend the Duke of Norfolk, whose wife played such a magnificent role in helping to develop them, or by care teams working throughout the country in patients' homes, which means that it is not always necessary for the patient to have the benefit of dying in the atmosphere of a hospice; they can die peacefully at home—such practices will develop also in the Netherlands. They now have four hospices compared with our 279. We hope that such practices may also develop to stem the number of both voluntary and involuntary cases which have shocked so many of us in your Lordships' House tonight.
§ 9.59 p.m.
§ Viscount Brentford
My Lords, I, too, am very grateful to my noble friend Lord McColl for introducing this subject this evening. My noble friend Lord Patten went down memory lane in considering it. I found my imagination running rife into the future. In my mind's 722 eye I saw myself addressing your Lordships' House moving a Motion with enormous power and verve, tremendously heartfelt, and with great eloquence. I then found that your Lordships rejected my Motion out of hand, which is not something to which I am unaccustomed. Then I found myself going home feeling very depressed by this and very sorry at what had happened. I told my family and party that I was feeling very depressed and very sorry about it all. Then a kindly doctor said, "Dear, dear, poor Crispin, how very sad that you feel so depressed about this. Let me help you". He kindly gives me a lethal injection so that the next morning I wake up not in my comfortable bed, but in the next life without feeling that that was entirely what I had planned, envisaged or wanted, nor, probably, what the Almighty had planned for me.
That was my imagination and not historical fact. When I read about the 1994 Dutch Supreme Court decision which has been mentioned several times and which upheld Dr. Chabot's decision to administer a fatal injection to a woman suffering only from depression and not terminally ill, I can see the scope for euthanasia proceeding further and further. It is normal practice, when people become accustomed to something, that the next step provides the next challenge. It certainly appears that in Holland the scope of euthanasia is expanding to those who are currently healthy and to those who have not made "explicit and persistent requests" for euthanasia. I see that position providing a very dangerous precedent for us and other countries as well.
The legalisation of euthanasia in this country would prove to be a fundamental change in the basis of law introducing intentional killing. It would seem to me very odd if we were—we are not—to consider introducing intentional killing at the same time as we are busy removing further legal possibilities of capital punishment through a Bill at present going through Parliament. The two things are quite contradictory.
We are all protected by the prohibition on intentional killing. Without it, as the Dutch have proved, it is impossible to police it. After all, as in a murder trial, the best witness is no longer available to testify. Like all other noble Lords, I am sure, I am a strong believer in palliative care in hospices. On Friday this week I shall be visiting a new hospice in the Weald at Tunbridge Wells, where superb healthcare is given. It does not seem to be the case that the same quality of healthcare is available in Holland. Other healthcare may be good, but I do not believe from what I have read and heard that this aspect of healthcare is available in Holland in the way it is here. The quality of care for the dying is now such that euthanasia is quite unnecessary in this country or in other countries. I do not believe that it should be permitted here.
§ 10.4 p.m.
§ Lord Ashbourne
My Lords, I am grateful to the noble Lord, Lord McColl, for giving us the opportunity of debating this important issue this evening. Along with many in this House, I admire the work that he and others did in producing the excellent Select Committee report on medical ethics a few years ago.
723 I am a long-standing supporter of the hospice movement, and have discussed the current Dutch practice with colleagues in the palliative care field. Indeed, it seems to me that one of the key problems with the practice of euthanasia in the Netherlands is the almost total lack of hospice care. There are only four hospices in the Netherlands and knowledge of palliative care is not widespread. I understand there is an excellent network of old people's homes, but these are not built on the hospice principle of symptom management, involving the physical, psychological, social and spiritual aspects of care. This point was most cogently argued by the right reverend Prelate the Bishop of Oxford.
While knowledge of palliative care is improving, I cannot see how further developments can take place when euthanasia remains an option. This is because the Dutch appear to have embraced a euthanasia mentality. Perhaps this is best illustrated by a case from the Netherlands reported in the Journal of the Royal Society of Medicine in 1996. An old man was dying of lung cancer. His symptoms were controlled and he asked if he could die at home. When his children were told about his wish they would not agree to take care of him. Even after repeated discussion, they refused. Instead, they pointed to their father's suffering and the need to finish things quickly in the name of humanity. When the doctor refused, they threatened to sue him. As the patient insisted on going home, a social worker went to investigate. She discovered that the patient's house was empty and every piece of furniture had been stripped out by the family.
It is easy to slip into critical rhetoric when analysing the Dutch situation but that would be wrong, so perhaps I may finish by drawing the attention of your Lordships to a paper written by Leo Alexander, an eminent psychiatrist, published in the New England Journal of Medicine in 1947. He outlines how the Dutch medical profession unanimously disobeyed the orders of the Third Reich commissars for the occupied Netherlands to concentrate their efforts on the rehabilitation of the sick for useful labour. When threatened with the revocation of their licences, they returned them, while seeing their own patients secretly. When 100 physicians were arrested and sent to death camps, their colleagues took care of their widows and orphans. As Dr. Alexander states:Not a single euthanasia or non-therapeutic sterilisation was recommended or participated in by any Dutch physician".When one hears of the Remmelink report, the Chabot case and the 1,030 reported cases of euthanasia in 1990 without any request and one reflects on Leo Alexander's paper, one is struck by the irony of the current situation. It is my sincere hope that, rather than seeing themselves as leading the way, the Dutch will embrace fully hospice principles and repeal their current euthanasia legislation. I also trust that Sir Stephen Brown, President of the Family Division, will take note of events in the Netherlands and resist a similar slide towards euthanasia in this country.
