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Incurable Patients Bill Hl

Volume 368: debated on Thursday 12 February 1976

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3.30 p.m.

My Lords, I beg to move that this Bill be now read a second time. I think that the Bill may best be introduced by a statement of what it is not rather than what it is. It is not a Bill that legalises euthanasia, or what is often called mercy killing. It leaves totally unchanged the present law about homicide, so that any person, be he layman, doctor or nurse, who administers a lethal dose deliberately and knowingly, or otherwise destroys the life of another person, is liable to a charge of murder—and will be liable under this Bill. We know that these things occur and that charges are not very often brought, but that is neither here nor there.

However, the Bill has been grossly misrepresented in the Press and in correspondence in various quarters—particularly I notice in correspondence to myself from the area of Birmingham where somebody must have done a very good anti-propaganda job. Last Sunday, even in the BBC's religious programme called "Sunday" it was announced that they were about to introduce a discussion on "the controversial Euthanasia Bill". There is no "Euthanasia Bill" before your Lordships' House. If I may use an analogy, there have been before your Lordships' House on many occasions Bills relating to the services and organisation of the Church of England. I think that the right reverend Prelates who are present here today would feel it most injudicious and most improper if these Bills were constantly referred to by the media as "Disestablishment Bills". That is strictly analogous to what has happened.

I am fully confident that your Lordships, having obtained the Bill, read it and studied it, will not have these ideas implanted into your minds but will form your own decisions from what you have observed from reading the Bill and that you will be far more discriminating and accurate than the media. This is a Bill to relieve the sufferings of incurable patients and not to kill them. I am indeed conscious of both the medical and the religious objections to euthanasia and, although a layman and an Agnostic, I sympathise very strongly with some of them.

I pass now to the positive objects of the Bill. First, it declares the right of incurable patients to receive the drugs necessary to give full relief from pain, even if this should cause unconsciousness. I have been told repeatedly that this provision is unnecessary because it is already possible to control terminal pain. I am in no position to deny that. I fully accept that it is true on the authority of many distinguished doctors who are Members of your Lordships' House, although it is said that there is a tiny minority for whom these measures are not successful. I know, too, that in the few small hospitals specialising in the care of the dying such treatment is successfully given—and all credit to them. But it is one thing to say that pain is controllable and another to say that it is generally controlled. Although I accept the first proposition, I emphatically deny the second.

Now for my evidence. First, I would ask your Lordships to pick up any newspaper such as The Times or the Daily Telegraph. In those newspapers you will most days find notices of people who have died after long suffering or after long and painful illnesses. It has been suggested to me that I have misinterpreted these notices and they have been referred to as "contentious notices". I cannot see how I can have misinterpreted them. I have merely recorded them and not even interpreted them, and I cannot see what is contentious about them. But since this matter has been raised I will say two things. I will say first that people who are well enough off to afford to announce in these newspapers their relatives' deaths are not likely to be drawn from what the Americans call the "disadvantaged social classes" who are too timid to say anything in a hospital or in the presence of people in authority, or who are, perhaps, too inarticulate. I will say, secondly, that I can find no conceivable motive why people in such a position should go out of their way at their own expense to publicise lying statements about the last days of their relatives.

Thirdly, perhaps I may quote some experience of my own. One correspondent has said that this Bill had its origin in what he called unfortunate and possibly atypical experiences which had created an emotional reaction, though understandable, in myself. That is not the case. Had I been speaking purely from my own personal experience I should have introduced this Bill at least 10 years ago. My attention has been called far more recently to the need for clarification and amendment of the law relating to the matters with which we are dealing today. I would, however, add that had I been speaking solely from my own experience I should not have regarded this as insufficient justification for introducing such a Bill. When even a small number of persons suffer injustice or injury from the law I regard this as a sufficient reason for trying to put the law right for the sake of the whole community. A handful of cases is not statistically significant. Humanly it is. If I may again draw an analogy, I would remind your Lordships that new legislation about the protection of children has recently been introduced as the result of certain tragic cases which have happened through the ill-treatment or neglect of children. So in the light of this experience I shall unashamedly quote some experience of my own.

