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Assisted Dying

Volume 717: debated on Wednesday 3 February 2010

Question for Short Debate

Asked by

To ask Her Majesty’s Government what consideration they have given to holding an independent inquiry to examine the evidence relating to a change in the law on assisted dying for terminally ill adults.

My Lords, this debate is time-limited to one hour. When the hour is up, the next debate will begin. I therefore urge noble Lords to do their utmost to keep their contributions brief and to consider omitting the usual courtesies so that the Minister has time to respond before the debate is brought to an end. Should there be a Division, the one hour will be extended by the period of the adjournment.

My Lords, it is a great pleasure to open this debate so close to Sir Terry Pratchett’s courageous and—dare I say it?—entertaining Dimbleby lecture. I may not reach the same audience as Sir Terry, but we seem to have pulled in quite a lot of people today. Using humour to cope with huge sadness, anger and despair is a rare gift. The theme of that Dimbleby lecture was shaking hands with death and coming to terms with it in the individual’s own way. As Sir Terry said, “My life, my death, my choice”.

As death is a personal matter, I do not expect the Government to get involved in telling people how to conduct their affairs when they are dying—quite the reverse. I expect the Government to recognise that we now have a confused legal situation around death and dying that is very threatening to a growing number of people. They have a responsibility to try to facilitate some resolution of the confusion. A responsible Government—this one or another—should not wash their hands of these difficult issues and simply say that it is up to Parliament to sort things out, especially when Parliament has demonstrated that it cannot do that unaided. The theme of my remarks today is why the Government need to bring in some wise and independent help to break the parliamentary gridlock.

Why do we need an independent inquiry or review? First, we have a mounting set of contradictions that produce far too much confusion for many citizens. Most people want to die in their own home with their family around them, and at a time of their choosing. Instead, 60 per cent of people still die in hospital. A growing number of very determined and reasonably well off British people slip over to Switzerland to die at a time and in circumstances of their choosing. More than 700 brave souls have registered with Dignitas to keep their options open. A few have managed to persuade doctors to help them on their way illegally—probably in less than 1 per cent of deaths. Some people just give up and effectively starve themselves to death, sometimes rather painfully, but we do not know how many of those there are.

We have legislation that gives us the right to make living wills to stop doctors treating us, but we have little confidence that healthcare staff will always respect our wishes. Doctors’ leaders have satisfied themselves that they have a satisfactory system for giving patients doses of drugs that may kill them, but that that is okay if it is only a secondary consequence of relieving pain. That is what I call the nudge and a wink approach to putting you out of your misery—very British.

With this confused situation, it is hardly surprising that year-on-year, we see a steady flow of mercy killing cases appear in our courts. Some of them look similar in circumstance but end up with different outcomes in decisions to prosecute or in court outcomes. In the recent Gilderdale case, the judge criticised the CPS for prosecuting. That does not bode well for the DPP's new guidelines. Personally, I think that Keir Starmer has done as well as anyone could expect with the poisoned legal chalice passed to him by Parliament and the Supreme Court.

We know that the law in this area is a mess because the Law Commission told us so in its review of murder law in 2006. It recommended that a further review was needed on mercy killings and other connected issues, such as assisted suicide, which would include assisted dying. The Government have declined to take up that recommendation but should, in my view, reconsider their position.

That is a brief summary of the policy and legal confusion, but there is also a lack of symmetry between governed and governing. Survey after survey for a decade or more has shown that the public want some form of change to legalise assisted dying for terminally ill people who are competent to make that decision. The recently published 2010 British social attitudes survey showed that 82 per cent of the public support assisted dying. Parliament—Commons and Lords—lags behind public opinion on this issue but, as in so many areas, the plates are shifting. In 2006, 33 per cent of participating Peers voted in favour of the Bill on assisted dying of the noble Lord, Lord Joffe. In 2009, 42 per cent of Peers who took part in, or listened to, the debate on an amendment to the Coroners and Justice Bill to safeguard those who assist people going to Switzerland to die voted in favour of it. In the Commons, a higher proportion of MPs now seem to support change than in 1997, when Joe Ashton brought forward his Bill on doctor-assisted dying.

