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Assisted Suicide

Volume 542: debated on Tuesday 27 March 2012

Before I call the hon. Member for Croydon South (Richard Ottaway) to move the motion, it may be useful for the House to know that I have selected amendments (a) and (b), and that Dame Joan Ruddock will be invited to move amendment (a) during the debate. I should warn the House that it will be possible for amendment (b) to be moved only if it is reached before 7 pm, after the House has disposed of amendment (a). That warning is for the benefit of the House. The House can make its own judgment in the handling of these matters.

Members will be aware that, because of the huge interest in speaking in the debate, I have imposed a five-minute limit on Back-Bench speeches, which will apply after the proposer and seconder of the motion have spoken.

I beg to move,

That this House welcomes the Director of Public Prosecutions’ Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide, published in February 2010.

The motion will be seconded by the hon. Member for Walsall North (Mr Winnick).

The fact that the debate is taking place today is significant, and reflects the willingness of Parliament to address society’s concerns in this area. It is more than 40 years since the subject was debated on a substantive motion, and I am extremely grateful to the Backbench Business Committee, without which I strongly suspect today’s debate would not be taking place.

This very sensitive area of law evokes deep emotions. I take the firm view that, in these circumstances, Parliament and not the courts should have the last word on prosecuting policy and the criminal law. I think it appropriate to put on record at this point that I have the highest regard for Mr Keir Starmer QC, the current Director of Public Prosecutions, who drew up the policy that we are debating as he was asked to do by the Law Lords.

Let me begin by explaining what the debate is not about. The motion welcomes the DPP’s “Policy for Prosecutors in Respect of Cases of Encouraging or Assisting Suicide”. This is not a debate on the recently published report of the Commission on Assisted Dying. The House is not being asked to express a view on voluntary euthanasia, which requires a change in the law of murder, and it is not being asked to support assisted dying for the terminally ill, which requires a change in the law on assisted suicide. Whatever our views, the debate is not about the application of Mr Tony Nicklinson to the High Court for assistance in ending his life, and whatever the outcome of the debate, assisted suicide will remain a criminal offence. This is a debate about the application of the existing law of England, Wales and Northern Ireland. There is not an exact equivalent in Scotland, which has an offence of culpable homicide and no guidelines.

In the wider debate, there are many differing positions. There are those who support a change in the law to allow some form of doctor-assisted dying within up-front safeguards. Equally vocal are those who do not favour a change. Between those differing positions is the pressing issue of how the current law is applied by the DPP and the courts.

The hon. Gentleman has listed the matters that the debate is not about. Does he acknowledge that a letter was sent to Members indicating that he would welcome comments on all those matters during the debate? Has not the debate been rather confused by his own note about it?

Let me say to the hon. Gentleman—for whom I have the highest regard—that it would be slightly naïve to think that the House will focus precisely on assisted suicide for five hours. One or two Members may stray on to the subject of assisted dying or voluntary euthanasia, if only within the scope of the amendment on palliative care, with which I shall deal shortly.

My hon. Friend opened the debate by saying, quite properly, that this was an issue not just for courts but for Parliament. To what extent is the discretion of the DPP to prosecute an issue for Parliament?

The guidelines—about which I shall say more in a moment—are a model of clarity. They reflect the way in which the DPP is applying the existing law. I hope that, if a majority in Parliament endorses the guidelines today, they will be strengthened because the debate has taken place.

Until the Suicide Act 1961, suicide was a criminal offence, and some of those who attempted suicide were prosecuted. Most were discharged, but the records show that in 1956 some 33 were sent to prison. In 1961, Parliament caught up with public sentiment, and both suicide and attempted suicide were decriminalised. That was done not to condone suicide, but to recognise that it was primarily a medical rather than a legal issue, and therefore better dealt with by healthcare professionals than by the police. Assisted suicide was a new offence, designed to protect against abuse. It created a unique legal precedent in that this was a criminal offence of being an accessory to a non-criminal act. It carries a sentence of up to 14 years in prison.

What our predecessors did not do, however, was to distinguish between the types of assistance—between the person who irresponsibly and maliciously encourages a suicidal person, and the loving spouse who fulfils a dying partner’s request for help to die. This is the question we are addressing today: should both actions be treated equally under the law?