Nobody can live to my age without being frequently brought into contact with the fatally ill. During the past 15 years, nine of my relatives, friends or former colleagues have all died of various forms of cancer. From my own knowledge I can say that in seven out of these nine cases full relief, such as I am told is generally available, was not obtained. In the remaining two cases, who happened to be brothers of my late husband, my contact was less close and I do not speak so much from my own personal observation. However, I have every reason to believe that the same was true. In two of these cases I found myself in the position of next-of-kin, and in that position throughout illnesses which lasted for a period of about three years. During that time I had close and intimate contact with many medical institutions—I might say with two private nursing homes, six National Health Service hospitals and four consultants, not to mention one dedicated general practitioner who gave great support throughout.

I have learned from this experience that attitudes and practices vary very greatly, whether through differences in knowledge, skill or resources I do not know. Certainly it is not for me to say. I have been accused of laying the charge of lack of compassion against the medical profession. That I do not do. I merely record my experience, and I hope that the doctor, also in the Birmingham area, who has written to say that I am totally ignorant of accepted medical practice will, in the light of this information, be inclined to withdraw his statement.

I turn now to the second main proposal of the Bill; that is, that we should have a right, while we are of sound mind —if indeed we ever are—to make a binding declaration like a will, that, should we become totally incapacitated, we do not wish to be kept alive, or perhaps I should say returned from death, to an existence which offers none of the normal experiences of human, or indeed animal, living. Here I must emphasise two points relating to the doctor.

First, the Bill strenuously upholds the principle that only a doctor can make the decision when the point of incurability has arrived, and of course in many cases this decision cannot be made at short notice. If a person is lying unconscious on a road after a road accident, a doctor cannot come up and say: "This chap is no longer likely to recover. He has no reasonable chance of recovery. I might as well say that he is already dead, though he could be resuscitated. Is there a declaration? Steps must be taken to find out whether there is a declaration and the procedures will be followed accordingly." That is not what will happen. Cases of unconciousness and of possible brain damage are treated very seriously in hospitals, and a patient is not declared to be incurable, as I know, until more than one medical opinion has been obtained and great care has been taken in the diagnosis. That is the first principle; that is, that only a doctor can say whether or not there is a reasonable prospect of recovery and, if he says that there is, the patient is altogether outside this Bill.

The second principle which the Bill upholds is that only a doctor knows whether or not a person is dead, and he does not always seem to be very certain, because the criteria on which this decision is made seem now to some extent in dispute in the medical profession. Is the person dead when the heart and lungs cease to function, or is he dead when the brain ceases to function? But it is for the doctor to say, on whatever criteria he thinks proper, whether a person is alive or dead. One correspondent in the British Medical Journal goes further:
"It is fundamental medical practice that treatment is based upon a doctor's competence and judgment."
That is a quite unexceptional statement in most ordinary circumstances. If one consults a doctor, one expects, and ought to expect, to listen to what he recommends and to do one's best to carry out what we would call his instructions. If one does not, one is wasting his time and it is wrong to consult him. But even when we are helpless and when we are patients; we are not slaves; we are not inanimate objects;we are not even helpless animals.

When it comes to the point of life or death, or life that is not life or death, it may be that the price of carrying out what we habitually call doctor's orders is too high. We have indeed a right, as we all recognise now, to refuse a surgical operation, if we do not want to have it and would rather die; and a doctor who performed the operation against our known wishes would be guilty of a criminal assault. So the Bill proposes that we should have a right to protect ourselves in advance, while we are capable, from any contrived prolongation or renewal of what has ceased to be life in any meaningful sense, if we have already recorded our wishes on that point. This would give some protection for the doctor. If he has an incapable patient, he has two decisions to make. First, he has to decide whether there is any hope of recovery. Secondly, if there is no hope of recovery, he has to ask himself whether he is to switch off the machine which keeps the patient's lungs and heart going while his brain is dead. He will still have to make the first decision, and if he makes the first decision—that there is no hope of recovery—then, if the patient has made a declaration, he is relieved of responsibility for the second decision, and, I might add, of the possibility that this raises of dispute with the relatives. For an adult, so far as one's own life is concerned, I think that it is more our concern even than that of relatives; and the Bill recognises this.