I do not expect the Government to bring forward legislation, but they should try harder to bring some greater order to the increasingly chaotic policy and legal situation. The position continues to change in other countries. We now have the experience of the Netherlands, Luxembourg, Oregon and Washington state to draw upon, with Montana likely to join them soon. The DPP’s guidelines are unlikely to produce stability. The Government’s own end of life strategy is incomplete in this area and will continue to cause the issue to be raised.

Now Sir Terry Pratchett has suggested a practical way forward for helping doctors out of the quandary in which they find themselves: a medical legal tribunal to which people who want assisted dying can apply. That is not much different from the situation now, where applications can be made to the High Court to switch off a brain-dead patient’s ventilator. Of course, we still have the Law Commission’s recommendation lying on the table.

There is a lot of material for an independent review to get its teeth into. There is a raft of medical, legal, ethical and other knots to untangle, as I have indicated. This is territory that in an earlier time we would have handed over to a royal commission. I do not much mind what one calls such an inquiry, provided its terms of reference are wide enough and its membership carries public confidence and avoids sectarian capture.

I have made no attack on those who have different views from mine. I hope that other noble Lords can be dispassionate, support this approach on a non-judgmental basis and encourage my noble friend the Minister to get his colleagues to consider seriously the idea of an independent inquiry.

My Lords, it is clear that people increasingly want the choice of an assisted death. Two very recent polls suggest overwhelming support: one put it at 75 per cent; the other at 82 per cent. In fact, all polls on assisted dying show that an overwhelming majority of people wish a change in the law. Opponents argue that the questions put to the public are biased but, given how many polls have been conducted, all with differing questions, surely one by now would have shown a result other than overwhelming support, but there is not one.

You cannot just ignore opinion polls. Some argue that the public do not understand the complexity of the issue. I would advise against patronising the electorate, who understand suffering all too well. I would also advise against paternalism, no matter how well intentioned. Parliament must wake up; assisted death will happen at some point in the near future, hastened on by the clamour of society at large. More importantly than that, it has to happen in order to relieve the suffering of those who can no longer endure intractable distress.

My Lords, I have no idea what my reaction will be if I find myself facing a terminal illness with only a few weeks to live. Will I want care at home or care in a hospice or help with suicide? What I do know is that I will want to be able to choose any of these. There are people whose religious beliefs prohibit suicide and they are entitled to have their beliefs respected. They are not entitled to impose their beliefs on me.

There are people who claim that legalising assisted suicide is the beginning of a slippery slope. The evidence from places where assisted suicide is lawful does not support that claim. We do not need an inquiry. Public reaction to the deeply moving Dimbleby Lecture of Sir Terry Pratchett and to the acquittal of Kay Gilderdale on the charge of attempted murder of her daughter show that the time for change has come. Let us get on with it.

My Lords, the sad stories of trips to Dignitas in Switzerland, together with the two recent cases of mothers and daughters, have been taken up by the media and supported by well known personalities. They undoubtedly make a case for change, but these cases and this publicity have obscured real and cogent arguments to the contrary, which will be made during this debate. My main concern is the position of elderly and vulnerable people who already feel that they are a drag on their family and friends, and that they should die even if, deep down, they may not actually wish to do so. They may feel impelled to agree to die. I am also concerned about the tip of the iceberg. Once legislation is in place, it can that much more easily be extended. The issues and arguments are clear; it is unnecessary to have a further inquiry.

My Lords, how ironic that Sir Terry Pratchett was given such a platform this week—a man whose views are purely from an individual perspective. It is a view so at odds with that of thousands of other terminally ill and disabled people, who want Parliament to concentrate on better support to live, not to die.

I will continue to read my noble friend’s speech on her behalf. That he articulated the majority view of the population is not disputed. However, he did not speak for disabled and terminally ill people. Not a single organisation of or for disabled and terminally ill people supports a change in the law. Does it not seem strange that those identified as beneficiaries of assisted dying are not insisting that their organisations campaign for a change in the law? The Multiple Sclerosis Society, the Motor Neurone Disease Association and the Alzheimer’s Society are all silent on the issue, and RADAR has come out in opposition.

