Baroness Finlay of Llandaff (CB)

When you prescribe a drug for a patient, NICE may have given approval for it, but the side effects, the toxic effects and the interaction with other drugs is not determined by NICE. That is done by the clinician, who must inform the patient. I do not dispute that they must be NICE-approved drugs, but NICE has not done an appraisal process for these drugs to be used for the process of ending life. The fundamental problem is that no research has been done into how these drugs, at high toxic dose, actually end life. I will come on to that, if noble Lords will bear with me. In 2022, I co-authored a review of the efficacy and safety of drugs used for assisted dying, which was published in the British Medical Bulletin. The Oregon mixtures used to bring about death, which have been referred to, have a 6% to 7% complication rate. We have heard about the complications; I will not go through those again. The drugs are not being given at a therapeutic dose. I am not going to go into the doses, because there will be people watching this broadcast who may feel suicidal and there is no way that I want to be complicit in giving them information that promotes their suicidality. The one thing I will say is that this is not about morphine. Morphine is not used to bring about the deaths. In Oregon, DDMA—the one already referred to—consists of overdoses of diazepam, digoxin, a small amount of morphine and amitriptyline. But the doses are 100 to 200 times the therapeutic dose. That means you are talking about 100 to 200 tablets to be swallowed or crushed in a mixture to swallow. Digoxin has a delayed effect in creating an abnormal heart rhythm or cardiac failure. Amitriptyline is highly toxic to the heart. Nobody has done the research in these patients to look to see why and when their heart stops. Some patients, however—nine in Oregon and seven in California—have been documented as reawakening. Although that was not counted as a complication in their reports, these are documented. The Bill says nothing about what happens when the patient starts to reawaken, when they will be extremely drowsy and unable to take a further dose of drugs, or if they are very drowsy and have a very prolonged time between ingestion and death. As we have heard, the highly toxic barbiturate that has been used in Switzerland and in some other countries is not licensed for humans and there is no data on it. Just to illustrate that it is not always straightforward, in 2017, a man called Kurt in Colorado was told that his death would come about within about two hours when he was given lethal drugs, but his wife described him coughing and choking for eight hours until he died—certainly distressing. If you are going to take this lethal mixture, you need to know what is in it and how it is going to bring about the end of your life. There is also the ability in this to have equipment—that is specified in the Bill. But again, without knowing what that equipment is, we do not know what the patient will be consenting to. We have heard about the Sarco pod, which was a disaster in Switzerland, but the person who developed it is trying to develop further modifications of it. Basically, the idea is that a lack of oxygen will cause cardiac arrest and death, but, again, no research has been done. When the drugs are given intravenously, there is a short-acting sedative and, in the case of about two-thirds of patients, it is followed up by a paralysing agent, which means that all movement stops, you cannot signal if you have reawakened, you will stop breathing because all your muscles are paralysed and you will die of asphyxia. The difficulty is that the research that needs to be done has not been done.