I shall be told that the Bill is a first step towards euthanasia, but I am never very greatly impressed by the first-step argument. Rational human beings, when they take one step, consider whether they will take another. I imagine that a number of your Lordships have, like myself, fortified yourselves for an apparently long and formidable debate by taking a glass of wine with your lunch. My Lords, you have taken a further step in the direction of alcoholism! But you trust your judgment to know when to stop, and the same is true in the context of the dying. There is never any compulsion that one step should inevitably involve another. If one does not like the first step, one should not take the second. But in this case there are some special differences. This Bill, far from precipitating the second step as a result of the first, would greatly reduce the clamour for positive euthanasia. If we were to establish that in certain cases, where there is no hope of recovery, nature should be left to take her course, there would be far less demand for the administration of murderous—as they still are—lethal doses.

I have in my own correspondence letters from cases of patients in the last stages of such diseases as multiple sclerosis who constantly pick up infections and are brought back again to life from the point of death by the administration of antibiotics. There was one particularly pathetic case in which, against the wishes of the husband, against the wishes of the patient, and against the instructions of the doctor, the administration of these antibiotics was continued—so the husband says—again in the absence of the doctor, by the sister in charge of a ward.

I contend that if the Bill became law, the arguments for mercy killing would be undermined, and that therefore it is a strength for those who, like myself, have very great respect and reverence for the maintenance of human life. In any case, those who do not wish to avail themselves of the opportunities offered by the Bill are under no obligation to do so. If one does not wish to receive pain-killing drugs in one's last illness one need not. One can ask the doctor not to give them, if one so desires. If one does not wish to make a declaration not to be kept alive by mechanical means when one is no longer in the ordinary sense a human being, one need not make the declaration, and then the responsibility will remain exactly where it is today. It will make no difference whatever to the present law.

That is my summary of the Bill. I now propose to look quickly at the clauses to show how these coincide with what is proposed. We should begin not with the first subsection of Clause 1, but the second subsection, which defines the key to the whole matter, which is incurability. A patient is here judged to be incurable,
"if he is judged by his attendant physician to be suffering without any reasonable prospect of cure from a distressing physical illness or disability that he"—
the patient—
"finds intolerable."
We ought to stiffen that provision in Committee by providing for not one medical opinion, but two. That would be an obvious Amendment that I should be very happy to support. I now turn to subsection (1) which provides for the right of the patient, as he now has, to refuse life-sustaining treatment, but nevertheless to be given drugs, even to the point that may produce unconsciousness.

I have here a quotation from the noble Viscount, Lord Waverley, who will be speaking later in the debate. The quotation is from a debate held on 25th March 1969 when a euthanasia Bill was before your Lordships' House. The noble Viscount said:
"If pain cannot be relieved by drugs except in such a dose that will make the patient unconscious, then those drugs are so prescribed."—[Official Report, col. 1217.]
I have given reasons to suppose that they are not always so prescribed, as I have seen from my own experience. But this would establish that the patient has a right for them to be so prescribed, even if unconsciousness results. But it does not authorise—I say again—lethal doses.

Clause 2 relates to suicide; first to successful suicide. Under the Bill successful suicide would be reckoned as death by misadventure and not by suicide. Suicide is not now a crime in this country, but it sometimes causes distress to relatives if a verdict of "suicide" is given, and sometimes there can be legal complications regarding insurances and such matters. That is really the primary purpose of this part of the clause; it is not the most important part of the Bill.