When we campaigned for equality we used the slogan, “Nothing about us, without us”. Now we feel that we are on the receiving end of a campaign waged by people fearful of disability and terminal illness. With the exception of a few individuals, it is a campaign wholly without us. Today’s Motion calls for the examination of,

“evidence relating to a change in the law”.

What about evidence supporting the current law? Does this relentless pressing for a change in the law help the newly diagnosed come to terms with their changing circumstances? Does it assist their families and friends in their support? No, it has the opposite effect. It says: you will not cope. You will not adjust. You will enter a living hell. You should consider a premature death. The ignorance of that approach astounds me. The House has done much to improve the lives of disabled and terminally ill people. It has rejected all previous attempts to change the law. The evidence I hear from disabled and terminally ill people is unchanged.

My Lords, where a matter has already been debated, to call for an independent inquiry looks like the old business of holding the referendum again and again until people give the right answer. Parliament is there not to bend to every media-manipulated public whim, but to take the larger and longer view. We do not see in the press the old lady who last summer told me several times that she just wanted to go to sleep and not wake up, but who eventually made a full recovery and celebrated her 63rd wedding anniversary last month and greeted her sixth great-grandchild last week. Had we been in Holland or Oregon, someone might have “compassionately” given her a paper to sign and the deed would have been done. I declare an interest: the lady in question is my mother.

Last summer I sympathised with her view—her desire to die—but I shuddered at the thought of speeding her on her way. That would not have been compassion but, rather, collusion with distorted desire. The assisted suicide lobby does not have a monopoly on compassion. I believe that it distorts the notion radically. The genuinely compassionate course includes the remarkable work of palliative care, in which we in this country are field leaders, particularly through the hospice movement. We do not need a further independent inquiry.

My Lords, when one contemplates issues of this kind, it is important not to be swept along by a tide of uninformed public opinion, stimulated by selective reporting of very difficult cases. It is important that our response to the lot of those who suffer from terminal illness or progressive disability is not to contemplate assisted dying as the final or only solution. If you have lived in close proximity to suicide or life-limiting illness, you will know that these matters are not simple. There is huge grief and emotion and pain; those are not the foundations on which we should build.

The protection and preservation of life is the most fundamental and important duty of the state under the law. To live with life-limiting illness is to live with uncertainty. Today the law protects individuals from mercy killing—for that, ultimately, is what assisted suicide is. They know that if someone determines that their life is no longer of value and takes steps to end that life, the law will intervene. They know, at least, that there is no pressure to die to protect the financial and other interests of those around them, to alleviate their pain or to set them free from their responsibilities. What pressure there would be on those people if they knew that someone who might not want to commit suicide might nevertheless feel constrained to move for it, and their carer or lover had the option of killing.

The BMA, like the many organisations referred to by the noble Baroness, Lady Campbell, does not want a change in the law. Let us seek, rather, to maximise the processes and funding for the care of those whose lives are in some way constrained and limited. Life is sacred. We, as legislators, have a profound duty to protect it.

My Lords, a call for an inquiry is not a rush generated by media hysteria: it is a balanced way of saying, “Let us look at all the issues and arguments and proceed sensibly and slowly”. Public opinion is on our side; it wants a change and the pressure is there. We in Parliament ought to be very careful before we say that public opinion has no right to have its voice heard in this House.

Of course an inquiry must look hard at the safeguards; of course it must look, in the words of the MS Society, at all “choice in death” issues, including the relationship of palliative care to other aspects. I would not wish to deny to others something that I would want for myself. I believe that very strongly. Some time ago, someone I knew who had motor neurone disease, begged me to support a change in the law.

My Lords on every occasion that proposals to change the law have been put before your Lordships’ House they have been defeated by significant majorities. If there is to be further debate, it should be properly conducted in the House of Commons.

Our votes have revealed that the majority here still agree with the view of the 1994 Select Committee of your Lordships’ House which insisted that,

“dying is not only a personal or individual affair. The death of a person affects the lives of others … the interest of the individual cannot be separated from the interest of society as a whole”.

