Contribution
For the sake of accuracy, I completely accept that. Perhaps the noble Lord might also see, while I am speaking, whether I am correct that the guidelines would tend towards prosecution if a person in authority was encouraging. That was my understanding.
I will raise a few points. The noble Lord, Lord Hunt, absolutely hit the nail on the head when he pointed out that, if we had had a royal commission and went through the processes and so on fully, we might be in a different place now. One of the big problems we have encountered in looking at this Bill is what has been deemed to be in or out of scope. If you do not have the services available, you do not have true choice. That is a real problem, yet those of us who have tried to table amendments to bring specialist palliative care provision into scope to match and stay parallel with any developments in assisted dying services have repeatedly been told—I have checked, and it is in the Companion that we cannot extend scope—that this was deemed out of scope. Therefore, we feel a bit stuck about how we can make sure that people get the services they need.
The Minister pointed out something in the Bill that has been a concern to a lot of us: that the family do not have to be informed. Behind that is the concern about grief. Let us take a 19 year-old with an osteosarcoma with metastases. The parents have been looking after him from childhood through to all his treatment, doing all they can to enhance his quality of life. He says that he now wants to go for an assisted death, and he does not want his parents told. The first thing that the parents hear is a phone call to say that he is now dead, having had lethal drugs. They may be aware of a whole lot of issues that have been going on in that 19 year-old’s life, which they would have shared with those involved in his care. This is pretty close to some patients whom I have looked after, because someone developing into an adult when terminally ill is very difficult, as are the transition issues.
There is another aspect to that. Having spoken to and heard from people who have a relative who has gone for euthanasia—it is usually euthanasia rather than assisted suicide—they often feel devastated that their love was not enough to support the person. They feel that they have failed, and they ask why they could not have helped the person find ways forward or access the services they need. I will quote from the commission chaired by the noble and learned Lord, Lord Falconer, with Demos, on the lack of services. It states:
“The Commission does not accept that any of these forms of pressure could be a legitimate motivation for a terminally ill individual to seek an assisted death. Therefore, 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”.
The motivation behind many of the amendments discussed today has been precisely to deal with that problem.
I will address two more things, beginning with the concept of how sure someone has to be. The civil standard of proof of 51% seems remarkably low when determining the eligibility of someone having lethal drugs. The implication in the debate in the other place was that the doctor should not ask the person, “Why is it that you want to end your life?” Yet in clinical practice, whenever patients say, “I’ve had enough; I do not want to go on”, you answer that with one question, another question and then another question. It feels like an onion: you take layer after layer off, and you find out what is happening. You find many remediable aspects to their situation—they might often seem trivial to some people, but they have been wearing the patient down.
I am horrified, frankly, whenever I hear of inadequate care and of people not getting the pain relief that they need. Morphine does not kill you; it is a good drug for pain relief, given appropriately in the right dose at the right time for the right reason. That is what prescribing analgesia is about. That is completely different to giving a massive overdose of lethal drugs—and, as we know, not all the ones in the world have been fully assessed.