The problem was, in part, recognised by the 1961 Act, which gave the DPP discretion, so that even when sufficient evidence existed, prosecution would not automatically occur. That recognises the delicate balance that needs to be struck in respect of motive, compassion, coercion and circumstance.

I congratulate the hon. Gentleman on addressing these issues so clearly and in such a measured way. Does he acknowledge that some of us support people in situations like that of Diane Pretty, my former constituent, who died 10 years ago? She went to the highest courts possible—the House of Lords and the European Court of Human Rights—to seek the right to assisted suicide and was refused, but there was massive public support for her at that time. Does the hon. Gentleman agree that that public support should be taken into account in our deliberations?

The hon. Gentleman is absolutely right: there is huge public support, and I shall talk about that shortly.

Turning to the policy itself, records show that more than 180 Britons have travelled to Switzerland to die in the last 10 years. No one has been prosecuted for accompanying them or assisting them with their arrangements, even when there has been sufficient evidence to prosecute. However, before the 2010 policy document, precisely what criteria were used was never published—until Debbie Purdy asked for clarity.

Debbie Purdy has primary progressive multiple sclerosis. In 2009, she took her case to the Judicial Committee of the House of Lords. She wanted to know whether her husband would be prosecuted if he accompanied her to Dignitas in Switzerland. In their judgment, the Law Lords instructed the DPP to make clear the factors he took into account when reaching a decision on whether or not to prosecute. Lord Brown’s judgment made it perfectly clear what was required. He said that we need a custom-built policy,

“designed to distinguish between those situations in which, however tempted to assist, the prospective aider and abettor should refrain from doing so, and those situations in which he or she may fairly hope to be...forgiven, rather than condemned, for giving assistance.”

The DPP did just that, with a clarity and precision that is to be welcomed.

In February 2010, following extensive consultation, the DPP published the guidance. I have sent a copy to every Member of this House. The policy recognises the reality of prosecuting practice in cases of assisted suicide: that in certain circumstances, compassionately motivated assisters will not be prosecuted.

There are 16 factors weighing in favour of prosecution, including the assisted person not having mental capacity, and if the assister is a doctor or other professional caring for the assisted person. There are six factors weighing against prosecution, including that the assisted person made a voluntary, informed decision—in other words, they were of sound mind—as well as that the actions were of only minor encouragement or assistance, and that the suicide was reported to the police. The policy reiterates that there can be no immunity from prosecution before a crime is committed.

The guidance lists six circumstances in which prosecution would not take place. How does my hon. Friend reconcile that with his statement that this does not represent a change in the law? Surely it does?

That is a fair point, and some people think it does represent a change in the law. However, the guidelines are set out as offering clarity on the application of the existing law, and not as changing the law. In the Purdy case, the House of Lords asked the DPP to set out how the existing law would be applied.

As my hon. Friend has pointed out, what we are debating is simply an interpretation of the law by the DPP that distinguishes between wholly compassionate assistance and malicious assistance, which will continue to be prosecuted. We are being asked to endorse a reasoned, rational approach that many of our constituents support.

My hon. Friend is absolutely right. That approach is supported by many of our constituents. Compassion is at the heart of this debate. The key question is whether someone should be prosecuted for minor assistance, within the terms of the guidelines.

As far as I am aware, there have been no prosecutions for escorting someone to Dignitas in Switzerland. I shall have to write to my hon. Friend with a precise answer to his question, but I am not aware of any prosecutions for assisting suicide in recent years.

I shall support the motion; indeed, I am a signatory to it. The DPP is merely doing his job. This House passed the 1961 Act, which explicitly states that a person may be prosecuted for assisting suicide only

“by or with the consent of the Director of Public Prosecutions”,

who must decide whether or not prosecution is in the public interest. He was asked to draw up these guidelines, and he has done so. He is not acting outside his statutory obligation; he is merely following it.

That is right. Returning to the point made by my hon. Friend the Member for Tewkesbury (Mr Robertson), every single case is investigated by the police, and there has been no derogation from the existing law of assisted suicide.

I invite the House to address how we as legislators should approach this difficult subject. When a person makes the decision to end their life, that draws on the depths of human experience and is intensely personal. The responsibility on parliamentarians to make a judgment on the rights and wrongs of assistance in such decisions is enormous.

The view of the British public is emphatic. In 2010, a YouGov poll found that 82% agreed that it is a “sensible and humane approach” not to prosecute someone who helps a close relative

“with a clear, settled and informed”

wish to die.