To disregard that belief would fundamentally alter the relationship of a doctor with their patient, which is the why the BMA and the royal colleges continue to oppose a change in the law. It would also endanger public safety and put disabled people at risk. The right to die would rapidly become the duty to die.

Two weeks ago, in the Sunday Times, the writer Martin Amis compared Britain’s elderly people, in his words, to,

“an invasion of terrible immigrants”,

and he called for “euthanasia booths” on street corners. Others have said that people with dementia represent a terrible economic burden to society. What a chilling and bleak future that is. Surely a civilised society can do better than that.

My Lords, in my brief contribution, perhaps I may mention what is happening internationally in this field. We do not want to copy in every last detail the laws that have been passed by others, but the inevitable impetus to change the law that is building up in this country is reflected in experience abroad. Apart from Switzerland, we normally tend to talk about only the Netherlands and Oregon. A similar law to that of the Netherlands was passed in Belgium, where it has continued to operate successfully since 2002. Recently, Luxembourg passed a similar law, and simultaneously included laws covering palliative care, advanced decisions and carers’ leave.

As well as in Oregon, in the United States the system has been largely adopted by the neighbouring state of Washington. In a vote at the same time as the recent presidential elections, 58 per cent of Washington voters approved the change in the law, which is now in force. The noble Lord, Lord Warner, mentioned stirrings on this subject in Montana.

In the face of all these continuing changes and the publicised cases and opinion polls in this country, I am astonished that we still have some absolute fundamentalist opinion trying to put back the lid on the box of this issue. Such people would be much better served by acknowledging the inevitable changes that are bound to come and working to make that change the best for everyone.

My Lords, the timing of this debate is surprising, to say the least; the noble Lord should surely have awaited the DPP’s guidelines in their final form. On that subject, he should be careful in his criticism on the case of Gilderdale, in which the judge held that there was a case to answer on a charge not of assisted suicide but of attempted murder.

My second point is about the impracticability of what is behind the proposal for an inquiry. The fact that a speech containing such a proposal is made by someone who is rightly regarded as a national treasure, a wonderful author speaking from the heart and using fine language, does not make him right. The fact is that the Pratchett proposals are at least as weak as the proposals made earlier by the noble and learned Lord, Lord Falconer, and heavily defeated in this House.

My third point is that we have already had the inquiry. No one has mentioned the name of the noble and learned Lord, Lord Mackay, so far in this debate, but some of us, including myself and some who have spoken already, were on that committee. I wonder if some noble Lords who have spoken today have taken the trouble to read the report, which contains every fact on both sides of this argument. It enables the decision-makers to make up their minds—and the decision-maker is Parliament.

I therefore regret the timing and the principle behind this Motion, which surely is, as the right reverend Prelate said, an attempt to ask the question so many times that eventually you get the answer you want.

My Lords, the onus of proof in this grave and weighty matter lies on those who seek to bring about assisted suicide. It is not a matter for public opinion any more than is the death penalty, and the case of those who seek the legitimisation of assisted suicide is riddled with fallacies.

The first is the fallacy that the DPP is in some way in a neutral position. He is not. Under the Suicide Act 1961, he is obliged to give his consent to any prosecution. That does not mean that he is entitled, nor indeed obliged, to seek to change the law, but that is practically what he is now almost invited to do.

The next fallacy is that one can proceed down the path of legitimising assisted suicide but not eventually lead to the issue of euthanasia, whether that be voluntary or involuntary. The noble Lord, Lord Carlile, has already referred to the ravings of Martin Amis in this connection.

The final fallacy is that you can in some way determine this matter by a public inquiry. We have had a surfeit of public inquiries and all the facts are well known. If you set up a royal commission to deal with the ethical and moral matters, you are then in even greater difficulty; you might as well set up a royal commission to determine doctrinal theology.

My Lords, the last time that there was a serious parliamentary investigation into assisted dying, it was published in the 2005 Select Committee report of this House, which unanimously recommended the referral of the issue to Committee for detailed debate. That detailed debate was prevented by a cunning tactical ploy by the noble Lord, Lord Carlile. It astonishes me that he refers with such confidence to that Select Committee because, as it happens, I have established that although no vote was taken in the committee, a majority of seven of its 13 members ended up by supporting assisted dying.

