Lord Carlile of Berriew (CB)

My Lords, “All’s Well That Ends Well”, and it is always a pleasure to follow such a story, particularly as it is the story of someone who told it to your Lordships himself. I put my name to the noble Lord’s amendment and intend to address it not from the viewpoint of positivity and negativity—I tend to view that as mostly potluck— but from the viewpoint of facts. The fact I start with is an assumption: that everybody who is given a prognosis by his or her doctor desires to make an informed decision and, if they wish to make such an informed decision, that it should be based on some factual and scientific basis. All that these amendments would do —I speak not particularly to their very words but to their meaning—is require that a doctor or any other clinician who is giving a prognosis should do so on a solid medical and scientific basis: a prognosis that is founded in medicine, not stories and the last three patients they happen to have seen who had a serious illness. I have spent a lot of time in recent weeks reading articles. There are some amazing American articles in which huge statistical samples are taken, but on this subject they all come to a similar position. For example, in one major study, only about 20% of predictions of six-month deaths were within a close range at all of ultimate survival. This is a very unscientific part of what clinicians tell their patients. Judging the moment of death becomes very difficult the further you are away from the actual death, but it is very difficult to know how far away you are from the actual death. When my father—who was the most reasonable person I have ever known, by the way—was dying, the night before he died, the last thing he said to me was that I was to wear his black suit for the funeral because he thought mine was scruffy. He and I had been the same size at a certain point in our lives, and of course I did. We knew the moment he said that—because I knew how ill he was, the family were there, the doctor was there, we were going through his last moments and it was a very happy death, a great family deathbed scene—that he would be dead by the following day. He died the following morning. However, when someone walks into the consulting room like the noble Lord, Lord Moylan, and is told that he is seriously ill, it is just an opinion at that stage on the part of the doctor, who may have varied experience and may actually have no scientific basis for what he or she is saying. Even what is now called GEST, the geriatric end-of-life screening tool, which uses algorithms and has tens of thousands of examples in it, still offers only varying levels of probability. I have also looked at actuarial tables because a surprising number of elderly and very ill people try to insure their lives for a relatively short period. A lot of companies insure senior directors for one year; I think it is called key person insurance. It is all based on mathematics, but it is not actually science. So I do not think it is asking much of the noble and learned Lord that there should be a provision in the Bill that means that, in every single case when the patient asks for an informed decision, he or she is given the basis upon which that information is founded.