The same question is before the House today: should someone who is wholly motivated by compassion, and who has behaved within the parameters of the DPP’s policy, be prosecuted for assisting a person of sound mind who has made a clear and settled decision to end their life? Is it right to prosecute Judy Johnson, whose husband, Ken, was diagnosed with terminal cancer and, after a long battle, decided to end his life? Judy helped Ken make the arrangements and, with his three children, travelled with him to Switzerland. Is it right to prosecute Susan McArthur, who sat with Duncan, her loving husband of 42 years, and held his hand as he ended his life? Duncan had motor neurone disease, and decided to take control of his death while he still had the physical capability to do so. In my heart, I cannot believe it is in society’s interest to prosecute them and to convict them of a criminal offence, and to give them a prison sentence. It is not in the public interest to do so. That has been the approach taken by the DPP for many years, and I believe it should be supported by the House.

How is it possible to be sure that somebody’s motivation is entirely compassionate, and that they are not affected by other factors?

At the end of the day, that has to be a judgment made by the police and the prosecuting authorities. I have confidence in their ability to make that judgment. Of course there is a human element to that, but the guidelines are perfectly clear, and there is plenty of guidance on the approach taken by the prosecuting authorities.

My hon. Friend is introducing the debate in a very measured way. I support greater patient choice at the end of life. It is absolutely right that there should be parliamentary oversight of prosecuting and sentencing policy, but does he agree that we must never leave far behind the notion that at the core of the debate is compassion, both for the patient and their immediate family? We must not lose sight of that.

Yes, it is about compassion for those facing an experience that, obviously, none of us has had. This is the most difficult of subjects, which is possibly why Parliament has been resistant to debating it for many years.

May I turn to the amendment by the right hon. Member for Lewisham, Deptford (Dame Joan Ruddock), which calls on the Government to consult on whether the code should be put on a statutory basis? The law is clear: if someone assists a person in ending their life, it is a criminal offence. However, the Director of Public Prosecutions has made it clear that in a narrowly defined set of circumstances, he will not prosecute. The crux of the point is that it is quite possible that, sometime in the future, the guidance will be changed without parliamentary approval. Parliament should be consulted before any further change, and the amendment ensures that.

There is another point: putting the policy on a statutory basis would address the charge that this debate is the thin end of the wedge, or the slippery slope. It is the complete opposite. The policy exists, and can be amended without parliamentary scrutiny. If we enshrine the policy in statute, it would take another statute to amend the law. Members will have their say on all sides of the debate, and will then vote. That is how we make laws in Parliament, and the public expect no less. In my opinion, the amendment deserves support.

I am grateful to my hon. Friend, and may I say how much I welcome what is on his website, which explains some of the issues? On the motion and amendment (a), the original motion that the House thought it was to consider included a reference to putting matters on a statutory basis. The motion was changed, and the amendment was brought forward. The first, and possibly only, vote this evening may put back into the motion what was taken out and put in amendment (a). Is that coincidence, or clever parliamentary practice?

I make no secret of the fact that the original motion included the words in the amendment, but in discussion with colleagues on both sides of the argument, people rightly pointed out that there were two separate arguments in the motion, and one part might be successful, and the other defeated. The part that people agreed with might be defeated because of the bit that they did not agree with. It seemed perfectly sensible to separate the two bits. I confess that I had a conversation with the right hon. Member for Lewisham, Deptford, and she has bravely undertaken to move amendment (a) today.

I turn to the other amendment selected—amendment (b), on palliative care, in the name of my hon. Friend the Member for Congleton (Fiona Bruce). I am happy to accept the amendment. I would have signed it, if it would not have looked odd to sign an amendment to my own motion. I pay tribute to those working in the area of palliative care, and in particular to St Christopher’s hospice in south London, which works closely with a number of people in my constituency.

The previous and current Governments deserve credit for the progress that they have made towards greater access to care, notably through the end-of-life care strategy. We all recognise the first-class palliative care services provided by hospices, and we should be united in hoping that it can be replicated across all care settings. I give a warm welcome to the additional funding for end-of-life care announced last week by the Secretary of State for Health at the Marie Curie Cancer Care reception, but we should recognise that—as was acknowledged by Baroness Finlay, the renowned palliative care professor and passionate campaigner against a change in the law on assisted dying—such care is not a panacea to all the suffering that the dying process can cause.

