Baroness Watkins of Tavistock (CB)

My Lords, I thank all those who have sent me opinions and information on this issue. I declare my interests as a registered nurse and a fellow of the Royal College of Nursing, which has adopted a neutral stance on the Bill, recognising the wide disparity of opinion within its membership. The fury expressed by some people that they will be coerced into asking for assisted dying is real. The concerns are particularly strong among marginalised communities, as so amply demonstrated by the previous speaker. Many people with severe disabilities who believe that they may become a burden to other family members, as well as those living alone who express fear about the future and the difficulties of living with a progressive condition, do not like the Bill. However, considerable safeguards in the Bill are designed to ensure that undue pressure concerning assisted dying is never placed on individuals. If a patient is given the opportunity to discuss their future options when planning the last months of their life, this should include the right to refuse further treatment and receive compassionate palliative care. Patients must be given the chance to explore the options available to them. One of the many issues raised in this House, and in correspondence with the public, is that many people fear staying with the uncertainty about dying—not necessarily about when they will die but how their health and bodily functions, including continence and mental capacity, will deteriorate. People report being fearful of incontinence, speech difficulties and losing capacity, so that they are unable to express their wishes as they become increasingly dependent. Let us encourage society to discuss and complete advance directives relating to future care, in the way that we are encouraged to make wills. This approach would enable those who would never want to discuss or consider assisted dying to make that clear in their personalised advance directive, and vice versa. Nurses and care workers are often those who are asked about assisted dying by patients, frequently during intimate procedures, including, for example, changing soiled bedding and washing. I recall, when I was a district nurse, a patient saying something similar to me: “My kind husband just can’t cope with washing me, so I wait for you and I do not tell him I am dirty below but just lie here in it. He does not know, nurse, because he does not sleep in the bed with me any more. We were so happy together. We are worn down with it. Can’t you hurry it up for me?” The Royal College of Nursing has published excellent guidance on how to respond to such a request to hasten death. It states that “nurses should acknowledge and act on all concerns raised”, investigating and escalating them to the doctor responsible for the patient’s care and treatment. The Bill is designed to establish a system for terminally ill adults to access assistance, yet no mention is made in it of the responsibility of health professionals to refer patients to an appropriate medical practitioner for preliminary discussion, to be recorded in the person’s notes when such requests are made. When the process works well and advance directives have been made, agreed active treatments may be stopped and compassionate, excellent palliative care interventions accelerated. Early clarity on the patient’s position on assisted dying would be helpful to everyone. However, if the patient’s wishes have not been recorded, and they choose an assisted dying pathway in the late stages of their illness, should the Bill pass, there could be challenges from relatives who are vehemently against assisted dying for religious and/or ethical reasons. I am broadly supportive of the Bill, but I would hope that we can consider the two issues I have raised—advance directives and other healthcare professionals’ involvement.