Surely, against that background, the 80 per cent of society in our democracy who consistently support assisted dying are entitled to the inquiry proposed by my noble friend Lord Warner, at which the issue can be calmly and objectively considered, based on research and evidence, rather than on conjecture and speculation about what might happen by those who hope that it will not.

My Lords, I see no reason for another inquiry, having been aware of the six-month Select Committee and the detailed debates that have followed. The press has recently highlighted a small number of assisted suicide cases, and an inquiry, if it took place, could lead to a change in the law. Enabling laws have a habit of encouraging the acts that they enable; that is, after all, one of the reasons why they are made. It is all very well to talk of safeguards, but if you read the facts rather than the spin—about what is happening in Oregon, for example—you will see that so-called safeguards do not work as the campaigners claim.

With the law as it stands, we have the best of both worlds: deterrence combined with compassion. Palliative care, end-of-life care, has the Government’s focus at present. We would be well advised not to tinker.

My Lords, one key question for any independent inquiry on this issue must be how we can give dying patients greater choice and control while ensuring that palliative care—of which we are justly proud in this country—continues to develop. Many people assume that there would be no need for assisted dying legislation if the best palliative care were available to all. However, this is not true: we know that without assisted dying legislation the suffering of a small number of patients will never be relieved by palliative care.

Almost 90 per cent of people seeking assisted dying in Oregon do so from within the palliative care services. Evidence from countries which have legalised assisted dying does not support the claim that it would undermine developments in palliative care. The percentage of patients in Oregon enrolled in hospice care programmes has more than doubled. In Belgium and the Netherlands there has also been improved palliative care provision since legislation was introduced.

Palliative care and assisted dying legislation share many common values: the alleviation of suffering, patient choice and a patient-focused process. They should not be seen in isolation. True patient choice at the end of life should include access to high-quality palliative care. An independent inquiry would show that assisted dying legislation would enable us to ensure that palliative care improved and increased in this country.

My Lords, those who help relatives who cannot travel to Switzerland by themselves to commit suicide are clearly as guilty of a serious crime as those who drive a getaway car to a bank robbery. However, whether they are prosecuted is a matter for discretion by the DPP. Is this a tolerable state of affairs? Even with guidelines, uncertainty remains.

My noble friend Lord Carlile defends the law as it stands, but someone who is an even more eminent lawyer in this House—the noble and learned Lord, Lord Bingham—has indicated that the number who go to Switzerland for this purpose shows that the law needs overhauling. Further, who can fail to feel revulsion at the different treatment of Mrs Inglis and Mrs Gilderdale? They were charged with different offences in different circumstances, but both acted nobly out of deep compassion to assist in the suicide of a loved one. There were very different outcomes: one was acquitted; the other has to serve nine years. In the case of Mrs Inglis, if the jury had had any guts or compassion it would have defied the law, as juries have with unjust laws in the past, and acquitted her. Our law in the field of assisting suicide is not only an ass; in the words of Mr Bumble, it is a disgrace to our society.

My Lords, a minority say that vulnerable people would be at risk from a change in the law. In reality, vulnerable people need protection. As things stand, about 1,500 deaths each year are a result of doctors ending life without an explicit request to die from the patient.

The most comprehensive research on assisted dying legislation and its impact on vulnerable people by Margaret Battin et al in 2007 examined data from Oregon and the Netherlands. They looked at vulnerable groups, including chronically ill and disabled people. They concluded that there is no evidence that vulnerable people are more likely to use assisted dying legislation, nor do they feel that they have a duty to die or that they are a burden. Yet these are the claims made by those against reform.

Finally, surveys consistently show that a majority of groups that might be considered vulnerable, including elderly and disabled people, support a change in the law to allow assisted dying for terminally ill people. I would very much welcome an independent inquiry in this area. It would highlight the importance of legislation to protect vulnerable people.