Some people, regardless of the care available to them, will seek to control the time and manner of their death. Melanie Reid wrote about that in a moving column in The Times today, which I commend to the House. She is not terminally ill; she is a tetraplegic, following a riding accident. She admits to contemplating ending her life regularly. She wrote:

“Knowing that I have a choice is a huge comfort to me; it sustains me on the days when I make the mistake of looking too far in the future. But the point is, I am blessed precisely because I have a choice.”

In other words, even if we can provide universal access to good-quality end-of-life care, some Britons will still seek to end their lives. The law must be equipped to deal with such cases and to help the vulnerable.

I was struck by a recent debate in the other place on the DPP’s policy, secured by the former Leader of the House of Lords, Baroness Jay. In that debate, there was a clear division between speakers on whether the law should change to allow doctor-assisted dying, but there was unanimous support for the DPP’s approach, with Baroness Finlay describing the policy as “clear, firm and compassionate.” Furthermore, in a recent Synod debate that overwhelmingly rejected a change in the law, the Archbishop of Canterbury, who has repeatedly made clear his opposition to a change in the law, said:

“We can be realistic, we can be compassionate in the application of the existing law”.

I hope that today, whatever view individually we may take on the law, we can agree that the approach taken by the DPP is both realistic and compassionate.

If there is a majority in the House in favour of this motion, we will have done the nation a service. If there is a majority against it, we will have a problem, as the DPP and 82% of the public will be saying one thing, and the people’s elected representatives another. I urge the House to support the motion and show compassion to those facing this terrible dilemma.

It gives me much pleasure to second the motion moved by the hon. Member for Croydon South (Richard Ottaway). I welcome the debate. It has been a very long time since the House of Commons debated the whole issue, and whatever view we take, it is only right and proper that the House should have an opportunity to debate the subject. The guidelines are a considerable advance on what happened before.

The hon. Gentleman mentioned Debbie Purdy. I pay tribute to the way that she, faced with a terminal illness, was determined to fight through the courts to find out what the position would be if her husband accompanied her to Switzerland should she at some stage want to go there. For someone without influence—a private individual without a private income—to do what she did, albeit with the help of an organisation and sympathisers, is remarkable. Even those opposed to a change in the law would agree that she should be praised for her sheer determination and will-power in fighting her campaign.

Of course, there were others before Debbie. My hon. Friend the Member for Luton North (Kelvin Hopkins) mentioned one of his constituents who, unfortunately, is no longer alive—Diane Pretty. She did not want to end her life in a way that was painful and humiliating, and did not want to be in a situation where she was almost suffocating. She did not succeed in her aim; she had the painful illness, and the ending that she so desperately wanted to avoid.

There were other such people. There are some whose cases we do not know; they, and their loved ones, would not wish their case to be publicised. One case that was particularly publicised was that of Dr Anne Turner, a medical doctor who knew full well from her work what was in store for her. Apart from anything else, her late husband, by a terrible coincidence, died from the same sort of illness that she faced, which would deprive her of all movement; at the end, she would not even be able to swallow. Dr Turner was determined that she was not going to end her life in the same way as her husband. Understandably, her children tried to change her mind, but in the end she decided—I believe she had already tried unsuccessfully to commit suicide—to make the journey to Switzerland. In order to publicise her plight and other such cases she invited the BBC to film her journey to Switzerland, and a film was made later about her position.

I can understand the situation that Dr Turner faced. Let me say straight away that I am a late convert to this position. There was a ten-minute rule Bill on euthanasia in April 1970, and had there been a vote nearly 42 years ago, I would have voted no. Indeed, I would have voted against such a Bill not only then, but today, because I am against euthanasia as such. If I was not, I would say so. I do not normally conceal my views, however much they may be in a minority. I am in favour of a change in the law, but only a very sharply defined change and one that is certainly very different from euthanasia, which, to some degree, occurs in Belgium and the Netherlands.

It is sometimes said that those of us who want a change in the law are doing a disservice to the disabled. It is pretty obvious that that is about the last thing I want to do. I have no desire to encourage disabled people in any way whatsoever to end their lives. At every stage in my parliamentary life, I have, obviously, supported every measure to support the disabled—it would be odd if it were otherwise. I believe that that would be the position of all Members of the House, regardless of where they stand on any change in the law.