Attempted suicide is covered by the next subsection, where it is provided that a person must not interfere with action taken by a patient likely to cause his own death—that is to say, attempted suicide—and that any action so taken against the patient's known wishes will be unlawful. Let me repeat that this applies to patients suffering from incurable diseases. There still remains the obligation on a doctor, or indeed on any competent person who can give the "kiss of life", to attempt to resuscitate, let us say, a girl who has taken an overdose in a fit of despair about a love affair which she will have forgotten all about in a year or two, if she recovers. This clause applies solely to a patient certified by one or, as I would say now, two doctors as incurable, without reasonable hope of recovery, who is taking his own life; and it requires that he may be left in peace for nature to complete what he has begun.

Clause 3 refers to the declaration which I have mentioned. This declaration will be made exactly like a will. To be binding it must be made before two witnesses; and it will also include, under subsection (3), the name of a person whose business it is to see that it is enforced, like the executor under a will. One can see situations in which a person might find himself incapable and when nobody would know that such a declaration existed. That is covered by Clause 3(3).

I am very well aware, my Lords, that this Bill is imperfect in detail and in drafting. What Bill ever emerged from the Back Benches which did not have those defects? I shall be very happy to receive help and guidance at later stages in translating it into that curious language known as "statutory dialect". There will be many opportunities for that. At the moment, I am asking merely for your Lordships' approbation in principle, and the principle for which I am asking approval is a very old one. It is contained in the commandment:
"Thou shalt not kill—but thou needst not strive officiously to keep alive".
I ask your Lordships to combine that commandment with the development of modern medical technology. I beg to move that this Bill be now read a second time.

Moved, That the Bill be now read 2a —( Baroness Wootton of Abinger.)

3.52 p.m.

rose to move, as an Amendment to the Motion for the Second Reading, to leave out ("now") and insert ("this day six months"). The noble Earl said: My Lords, I beg to move my Amendment to the Motion for the Second Reading. In so doing, of course, I move the rejection of the Bill, which is a rather unhappy thing to do in the light of what the noble Baroness has just said in introducing it. I imagine there cannot be anyone in your Lordships' House who is not totally convinced of the sincerity with which the noble Baroness has spoken, nor who can fail to be entirely at one with the motives that she has described as being behind the drafting of this Bill. How, then, is it possible to be opposed to the Bill itself? My Lords, it is that which it is my task to explain.

Perhaps it will be not unfair if I dispose (if that is not too strong a word) of a little of the evidence which the noble Baroness gave at the beginning of her speech, when she referred to newspaper notices about how patients had died after long suffering and painful illness, and to certain cases which had been within her own experience. She did not—I think it is not unfair to say this—give any reason for us to suppose that any of these patients would have fallen within the definition of an incurable patient who found their disability intolerable. That is perhaps a small point, but it may be worth making.

What I hope to be able to show are four things, none of which perhaps leaps immediately to the mind on a first reading of this Bill. Firstly, that indeed it is a euthanasia Bill. I do not like the word, and I know that the noble Baroness does not like it; but she has used it, and it is difficult to do away with it, loaded and distorted though it may have become. And, not only that it is a euthanasia Bill, but that it is in fact in some respects more dangerous than the Voluntary Euthanasia Bill which we rejected in March 1969. Secondly, that if it were amended, as it could be, so as to remove that particular effect from it, its main provisions would become almost wholly inoperative in law. Thirdly, that some parts of it are so strange that it is difficult to take them altogether seriously. Lastly, that, amend we it never so skilfully, it will still be fraught with danger to the very people whom it is devised to help, chiefly because it would damage, perhaps beyond repair, the doctor-patient relationship which is, and must be, based on trust.

My Lords, I would invite your Lordships' attention first to Clause 1. Here we find that in certain circumstances a patient is entitled to receive enough drugs:

"to give him full relief from pain and physical distress, and to be rendered unconscious if no other treatment is effective to give such relief."

Now the intention there is unquestionably humane, and as the noble Baroness has said, if I may paraphrase it, this has no particular effect, it does not change the law in any way. The reason is that, although it gives the patient a certain entitlement, it imposes no corresponding obligation on the doctor to honour that entitlement.