My Lords, over the past few years we have seen an increasing number of hard cases—difficult moral cases—hitting the headlines. We have seen cases of Britons travelling abroad to die, people committing suicide behind closed doors and, just this week, as has been referred to, loving parents assisting their children to die. These cases are not going to go away; if anything, they are likely to increase as the media spotlight gives courage to others to follow their lead. As things stand, we are exporting the problem to other countries’ jurisdictions, while at the same time failing to provide proper protection from potential coercion or abuse.

These complex cases give us a particular challenge, but we should not be making up the law on assisted dying as a knee-jerk reaction to them. That is why I support an independent inquiry into the issue to enable a serious measured response to all the issues surrounding this important debate, away from the media spotlight.

I am tired of these polarised debates, I have to say. It is time that we looked at ethical, societal and practical issues in a dispassionate way. I therefore strongly support an investigation along the lines proposed by the noble Lord, Lord Warner.

Let us take, for example, the issue of mental competence. I think that noble Lords will agree that the decision to die requires the highest test to be satisfied. An inquiry would allow us to define in advance how the complexities of mental competence, depressive thinking and undue influence could be assessed properly in practice. Does it not make more sense to review mental competence and the influence of mental state before the event via a safeguarded law, as opposed to afterwards via an investigation of a mercy killing and a potential prosecution? I think so.

As to those who quote Martin Amis, he is as serious about killing off older people as Jonathan Swift was about boiling babies.

My Lords, I strongly support the proposal for an independent inquiry. I totally disagree with the view that an independent inquiry is not a suitable vehicle for coming to moral decisions. A truly independent inquiry has time, its members can listen to one another’s arguments and, above all, when they come to their inquiry they will not be in an already entrenched position.

We are not likely, in this House or the other place, to come to a consensus on this important issue. We are all too much entrenched as lawyers, priests, doctors or philosophers. An independent inquiry is exactly what is needed now, and it would not overshadow the results of the Select Committee chaired so ably by the noble and learned Lord, Lord Mackay. I am very much in favour of this proposal.

My Lords, I must declare a possible conflict of interest: if the law were to be changed, as I think it should be, I might wish to be its beneficiary. As all the recent cases show, the current law on assisted dying is the source of much unhappiness and misery. It is constantly circumvented, it is out of pace with public opinion and it is increasingly becoming discredited. Desperate individuals who seek relief from unbearable or unrelievable pain want to take their lives, and they either go to Switzerland, lean on sympathetic doctors or turn to botched or highly gruesome forms of suicide. The law therefore needs to change.

It is obvious that we have had a lot of public and parliamentary debate on this subject. Why do we need an inquiry? I think we do because much of the debate is either not based on evidence, or based on wrong conclusions drawn from the evidence, or based on certain hypothetical fears and arguments not properly considered. We therefore need an independent inquiry that could look at the evidence more impartially.

Often we are told that we do not need to worry about assisted suicide because there is palliative care, but palliative care does not address the same question. Much pain is unrelieved, and palliative care does not address the issues of dignity and autonomy, nor does it address the simple fact that one might have reached the point where one does not wish to live or to become a burden either to society or to those that one deeply loves.

My Lords, my name was omitted from the first printing of the Speakers List so I apologise if I am surprising anyone. Many points have been made. I just wish to stress that if there is an independent inquiry—whatever “independent” might mean here—it should recognise that the safety of the people is the fundamental purpose of legislation. In my view, the draft legislation that we have debated in the past has not paid sufficient attention to that.

This debate has been polarised between autonomous choice and those who do not favour it. If we get serious about autonomy, we have to realise that much choice is impulsive, and measures have been suggested for dealing with that. However, I have not seen any good way for dealing with choices made when depressed, and we have not even begun to discuss choices made out of deference.

On the other side, we see sentimental references to compassionate friends and family. Friends and family are sorely tried by terminal illness, and they have a plurality of complex motivations. That may include great compassion, but one has to recognise that they may also be heirs, they may be burdened financially by paying for care or they may be burdened emotionally and physically by the task of caring.

We have to get a little further before we are even ready to think about the terms of reference for a supposedly independent inquiry, and I hope that any such inquiry would test its conclusions by attempting to draft legislation that could meet the standard of not endangering members of the public.

