Contribution
My Lords, I shall speak in support of Amendments 44, 313, 341, 452, 511 and 580 in my name, which are distinct from the group that we have just addressed in a very quick fashion but are a variation on the same discussion. My amendments seek to make a simple but substantive clarification to the Bill, which is that assistance in ending life should be available only where a person’s clear, settled and informed wish to die arises because of their terminal illness, not for any other reason.
As drafted, not only does the Bill not require a causal link between a person’s terminal illness and their request for an assisted death, but it does not actually specify any reason at all. That is a significant difference from assisted dying laws in many other jurisdictions, and that includes some of the countries whose laws have been presented to us as comparable to the Bill and as proof that we can have confidence in it.
Under New Zealand’s End of Life Choice Act 2019, not only must a person have a terminal illness likely to end their life within six months but they must be in an advanced state of irreversible decline and capability and be experiencing unbearable suffering that cannot be relieved in a manner that the person considers tolerable. In Spain, which we are told is a model for the new voluntary assisted dying panels, the requirement for an assisted death in Spanish law is intolerable suffering.
By contrast, our panel will not have to investigate or even ask why the person has chosen this route, as long as they appear to mean it. As long as the person fulfils the other requirements, medical professionals and the panel will not be expected to ask whether the person may be motivated not by the disease itself but by, for example, the shock and despair that follows a terminal diagnosis, the stress and anxiety that come with the cost of care, the sense of guilt of being a burden on family and partners, or the family breakdown that sadly can often happen next. Perhaps the person has previously struggled with suicidal ideation even before they were diagnosed with a terminal illness. None of these examples would rule the person out of eligibility under the Bill.
That is a profoundly concerning weakness in the Bill’s construction, and one that fundamentally undermines the claim that it has “the world’s strongest safeguards”. It does not have one of the most common and obvious safeguards there is, which rightly exists in other countries. Indeed, the 2012 Commission on Assisted Dying, chaired by my noble and learned friend Lord Falconer, came to the conclusion that
“it is essential that any future system should contain safeguards designed to ensure, as much as possible, that any decision to seek an assisted suicide is a genuinely voluntary and autonomous choice, not influenced by another person’s wishes, or by constrained social circumstances, such as lack of access to adequate end of life care and support”.
My amendments go to the heart of the balance that the Bill is trying to strike and which many of us fear may not be possible: that is, to allow dying people to decide when to end their lives but without taking any steps towards the encouragement or normalisation of suicide. This is not a theoretical concern. Make no mistake, the demand for assisted dying for other reasons does exist, and will be seen all too clearly if the Bill passes as drafted. In jurisdictions that have introduced assisted dying without a requirement for a terminal illness at all, or which have afterwards expanded beyond it, there are documented cases of people seeking to end their lives not because they were dying but because they could not access the care, housing or social support they needed to live well. That cannot be the path that we take here.
We must ensure that our law is rooted in compassion, yes, but also in moral clarity about the need to prevent suicide. Great strides have been made in doing that in recent years, both within the medical profession and in other public services. In the Select Committee on the Bill, we heard about the importance of this from witnesses, including the chief executive of the mental health charity Mind, and the Royal College of Psychiatrists. We must have confidence that, if the Bill passes, it will not be at the cost of that vital progress.