The hon. Gentleman is making the point that one particular disabled individual should be given the right to make this judgment. Is he not, by definition, therefore making the case that a particular form of disability inevitably makes a life not worth living? Is that not a dangerous utilitarian judgment to make?

That is the very opposite of my view. As I said, I have supported every move to support the disabled in every conceivable way. It is an advance for the House of Commons that we have disabled Members and that we do not just represent disabled people who happen to be constituents. One of my colleagues is confined to a wheelchair and it is right and proper that she should be here. There is an idea that, in some way, those of us who want a change in the law would wish to harm the disabled, but the very opposite is the truth. However, I take the point that to the extent that disabled people—or, at least, the organisations that speak on their behalf—have concerns about any change in the law, people such as me, who want a change in the legislation, should certainly bear that very much in mind.

On five separate occasions my hon. Friend has talked about changing the law and about his desire to do so. Will he confirm, for the sake of everybody in the House this afternoon, that support for the motion is not support for a change in the law, but an acknowledgment that the Director of Public Prosecutions has done his job?

Absolutely. I prefaced my remarks by saying that the DPP guidelines can be supported—the debate is actually titled “Assisted Suicide”— by those who are very much in favour of the existing law and by those who are opposed. No contradiction is involved, and I am glad that my right hon. Friend has had the opportunity to make the point.

That response to that last intervention was helpful to the House. May I ask the hon. Gentleman kindly to give the House a little more help? He is arguing that he would like to see the law changed. An amendment is to be moved which says that the guidance should be put on a statutory basis—it talks about “whether” that should happen, but it, in effect, proposes that it should. Will he be supporting that amendment or is he against it, given that he wants the law changed?

I want the law changed, but that does not mean that if the time comes for a vote on the amendment I will not make up my mind accordingly.

If I were asked what sort of change I would like, if change were to occur, I would reply that it would be very much along the lines of what happens in Oregon in the United States. In Oregon, which has all the necessary safeguards in place, those with a terminal illness who wish to end their lives—they must have a terminal illness—are allowed to do so. Some may argue that that is a sliding slope, but palliative care was mentioned by the hon. Member for Croydon South and we should bear in mind what has happened in Oregon, where assisted dying has existed since 1994. The number of people who have died naturally in hospices has actually doubled there. So the argument that hundreds or thousands of people would go to their deaths if we were to change the law and allow assisted dying for the terminally ill is a total fiction.

Does the hon. Gentleman not agree that such an approach would change a fundamental principle, which is that doctors do not kill their patients?

It is a point that the hon. Lady, a medical doctor herself, has made with great sincerity. The British Medical Association makes the same point, but presumably there are other doctors who take a different view from her. I do not know how many of them there are, but, as we know, there must obviously be certain doctors whose view is that, out of compassion, the law should not prevent them from doing what they consider to be appropriate. Of course, that would all be debated at length and in detail if any measure were to change the law as such.

Many of us have had the experience, as have many people in other countries, of doctors saying to them when their loved ones are suffering greatly that they will make sure that she or he “will not suffer”. What does my hon. Friend think doctors mean by that?

I think that we could all come to the same conclusion. Are we to take it that doctors in Oregon, Belgium or the Netherlands are not concerned about their patients, that they are potential Shipmans and that they could not care less whether or not their patients die? Although I accept the sincerity of the hon. Member for Totnes (Dr Wollaston), I must, as my hon. Friend has indicated, accept that some doctors, however much they may be in a minority, take a different view.

I simply say to the House that whether or not we agree to any change in the law, this issue will not go away. The hon. Member for Croydon South said that more than 180 British citizens have gone to Switzerland in these circumstances. Perhaps there are others who would like to go, for they do not want to face an unbearable death, but do not have the financial means to do so. I hope that the House will not only agree to the guidelines, but be willing to explore the dilemma faced by these people. This could happen to any of us, as nobody is exempt from the possibility of having a severe illness of the sort that Anne Turner was facing and was determined to avoid at all costs, and which resulted in her going to the clinic in Switzerland. I hope that we will have a very good debate. The issues are very important and I hope that at the end of it the guidelines which the Law Lords instructed the DPP to produce will be fully supported on all sides and by all the opinions in this House.

Royal Assent

I have to notify the House, in accordance with the Royal Assent Act 1967, that Her Majesty has signified her Royal Assent to the following Acts:

Health and Social Care Act 2012

London Local Authorities Act 2012.