My Lords, the noble Lord, Lord Warner, has raised a topical and complex question of great public importance. Current English law on assisted suicide for terminally ill and mentally competent adults is not satisfactory; it sweeps too broadly and leaves too much discretion to prosecutors and too much uncertainty to patients and those who care for them.

An exception to the law of homicide is needed to give mentally competent adults the choice of a medically assisted death if they have a terminal illness and no possibility of recovery and they have a clear, settled and informed wish to die. There need to be strong and effective safeguards against abuse by relatives, friends or anyone else. That is why a decriminalising measure must ensure that assistance is given only by doctors and nurses and only in accordance with good medical practice.

An objective independent inquiry would provide evidence and informed opinion on whether and how such an exception should be made. It is needed for the reasons given by the noble Lord, Lord Warner, and others. We have nothing to fear but fear itself.

My Lords, helping people to kill themselves is often portrayed as something humane and harmless, but the noble Lord, Lord Joffe, told the Select Committee that it was just “a first stage”. The noble Baroness, Lady Warnock, said in September 2008:

“If you’re demented, you’re wasting people's lives—your family’s lives—and you’re wasting the resources of the National Health Service”,

and that if you are old and sick and thinking of dying,

“there is nothing wrong with feeling you ought to do so”.

Those remarks were condemned by Alzheimer’s charities, but the pressure is on for involuntary euthanasia.

Alison Davis was severely disabled at birth with multiple defects. She bravely bore all these until she was diagnosed with an incurable disease. Her repeated requests for euthanasia were refused, and there followed three serious suicide attempts. She was rescued by her friends, who persuaded her that her life was worth living. She formed a charity looking after orphans in India and has found the past 15 years the happiest that she has ever had. She said to the Select Committee that if euthanasia had been legalised, she would have been deprived of the best years of her life. What have noble Lords to say to that?

My Lords, I congratulate my noble friend Lord Warner on securing what has turned out to be an extraordinary debate on a matter of profound importance. This is not the first occasion on which the House has had the opportunity to debate the issue of assisted dying, and obviously it will not be the last. On this occasion, as on previous ones, we have heard passionately held but deeply divided views.

By any standards this is a very distinguished cast list, and I thank all noble Lords for the discipline that they have shown in their speeches and, of course, for what they have said. My belief is that tomorrow’s copies of Hansard should sell like hot cakes because the arguments for and against change in this field have rarely, if ever, been put so concisely and so well.

The moral and ethical questions surrounding this issue have been well rehearsed. Time is short—although, I fear, not short for me—so I will focus on what my noble friend has asked: namely, what consideration the Government have given to holding an independent inquiry on assisted dying to examine the evidence for and against a change in the law. As he reminded the Committee, in an Oral Question last October my noble friend raised the issue of an independent inquiry or commission. I said then that it was an idea that I would take back.

A public inquiry is a long-term commitment. Whatever the merits of an independent inquiry on this issue, I have to tell the Committee that realistically there is little prospect of such an inquiry being set up during what remains of this Parliament. At this stage, debating the possibility is academic. However, the question of whether there should be an inquiry will almost certainly arise again in the next Parliament. Therefore, it is more than useful to have this opportunity to consider the issue.

I and the Government have made clear on previous occasions that our view is that any change to the law in this area is, of course, an issue of individual conscience. It is rightly a matter for Parliament, rather than government policy, to decide. We therefore take a neutral view when others seek to change the law. To be clear: this means neither standing in the way of such a change nor actively pursuing it.

There are of course options open to Parliament if it wants to look at the issue of assisted dying, whether in relation to people who are terminally ill or more widely. One such option would be consideration by a Select Committee. Indeed, as we have heard, the Assisted Dying for the Terminally Ill Bill, brought by my noble friend, Lord Joffe, was considered at some length by a Select Committee, mentioned in this debate, and chaired by the noble and learned Lord, Lord Mackay of Clashfern, which reported in April 2005.