In extreme cases, the doctor may have to explain to his patient that "full relief" in his case must mean permanent unconsciousness; and if he has already refused life-sustaining treatment, he cannot while unconscious be fed. He is therefore asking, in effect, to be allowed to die from lack of nourishment, and if he continues to insist the doctor may not refuse, because in Clause 2(2) we find these words:

"No person shall be under a duty to interfere with any course of action taken by an incurable patient to relieve his suffering in a manner likely to cause his own death…"

By demanding permanent unconsciousness while refusing life-sustaining treatment, and knowing what the result of this will be (because the doctor has told him), the patient has taken just such a course of action. I read on:

"…and any interference intentionally undertaken contrary to the known wishes of the patient shall be unlawful".

By these words the doctor is not only empowered but actually required by Statute to end his patient's life, and no safeguards are proposed. Am I told—indeed, I am told—that such a thing is far from the intentions of the Bill? If so, I am bound to ask how anything so deadly ever got into it. I know that such a situation is unlikely to arise, but it can.

Now I turn to Clause 3(1). I note at once that it refers to "a patient" and

not, as do Clauses 1 and 2, to "an incurable patient". I take it that that is not a mistake; it is intended to be like that. Very well. The whole clause then appears to have strayed in from some other Bill, since this one is supposed to deal with incurable patients only, as defined by Clause 1(2). This is the part of the Bill that I find the most objectionable, not to say appalling. Here we have a patient who, by reason of damage to or degeneration of the brain, is unable to make decisions—and may I ask in passing whether a person who is unable to convey a decision is to be regarded as necessarily, for that reason, being also incapable of making one? He may not be, in the words of the Bill, suffering from

"a distressing physical illness or disability that he finds intolerable".

On the contrary, he may be in good spirits and bodily health, and leading a contented and even useful life. He may be old or he may be young; but if he has at some time signed the necessary statement he is now to be regarded as refusing life-sustaining treatment. What—no food? Well, yes, all right—food. I suppose it does not mean that. But no resuscitation if he should have a first heart attack at the age of 40? No succour if he should be poisoned by a leaking gas fire, or fall into a swimming-pool and be half drowned, or fall through a plate glass window and be bleeding to death?

Here again, my Lords, we have a patient who has taken a course of action —in this case the signing of the statement likely to cause his own death. This is a type of situation infinitely more likely to occur than any arising under Clause 1; and in every case the doctor will be obliged by law to let his patient die.

My Lords, may I point out that Clause 3(1) covers only a patient who has by reason of brain damage or degeneration become permanently incapable of giving directions and therefore presumably incapable of saying whether he wishes to live or not live.

My Lords, that is my point. That is the only thing of which he is incapable—nothing else. He may be in good health, he may be young. It is because he is incapable of making a decision or of expressing it, for that reason and for that reason alone, he must die. Not only must the doctor or the nurse allow the man to die but so too must any informed person who may happen to be there at the moment of emergency.

The 1969 Bill of the noble Lord, Lord Raglan, proposed to allow euthanasia in certain carefully defined circumstances but never proposed to make it mandatory. It had its safeguards. This Bill goes beyond that; for it not merely allows but requires a patient to die even if he demonstrably enjoys life but cannot say so. It is not even voluntary euthanasia, it is compulsory. It is not permissive only but mandatory on everyone responsible for his care, and there are no safeguards proposed. I have known and I know still many people in both categories covered by this clause who could have been wrongly caught by it if they had been misguided enough to sign so dangerous a declaration. With the sad phenomenon of brain degeneration, in particular, I dare say most of us are acquainted. I, myself, have been acquainted with it too closely and for too long. The implications of this clause leave me horrified.