§ 10.8 p.m.
§ The Parliamentary Under-Secretary of State, Home Office (Lord Williams of Mostyn)
My Lords, I thank all noble Lords who have spoken, and not least of course the noble Lord, Lord McColl of Dulwich, for returning to this important topic.
I do not think it would be appropriate for Her Majesty's Government to criticise the practice of euthanasia in the Netherlands. However, I assure your Lordships that we have no intention of following the Dutch example. The noble Lord, Lord Taverne, said that there was widespread support in the Netherlands for the regime which they have, which I shall come to in a moment. That may well be so: I do not know. I have not myself detected widespread support for the Dutch regime in this country.
When we last debated this matter in November of last year, again the noble Lord, Lord McColl of Dulwich, spoke and I do not think I could have been plainer than I was then in the statement which I made of the Government's stance. On that occasion, the noble Lord did raise concerns about the Dutch practice. I made it perfectly plain that we do not intend to legalise euthanasia in the United Kingdom, and I hope that statement is sufficiently unambiguous to satisfy the noble Lord who asked me to make it.
In a sense, this debate covers some ground that we have traversed in the past. It is sometimes said that euthanasia has been legalised in the Netherlands. That is not strictly correct. It is still a criminal offence, as is assistance with suicide. It is open to the courts to try such cases but, as the noble Lord, Lord Taverne, and others have pointed out, there is a system of statutory guidelines which in effect means that if doctors comply with them, prosecutions do not occur. All acts of euthanasia or assistance with suicide must be notified to the Public Prosecution Department, which considers whether the criteria and guidelines were applied in that particular case. The department then has the discretion not to prosecute.
We have no intention of going down that road. We are, of course, interested in the experience of the Netherlands and elsewhere. Some jurisdictions in Australia have been mentioned, as has one in the United States of America. Obviously, we pay attention to what happens elsewhere, but our duty as a government is to come to our own conclusion in the context of our own jurisdiction.
Some have the view, which I accept is conscientiously held—indeed, I think all views on this are conscientiously held, which is perhaps why there can be no reconciliation between them—that they would not be happy with euthanasia for all; some advocate physician-assisted suicide. As I said in November—I do not mean this offensively—sometimes fancy labels are used as tools of utility when we should perhaps concentrate on what we actually mean. We do not believe that there is any essential difference between physician-assisted suicide and euthanasia. Both are deliberate acts to end the life of another human being. The deliberate act of killing another human being is unlawful in this country and can result in a charge of 725 murder or manslaughter. The noble Lord knows perfectly well that colleagues in his profession have been so charged and, indeed, convicted on occasions, certainly of attempted murder.
There is always the danger of being morally certain that requests for euthanasia are really voluntary and without coercion—sometimes the rather subtle coercion of circumstances, of family pressure unspoken or of financial worries. The principle upon which we stand firm is that the law is there in significant part to protect the weak and to deter the malefactor even when the malefactor acts on what he thinks conscientiously to be right.
We have been considering the Dutch experience. I have recently read a report of a study—admittedly, of a small number of cases—conducted by a medical director of a Dutch hospice. His published views showed that most of the terminally ill patients who entered his hospice, having previously expressed a desire for euthanasia, changed their minds when good palliative care was made available to them and, in some cases, when they had the opportunity to discuss the issues fully with their doctor and with members of their family. It was the first time that the family mind had felt itself able to have an open discussion of the issue.
Palliative care is important. We have a good record in this country, better than that of many other countries. Of course, it is true—I sympathise with this—that people in great pain and distress—the sort of pain and distress which we cannot imagine or guess at if we have not suffered it—may want a quick release from suffering. However—I do not split hairs on this—it is the suffering of which they wish to be free, not life itself. As the noble Lord said—his expertise is infinitely greater than mine—there is the possibility that distressing symptoms, both physical and mental, can be controlled and dealt with decently and caringly, as the hospice service—that is what it is—demonstrates.
We also stand firm on this principle: terminally ill patients have the same rights to healthcare as any other group of patients. We regard it as wrong to legalise certain forms of killing, even for those who ask for it. It is true—we dealt with this matter at great length in 726 November—that the double effect may sometimes be a consideration, so that legitimately offered and delivered medical treatment by way of particular medication may limit a patient's already shortened life expectancy. I do not believe that doctors shy away from that. But we believe that that is fundamentally different in principle from simply killing someone because he requests to be killed or helping that individual to kill himself. Symptom relief can be achieved by excellent palliative care, but not always. One does not suggest that as the easy way out of this dilemma.
Mention was made of the Green Paper, which is subject to consultation. The consultation period closed on 31st March. Of course, it is the law in this country that if I as an individual do not wish to receive medical care for good reasons, bad reasons, religious reasons or no reason at all, as a human being I am entitled to decline it. As I understand medical ethics and the law, the doctor is obliged to attend to my wishes and follow them. In a sense, advance statements and directives—one may choose whatever phrase one wishes—are only an expansion of that. But based on what my noble and learned friend the Lord Chancellor has already said, plainly that kind of advance directive needs to be approached with great care and caution because circumstances change. People change their mind. I imagine that most noble Lords have at one time or another forgotten to change their wills—even if they have remembered to make them in the first place. Medical techniques and advances are beyond our present contemplation, and they are taking place extremely rapidly.
I do not believe that I can say any more. There is only one thing to be said; namely, that we understand that different people in other countries have different views. They do things differently there but we do not propose to follow their purported example.