Beyond such options, the question of holding an independent inquiry on the issue is not as straightforward as it may seem. I hope that noble Lords will appreciate that, whatever a Government may say, it may not be perceived as neutral for us to facilitate any such action. Even if we remain entirely neutral on the moral issues involved, the very fact of setting up such an inquiry would be seen by some as tantamount to a policy decision that the law should be changed. In the debate, it was interesting that those in favour of change were very keen on an inquiry and those who were against change were equally keen for there not to be one.

The Government have not been blind to the extremely high public profile that this issue has had over many months—particularly in the past few weeks and days—or to the growing pressure to put in place a mechanism to allow the issue to be properly looked at. Our postbag in the Ministry of Justice reflects the very real concerns that members of the public have about this issue and, I am afraid, the extent to which it polarises opinion. Some people have called for a public consultation but, in the absence of any policy proposals—and such proposals could be difficult to formulate when starting from a position of neutrality—a public consultation would be unfocused and unlikely to reach any meaningful conclusions.

Of course a public inquiry can be a good way of responding to an issue or events that have caused, or are capable of causing, public concern. In theory, I do not doubt that the sort of independent inquiry that my noble friend envisages and argues so strongly for would be a good way of ensuring that all the relevant issues around assisted suicide were properly addressed. These include personal beliefs, personal autonomy, safeguarding the vulnerable and medical ethics, among others. Evidence could be taken from all relevant disciplines, including health professionals for whom any relaxation of the law could, and probably would, have significant implications. However, we argue that in practice there is a very real question about whether such an inquiry could be expected to resolve this extremely divisive issue.

Let us leave aside for a moment the question of whether it would be appropriate for the Government to set up an inquiry and, instead, look at some of the considerations that would necessarily be involved in doing so. Under the Inquiries Act 2005, Ministers can establish an inquiry, appoint the inquiry panel and set the terms of reference for that inquiry without the need for resolutions of Parliament. Indeed, we debated this matter in another context throughout last summer. Although the inquiry is independent, sponsoring Ministers will be accountable to Parliament for its spending and governance.

Even the best-managed inquiry will inevitably involve significant costs and resources, although there is no argument against that. As this House knows, controlling the costs of such inquiries was a prime motivation for the 2005 Act. Surely, therefore, before deciding whether to hold a public inquiry, it is sensible for Ministers to be very clear that the benefits of the inquiry, in both the short and longer term, will be worth while, given the expenditure of costs, time and effort.

A crucial factor in controlling the cost of any inquiry is its terms of reference. They must be tightly drafted to establish the scope of the inquiry. The sponsoring Minister has responsibility for setting the terms of reference, although the Inquiries Act specifically requires him or her to consult the chairman on them. This helps to ensure that they have a shared idea of the scope and purpose of the inquiry.

The legal, administrative, practical and resource implications of any change to the law in this highly controversial—

Sitting suspended for a Division in the House.

My Lords, before we were so rudely interrupted I was making my concluding remarks. I thank all noble Lords who have been good enough to return to listen to me for the last couple of minutes of this debate.

I was talking about the benefits of inquiries and pointing out—I hope sensibly—that the legal, administrative, practical and resource implications of any change to the law are considerable. There are many different aspects to this complex issue and so the range of options that an inquiry could be asked to consider is potentially very wide. Our real worry is that however carefully we drafted the terms of reference, there could be no certainty that such an inquiry would reach a consensus or anything like it. Given the deeply divided views on this issue it would be necessary to ensure a balanced membership, which might make reaching a consensus even more difficult. I do not think that a majority of seven to six either way would constitute a good result.

Indeed, the Select Committee that considered the Bill of my noble friend Lord Joffe, to which I have referred already, from March 2004 to March 2005 did not take a position either way on this central issue. The danger, although I am not saying that it is inevitable, is that we could embark on a time-consuming and potentially very expensive exercise that might not take us very much, or any, further forward.

As I have said, this is clearly not an issue that can be resolved in what remains of this Parliament. I have absolutely no doubt that the debate will continue in one form or another in the next Parliament. In the mean time, I again thank my noble friend Lord Warner for raising the issue and I thank all those who have contributed so well to today’s debate. It once again reinforces the importance of Parliament in providing a forum for considering this huge ethical issue.