We are being asked to say that a person who at some time in the past has signed a paper saying that if he ever becomes incapable of making such a decision he, for himself, should in no circumstances receive life-sustaining treatment. Now, in imagination we are confronted with such a person. We do not know at the moment whether he is old or young, immobile and incontinent or living a reasonably full life at home or in hospital; lonely or outcast or surrounded by a loving family. We do not know whether he understood the paper that he signed, whether he were persuaded to sign it or whether it was of his own free or comprehending will. We do not even know whether he is ill. All that we know is that, if a sudden emergency arises, the law forbids us to save his life. No matter what the nature of the emergency, or whether or not we think we are acting humanely or reasonably, we must let him die.

To prolong a life when there is no medical or moral requirement to do so, is meddlesome medicine and bad practice. To decline to do so, is good and accepted medical practice as I think the doctors who are to follow me will agree. In that case, it is not euthanasia. On the other hand, to fail to save a life on no better grounds than that the person is unable to tell us whether he wants to live or to die is to flout every accepted canon of Church and State. Again, it is not euthanasia. It is murder, by deliberate neglect. I nominate this clause with some confidence as the most dangerous notion ever drafted into a Bill. I shall have to return to this clause later; but I will pass to my second leg, to the possibility of amendment and what might be the result of that. The noble Baroness has said that she would like it to be amended in certain ways to remove any euthanasia clement it may be shown to contain. As I hope I have shown, the euthanasia element is contained (and the dangers of it) in Clause 2(2). What would happen if they were to be removed so that it is no longer possible to describe this in any way as a euthanasia Bill? What should we be left with? We should be left with practically nothing. The Bill would fall to pieces like a house of cards.

My Lords, may we return to Clause 1(1) and consider how that would stand after Amendment; that is, after the removal of the lethal provisions of Clause 2(2). This clause gives to the patient an entitlement without at the same time imposing on the doctor any obligation to provide him with that entitlement. Thus, the doctor would still be free to rely on his own clinical judgment and to decide, after consultation with the patient's family, to do what the patient asks. That is as it should be. In the case of terminal patients, this would leave the doctor in precisely the position that he is now in and accurately reflects the normal standards of good medical practice. As moral support for the doctors' freedom of action in such cases, I pray in aid these words from the speech of the late Bishop of Durham during the Second Reading debate on Lord Raglan's Bill:
"…there is no moral difficulty, on any theory, about administering analgesic drugs that would at the same time both lessen pain and shorten life".—[Official Report, 25/3/69; col. 179.]
Clause 1 makes an extension of this principle to non-terminal patients. So the definition of an "incurable patient" in Clause 1(2) makes no suggestion that his condition should be terminal, that it should be only incurable. But no new benefit accrues even to the non-terminal patients since the ultimate deciding factor is still the judgment of the doctor; and he is inhibited by the law of homicide which the noble Baroness says she has no wish to disturb. So Clause 1(1) and with it, for the same reason, Clause 3 would become inoperative in law, a mere declaration of approval of what is already being done; and we hardly need an Act of Parliament for that.

I return to the Bill as drafted and pass on to my third leg; that is, to those parts of the Bill which appeal to me as curiosities. It is at this point that I miss my late and greatly lamented noble friend Lord Conesford. Clause 2(1) states:
"An incurable patient who causes his own death by overdosing or by other intentional action shall be deemed to have died by misadventure."
In a Second Reading debate on the British Standard Time Bill, Lord Cones-ford said that it could have been drafted more simply by saying that in future:
"…'the winter shall be deemed to be the summer'."[official Report, 23/11/67; col. 1208.]
He would have been quite at home, I feel, with the notion that suicide shall be deemed to be an accident. If you can say that, you can equally well say that accidents shall be deemed to be suicide; and I have no doubt that is what would happen.

I understand the intention and, indeed, I applaud it. It is to remove the stigma of suicide from suffering persons; to give, as it were, a more honourable status to certain kinds of suicide. Unfortunately, it would also give a less honourable status to certain kinds of accident. A man falls asleep while driving his car which dashes him lethally against a tree. "Death by misadventure," says the coroner, with perfect truth. "There you are," says a knowing neighbour to a friend, "I always thought there was something wrong, you know. Always in and out of hospital, he was. Cancer, if you ask me. Couldn't stand it and took the easy way out." "But the inquest said death by misadventure," says the friend. "Of course," says the knowing one. "They always say that about incurables. You know that." Such an accident is assumed to have been suicide; and unwitnessed accidents are more numerous than suicides of incurable patients, are they not? And how about insurance? I should be interested to hear the comments of an underwriter who found himself obliged to pay out on a life insurance policy because a suicide had been deemed to be an accident.

Now here is Clause 2(2) again. An incurable patient tries to relieve his suffering in a manner likely to cause his own death and it shall be unlawful to interfere. What, never? If an incurable patient crawls to the ward window and throws himself out, is the nurse to stand by and watch, in full view of the other patients? If she does will she be liable to be prosecuted for abetting a suicide, which is still a crime? Will it be an offence, knowing him to be an incurable patient, to try to prevent a man from throwing himself off a bridge or under a car, with the attendant risk to the lives of others? And how about the incurable patient who takes sleeping pills, awakes half doped, thinks he must have forgotten to take them, takes some more and is discovered in extremis? Is lie to be allowed to die in the belief that he has done it on purpose? What would happen then?

My Lords, this clause only comes into operation against a patient's known wishes. If he has accidentally taken a lot of sleeping pills and they have had this effect, his wishes in the matter are not known; and there there is the right and the duty to resuscitate the man.

My Lords, his wishes may well be known. I am not suggesting for a moment they are not but the fact that he took sleeping pills will be taken as evidence that he wants to put those wishes into effect, when in fact it was an accident. He would be found to have died by misadventure when all the time he would have been murdered by Clause 2(2). And what of the large class of suicides, of incurable patients again, that are in reality cries for help—as likely as not the very kind of help that this clause expressly forbids?

Now we have Clause 3(1) again dealing with the written statement attested by two witnesses. All that is said about this possibly fatal document is that it shall exist at the material moment. It is irrevocable except by destruction. If the signatory cannot get at it to tear it up, it is still in force. Of course he has to have been of sound mind when he signed it. The Bill says so in the last line on page 1. But, good gracious me, look what comes next! The patient should be presumed to have been of sound mind when making the statement. Well, what is the point of mentioning it, then? Fancy saying that he must have been of sound mind, then going on immediately to say that it does not matter whether he was or not! You must in any case presume that he was. Yet he or she may have been a case of arrested development, or a psychopath, or a manic-depressive, or on a trip", or in a post-natal depression or simply drunk, and, what is more, the attendant physician (a term, incidentally, that is used in the Bill but nowhere defined) may know this perfectly well but still be bound to let his patient die.

My Lords, I really do think that this is in some ways not a very good Bill. Finally, as I have said, no matter how we might amend the Bill it would still be full of danger. In the name of compassion it strikes at the whole root and principle of care of the dying and irremediably ill. What then is this root and principle? I will answer that question in the words of a doctor whose name is well known to your Lordships' House, and in the world outside, as that of a leading figure in the world of care: Dr. Cicely Saunders, Medical Director of St. Christopher's Hospice at Sydenham. Doctor Saunders was speaking at a symposium of the British Cancer Council (of which I am now President and Executive Chairman) and she said this:
"The aim of the relief of pain and other distress is that the patients should not only die peacefully, but also that they should live fully until they die, giving what they have to give not only to their families but also to the rest of us who meet them."
My Lords, in this Bill there are no people. There are just two shadowy characters labelled "the doctor" and "the patient" facing each other at a moment of crisis—not a moment of decision, for the decision has already been made for them by this Bill. Where are the patient's wife, husband, children, friends, family? Where is the nurse, the therapist, the health visitor, the medical social worker, the psychologist, the almoner, the priest? Where, in short, is the caring team of which the doctor is only the captain? "Noman is an island", said Dr. Donne. Another doctor, speaking at the symposium that I have mentioned, said much the same:
"When we speak of the care of the individual we must be continually aware…that an individual is always part of a set-up, and therefore we cannot speak of an individual as though he were an entity in himself…".
Those were the words of the Russian Orthodox Metropolitan, Anthony, Archbishop of Sourozh, who was a doctor before he was a priest. And that, in my submission, is what this Bill does. It presents to us the patient as an individual, an island, alone with his pain, his distress, his loneliness, despair and fear. Alone but for the doctor whom he can no longer wholly trust, the law being what, thanks to this Bill, it has become.

I think I hear a voice protesting:
"But of course. The Bill deals solely with the ultimate situation as it exists as between these two people, the patient and the doctor or someone who has taken over from the doctor. By the time this moment comes all those other people you have mentioned have played their part".
Have they, my Lords? If they have, then this situation will be so unusual as to be a freak. If a patient comes to the pass described in Clause 1(2) then somebody somewhere along the line has failed.

Whether or not such persons should receive life-saving treatment in any particular circumstances is a matter for the caring team to consider, probably (but not always necessarily) in advance. Remember, there is no one in the land so isolated that no caring team exists for him. At the end the doctor will decide what is best. Do not let us try to make laws to tell him what to do. The relief of suffering is what he is there for, and he will not try needlessly to prolong a suffering life. If, as may occasionally happen, he does do just that, then he is falling short of the accepted standards of his calling; and if you try to correct his shortcomings by means of dangerous laws, you will not only fail, you will kill a lot of people who ought not and do not want to die.

Even if that were not so, even if the Bill could be so transformed that nothing of that sort could happen, we should be left with a useless, but still dangerous Bill. Once it was law a new and frightening pressure would be on the suffering old. They are not just units, to be bunged into a Bill as with a rubber stamp; they are actual people and are all different. They may be intelligent, educated and wise; or they may be simple, uneducated, bewildered and frightened. One of them may think: "I am a burden. The children cannot look after me properly and they need the room. I am old and I know I cannot get better. I am ready to go and the health visitor says that if I cannot stand the pain I have only to ask the doctor. I can really, but if I were to pretend a little, perhaps that would be best; perhaps that is what I had better do."

If we were to enact this Bill in whatever form, we should be proclaiming to the medical profession that it is in order to think of drugs in terms of quantity—the word actually used in the Bill—rather than quality, which is all that counts. We should be proclaiming to all people with incurable complaints that at the end of the road there waits a doctor with a merciful syringe. We should do possibly irreparable damage to the whole trustful doctor/patient relationship simply by announcing that we thought the medical profession so frequently failing in its caring duty as to make such a proclamation necessary.

That is not the message that should go out from this debate. The message which should go out is this: pain and physical distress are controllable and are controlled. Suffering resides not in the body but in the mind or soul or spirit, and is also controllable by numerous techniques, but chiefly by patient understanding and loving care. If there are still places where these enemies are not being fought as well as they might be—and few deny that there are—the reason is not lack of technical capacity, or lack of nurses, or lack of time, not necessarily even lack of money, and certainly not lack of drugs; it is lack of knowledge. This knowledge is spreading ever more widely from an ever-increasing number of centres which I could enumerate if I had time.

The cure for ignorance is education not legislation. The battle is to be fought by educators not politicians, and here I quote Dr. Saunders again:
"We have not won the battle against pointless pain and indignity in dying yet, but this Bill makes it more difficult for the doctors to give proper care and for patients to ask for it."
I have no doubt that the same message will sound again and again in the speeches that follow. So far as possible, I have kept myself to empirical arguments, leaving more philosophical ones to those better qualified to set them forth. I have spoken long, and perhaps for that matter it will seem impertinent for me to ask your Lordships to be brief later in order that, when we come to the vote, I may have the opportunity of asking as big a majority of your Lordshipsas possible, as I ask you now, to say that this Bill will not proceed. I beg to move.

Moved, That, as an Amendment to the Motion for the Second Reading, to leave out ("now") and insert ("this day six months").—( The Earl of Cork and Orrery.)